Category Archives: Transparency

Transparency 2.0

I had the opportunity recently to speak about our practice of posting patient comments and survey scores on our physicians’ web pages. The conference at which I presented was devoted to “transparency and innovation” and it became clear to me that making patient satisfaction scores public, while innovative today, will be universal pretty soon. The same forces that convinced us to go this far – rising consumerism among care-seekers, the ubiquity of ratings and information for other goods and services, and the evolution of payment models away from fee-for-service – will compel us to provide more and more information to patients and potential patients.

What might that look like? Here are a few possibilities.

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More Public Reporting

Readers of this blog know that I am a fan of public reporting of performance data. I believe that data transparency helps fulfill an obligation to our patients to be honest about the care we provide, and is also a potent stimulus for improvement. There are obvious conditions that ought to be met before any sort of data – about quality, patient experience, finances or anything else – is shared in this way. The data should be meaningful (pertaining to something that patients are likely to care about), valid (the data actually measure what we say it measures), reliable (vary consistently with performance) and presented in a way that patients can easily make sense of it.

Our own efforts to report the patient satisfaction scores of Northwell Health Physician Partners physicians has been well received by our members and the press because it meets all of these criteria.

Some of the other public reporting efforts, such as recent reporting of surgical complications by Pro Publica, have been criticized for failing to meet the standards of validity and reliability, although I and others have been supportive of their efforts.

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Good Enough?

There are a few themes that permeate this blog – the impact of new technology on medical practice, evidence-based care, health care financing, and a patient-centered approach to care delivery. The recent dust-up over the release of surgeon-specific outcome data touches almost all of them.

ProPublica, a not-for-profit organization devoted to investigative “journalism in the public interest” got the ball rolling last week with the publication of their “surgeon scorecard.” They compiled 5 years of Medicare data (2009-2013) on 8 generally elective surgical procedures: Knee and hip replacement, laparoscopic cholecystectomy, lumbar spinal fusion (broken out by anterior and posterior approach), “complete” prostatectomy, TURP and cervical spinal fusion. For each one, they identified a list of principal diagnosis codes associated with a hospital re-admission within 30 days of the surgery that could reasonably be interpreted as complications of the index surgery. For example, if a patient had undergone knee replacement and was admitted within 30 days with a principal diagnosis of “infection due to prosthesis” then that “counted” as a complication of surgery. Details of the methodology were provided online. The complication rates were adjusted by patient age, gender, and a few other variables, and their user-friendly tool allows for easy look-up of complication rates by surgeon or hospital.

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