Patient and Physician Perspectives on Public Reporting of Mortality Ratings for Percutaneous Coronary Intervention in New York State

Abstract

The study provides further evidence that public reporting of physician-specific outcome data influences physician behavior and indicates that significant discrepancies exist in how scorecards are perceived by physicians versus patients.

Taking the “Public” Out of Public Reporting of Percutaneous Coronary Intervention

“…Even interventional cardiologists acknowledge that knowing mortality statistics will be made public influences their decision to performPCI. 6 Beyond risk aversion, up-coding of high-risk variables in PCI may occur in public reporting states, which inflates predicted risk and improves risk-adjusted outcomes in the absence of actual improvements in care. 7 This is likely a consequence of the pressure clinicians feel to optimize outcomes due to fear of embarrassment or reduced referrals if poor outcomes are publicly disclosed.…”

“…Despite the investment of resources to ensure the public availability of outcomes data, in general, patients do not appear to use this information in a way that meaningfully influences where they choose to receive care. 6 For emergency care, such as PCI for acute MI, patients may have limited ability to select hospitals. Furthermore, there is no evidence that public reports affect physician and hospital referral patterns.…”

Public Reporting of Percutaneous Coronary Intervention Outcomes

“…However, the better outcomes noted in this procedure-based analysis likely reflect some degree of case selection. 11 Collectively, the evidence to date suggests that public reporting impedes access to potentially life-saving interventions for the critically ill. 3–5,8,9 …”

“…8 Mortality reporting falls short as a stand-alone quality measure for a number of reasons. First, mortality may not truly reflect PCI quality but rather the totality of care provided by the care team across the clinical episode—from the nursing staff in the coronary care unit to the intern completing the discharge paperwork; attributing mortality to the PCI operator alone may be inappropriate.…”

Lifting the veil on stroke outcomes: revisiting stroke centers’ transparency through public reporting of metrics

“…This indicates that providers may make treatment decisions based on public reporting and therefore may withhold life-saving treatment from patients who may need it the most to avoid negative scoring. Measures to mitigate this bias, such as removal of patients with cardiac arrest or cardiogenic shock from RAMR calculations, have led to a reduction in self-reported risk avoidance 31. Further, disease-specific reporting (including all patients with a specific diagnosis, regardless of treatment) as opposed to procedure-specific reporting (for instance, only patients undergoing PCI) may be integral in reducing the influence of public reporting on medical decision-making.…”