8
O U T P A T I E N T S U R G E R Y M A G A Z I N E O N L I N E | A U G U S T 2 0 1 5
Surgeon Report Cards Get Failing Grade
They don't always measure what matters most to patients.
T
he best joint replacement surgeon looks the
worst on the Surgeon Scorecard. He has the
most complications — infections and readmis-
sions — because he does all the redos and hard
cases. But he's hardly a dunce with a slew of demer-
its. He's the doc you'd want to give you your new
knees. That's the trouble with surgeon scorecards and report cards:
They don't always measure what matters most, and they punish sur-
geons who perform the riskiest surgeries on the sickest patients.
ProPublica released its Surgeon Scorecard project (projects.propubli-
ca.org/surgeons) last month. In its first 2 weeks, the online database has
been viewed more than 1.3 million times by people looking up doctors
— and by doctors looking up doctors, seeing where they stand rela-
tive to their peers.
ProPublica compared the performance of surgeons by examining 5
years of Medicare records for 8 common elective procedures, includ-
ing knee and hip replacements, spinal fusions and prostate removals
so that "patients will be able to weigh surgeons' past performance as
they make what can be a life-and-death decision." Overall, Surgeon
Scorecard looked at 2.3 million surgical procedures and rated nearly
17,000 surgeons by their death and complication rates.
Report cards can penalize more skilled and more aggressive sur-
geons for operating on patients at higher risk. That's like penalizing a
high school student for getting a B in an Advanced Placement course
instead of settling for the easy A.
Besides discouraging surgeons to shy away from more difficult and
complicated high-risk patients, lest they incur higher mortality rates,
critics claim ProPublica's analysis of surgical complications, while
E D I T O R ' S P A G E
Dan O'Connor