ACS should work towards public disclosure
July 26, 2015
Last week, I commented on ProPublica's release of their Surgeon Scorecard tool. Consumers' Checkbook also released its Surgeon Ratings tool, garnering much less attention. Their tool is friendlier towards the provider community in that they suppress listings for surgeons who appear to perform poorly. They also suppress information on surgeons for whom there are too few data points, so a surgeon might not be listed for either reason. We think that both of these tools are steps in the right direction.
Perhaps not surprisingly, the American College of Surgeons (ACS) chimed in with their own statement, offering a dismal view of these tools. Their critique echoes the criticism of others, faulting the tools, for example, for not relying on clinical data. This criticism is a convenient excuse in that at one level, everyone understands that using clinical data to assess clinical outcomes is better than billing data. On the other hand, people also know that the release of clinical data for public reporting purposes is very far away.
The ACS ends its statement with a warm and fuzzy sentiment: "At its core, the American College of Surgeons is committed to improving the care of the surgical patient and believes that sharing meaningful data is key to that endeavor. Let's do it right and together." It so happens that the ACS has been collecting clinical performance information about surgeons (via a program called NSQIP). ACS's platitudes and objections to these billing-based surgeon rating tools ring hollow unless we see it work towards the public disclosure of the metrics that it has developed. Two straightforward steps that ACS could take today are to make it easy for individual surgeons to agree to publicly disclose their metrics via ACS and for ACS to make a public statement encouraging surgeons to do so.
Until the medical community truly engages with the issue of quality variation across providers, it is my hope that these imperfect tools based on billing data will prod the industry into further deliberation and eventual release of metrics based on clinical data. Let perfection not be the enemy of progress.