New Surgeon-to-Surgeon Rating Provides Key Information for Patients

Medical rankings are everywhere: from U.S. News and World Report to Healthgrades and Leapfrog. But making sense of those rankings can be a difficult process. Now, there's new information to help you compare surgeons to one another based on how they perform in the operating room.

"For the first time ever, we are collecting information on the performance or result of our treatment. We're actually seeing how the patients do after we operate on them," said Dr. Marty Makary, professor of surgery at Johns Hopkins University.

Makary is speaking about a project of the journalism non-profit ProPublica.

ProPublica culled five years of Medicare data to generate what it's calling "complication rates" for doctors across the country on eight different lower-risk, elective surgeries.

Partnering with ProPublica, the NBC Connecticut Troubleshooters have reviewed the data to find the surgeons in the state whose records show they are among the highest and lowest performers.

"I think it's a great time to look at the data, look at our performance, particularly as compared to peers and figure out what differentiates us either positive or negative from our peers," said Tom Balcezak, the chief medical officer at Yale-New Haven Hospital.

Using the Medicare data, ProPublica computed a complication rate for each surgeon. Complications for this analysis are defined as death or re-admittance to the hospital within 30 days. Then, ProPublica adjusted that complication rate to take into account factors like age and overall health of certain patients.

While each complication isn't necessarily the doctor's fault, the American College of Surgeons does state that the surgeon is responsible for every aspect of a patient's care.

As an example, the rating for Yale orthopedic surgeon Dr. John Irving shows that among the 247 hip replacements he performed, there were no more than 10 complications. His adjusted complication rate, or "ACR," is 2.2, which places him in that green "low-risk" area on the graph and among a group of 4 percent of the best-performing surgeons in America for the data on this procedure.

Irving, who also operates at Milford Hospital, told the Troubleshooters that he's honored by the rating, but any success comes out of "teamwork, education and communication and the surgeon is just one part of that."

But there are three doctors at Yale-New Haven Hospital whose adjusted complication rates place them in a group of the 9 percent "high-risk" hip surgeons nationally, according to the ProPublica analysis.

Balcezak says Yale-New Haven Hospital looks at surgery as a "team sport" that includes the doctor and several others who play key roles in the process.

"With regard to any of event that would end up as a complication in this study, it's really very, very rare that it's a single individual's responsibility," said Balcezak.

Hartford HealthCare is the second largest health system in Connecticut, with six hospitals under its umbrella. Like Yale-New Haven, Hartford Hospital has surgeons whose performance places them at both ends of the spectrum.

Dr. Rocco Orlando, chief medical officer for Hartford HealthCare, says the most important aspect for patients in this analysis is how often a doctor performs a particular procedure. Generally speaking, the more surgeries performed, the better.

Drazen: Is that a catalyst for questions and investigation from where you sit?
Orlando: Absolutely. We're always interested in knowing what our complication rates are and fixing it.

Orlando says data analysis is an ongoing part of the conversation at Hartford HealthCare, which brings together "clinical councils" involving doctors from every hospital in the system.

"When you find that best practice physician, you say, 'What is that individual doing that's different from the others?' and how can we generalize what they're doing to eliminate that variation and to drive performance so that everyone is performing at that highest level?" said Orlando.

Saint Francis Hospital in Hartford also has surgeons at opposite ends of the spectrum.

Orthopedist John Grady-Benson performed hundreds of knee and hip replacements over the five-year study period and rates among the 4 percent of surgeons across the country in the low-risk category for both procedures.

But the ProPublica study indicates Saint Francis also has seven orthopedic surgeons who fall among the 9 percent nationwide in the red "high-risk" category.

Saint Francis sent the Troubleshooters a statement that reads:

"Contrary to outdated findings of this recent study, Saint Francis has consistently achieved superior quality ratings from experts like Consumer Reports, Leapfrog, Healthgrades, CareChex, and others – including being named last week a 'high performing' hospital for knee replacement by U.S. News and World Report."

Both Yale-New Haven Health System and Hartford HealthCare take issue with the type of data used in this ProPublica analysis, pointing out that Medicare data is used strictly for billing and lacks detail.

"The real data, the gold standard, is what's in the clinical medical record, the electronic health record, so that's what we use to drive performance improvement," said Orlando.

Balcezak encourages patients to have a conversation with any doctor they may be considering for surgery.

"I think you should ask him or her about their results and what perhaps their take on it is. If they won't answer the question, you probably don't want to have a relationship with that physician and you probably don't want to have that physician operating on you," said Balcezak.

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