http://www.nytimes.com/2010/09/08/health/08heart.html?ref=health
Consumer Reports Is Rating Surgical Groups
New York Times
By DENISE GRADY
Medical groups that perform heart bypass surgery are now being rated alongside cars and toaster ovens in Consumer Reports.
In most parts of the country, data-based ratings of doctors are not available to patients. Only a few states, including New York, provide them.
The magazine published ratings of 221 surgical groups from 42 states online on Tuesday and will print them in its October issue. Groups are rated, not individual doctors. The groups receive one, two or three stars, for below average, average or above average. The scores were based on complication and survival rates, whether the groups used the best surgical technique and whether patients were being sent home with certain medicines that research has shown to be beneficial after this type of surgery.
For now, the information is available only to people who subscribe to Consumer Reports online or buy the magazine. But within a few months, the ratings should be posted and freely available to the public at the Web site of the Society of Thoracic Surgeons (www.sts.org/), said Dr. Fred H. Edwards, the chairman of quality and research for the society, and medical director for cardiothoracic surgery at the University of Florida in Jacksonville. The society, which has been tracking surgeons’ performance since 1989, gave the information to Consumer Reports. More than 90 percent of the nation’s heart surgery programs participate in the society’s registry.
The 221 groups in the Consumer Reports ratings, fewer than a quarter of those performing bypass surgery in the United States, are the only ones who permitted their information to be published. Only five were rated below average. A report explains the ratings. For example, at one below-average hospital, patients had only a 24 percent chance of receiving the recommended drugs when they left the hospital; at an above-average hospital, they had a 92 percent chance of being given the right drugs.
Dr. Edwards, whose group got two stars, said the Society of Thoracic Surgeons decided it was time to go public with the data the group had been gathering because there had been increasing pressure for this kind of information from lawmakers, Medicare officials and consumer groups. He said the surgeons figured public disclosure would be inevitable, and they wanted to provide meaningful data. He said he thought more and more heart surgery groups would start allowing their data to be published.
Dr. Edwards said there was debate about whether giving patients access to this kind of information could improve overall outcomes from heart surgery, adding, “It’s one of the things we plan to investigate.”
The surgeons’ society collaborated with Consumer Reports, he said, “because the readership of Consumer Reports is certainly a lot broader than any audience we could reach, and we thought there was real value in having a highly reputable independent organization report the results.”
Dr. Edwards added, “As you might imagine, it was not an entirely easy sell to the profession.”
The society had extensive information about patients’ health before surgery and also about the nature of each operation, like how many vessels were bypassed and whether arteries or veins were used to create the bypasses. Dr. Edwards said that kind of detailed information was much more useful than the records that were more commonly available, which generally disclosed only the diagnosis, the procedure performed and whether the patient lived.
Such incomplete information can be misleading. For example, he said, if a surgical group performs bypass surgery mostly on low-risk patients, its statistics may look great. Another group may perform just as well or better, but have worse outcomes because it accepts sicker patients. But a high-risk patient needing surgery might see the seemingly better results from the first group and choose it.
“What if you’re the sickest patient they’ve seen in three years?” Dr. Edwards asked, and explained that the data in the ratings were adjusted to take into account the patient’s overall health and degree of risk before the surgery.
An article published online Tuesday by The New England Journal of Medicine said this effort to make the comparative data public was “a watershed event in health care accountability.”
A version of this article appeared in print on September 8, 2010, on page A18 of the New York edition.
Consumer Reports Health.org
Heart surgery ratings
Last reviewed: September 2010
It’s sad but true that it’s easier to make an informed choice about cars and refrigerators than it is about health-care providers. Now Consumer Reports has teamed with The Society of Thoracic Surgeons (STS) to rate heart-surgery groups based on their performance data for bypass surgery. For the first time, consumers can easily see how surgical groups compare with national benchmarks for survival, complications, and other measures.
No organization is better poised to provide this snapshot of surgical outcomes than the STS, a nonprofit organization that represents some 5,400 surgeons worldwide who operate on the thorax, or chest. Its Adult Cardiac Surgery Database includes more than 4 million surgical records and covers roughly 90 percent of the more than 1,000 surgical groups in the U.S. that perform cardiac surgery, making it the largest such registry in the world. Participating groups add data four times a year, providing an up-to-date picture of their surgical practice.
The three-star rating system (available to subscribers) draws on this extensive database to show how well surgical groups performed in terms of survival rates, the absence of complications, and other key measures. Groups that score above average receive three stars, average performers get two stars, and those that are below average get one. Because the average performance of surgical groups has increased substantially in the past two decades, it is possible to get very good care even from many two-star practices.
These ratings include only those groups that have agreed to let us publish their performance results. That includes 221 groups from 42 states, plus the District of Columbia. Fifty of those groups received three stars for their overall performance, 166 got two stars, and five got one star. We will periodically update the ratings with data from additional groups that agree to release their information to us.
In the meantime, if you are considering a group that is not in the ratings, you should still ask for its results. That’s because most surgical groups that have not yet agreed to share data with Consumer Reports do participate in the STS database. And they should be willing to provide those results to you. In fact, our medical experts say that if a group can’t share that information—or won’t—you should consider looking for a different one.
Our report also provides advice from our experts on treating heart disease, including basic medical management that every heart-disease patient should have as well as less-invasive alternatives to standard bypass surgery that might make sense for some people.
Heart Bypass Surgery Ratings
There are more than 1,000 surgical groups in the U.S. that perform heart bypass surgery. About 90 percent of them provide performance data to The Society of Thoracic Surgeons, a nonprofit organization that represents heart surgeons and other doctors who operate on the chest. The surgical groups in these ratings are those that agreed to share data with Consumer Reports. If a group you are interested in is not listed here, ask the heart surgeons if they would show you their results, and if they plan to share them publicly in the future. Read more about the heart bypass ratings and treating heart disease.
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These heart bypass surgery ratings (available to subscribers) draw on data from millions of heart surgery records.
VIDEO: Heart Bypass Surgery
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