Doctor Scorecards: Affecting Care (but not in the way you think)

A recent perspective article (L Rosenbaum. NEJM 2015; 373: 1385-8) explains how the use of physician scorecards are negatively affecting patients and the pitfalls in their interpretation. Her article describes a situation, that is ‘not uncommon,’ in which a higher risk cardiology patient will not have a surgical consult for a few days because most surgeons “wouldn’t touch our patient with a 10-foot pole.”  In several states, the increase reports of cardiac surgery outcomes has resulted in surgeons avoiding the sickest patients. The author notes that transparency/public reporting needs to be balanced against the potential harms. Other key points:

  • The public reporting thus far has been deeply flawed, based on insurance claims that are “notoriously inaccurate.”  The reports have poor reliability, in part, due to too few surgeries to make accurate conclusions.
  • The public reports amount to “fear mongering” rather than the “professed commitment to protecting patients.”
  • “The key question, then, is less about transparency with regard to quality than it is about what constitutes quality in the first place.”
  • “The irony in hailing the scorecard as a victory for transparency is that its purported objectivity obscures its methodologic limitations.”

My take: While you are looking a surgeon’s scorecard, keep in mind, he/she may decide to not operate on you when he/she looks at your scorecard (of illness). Related blog posts: