ProPublica has recently announced that the American Board of Orthopaedic Surgery, the board responsible for certifying orthopedic specialists, will use ProPublica’s Surgeon Scorecard to help assess the competency of its surgeons seeking recertification.
However, despite being reported on by ProPublica, the American Board of Orthopaedic Surgery has issued a statement: “To all diplomats and the orthopaedic community. You may have read certain information from an online publication, ProPublica. It should be known that the ABOS Board of Directors has not discussed nor considered the use of any ProPublica’s scorecard or any data in any certification or credentialing process.”
ProPublica announced that the board will incorporate the Surgeon Scorecard’s rating into its recertification process and surgeons might be put on a watch list based on their Scorecard rating. Shephard Hurwitz, Executive Director of the American Board of Orthopaedic Surgery, maintains that actions will not be taken based only on ProPublica’s Surgeon Scorecard, but instead, “in concert with other quality issues, could lead us to delay their recertification or require them to explain to us why they are having this high problem rate.”
Board certification is an important credential for surgeons and other specialists; many hospitals and insurance plans require affiliated doctors to be board certified, and many patients use it as an indicator of a surgeon’s credibility. The current recertification process is fairly rigorous and requires surgeons to take exams while the board reviews reports by peers and patients as well as any criminal convictions, or disciplinary actions taken by state medical regulators. When applying for recertification, surgeons are currently required to report how their patients fared postoperatively, but that information is not typically audited and verified.
Since its introduction in July 2015, the Surgeon Scorecard has been controversial, with many experts questioning the reliability of the data. At the beginning of this month, we wrote an article about Rand’s questioning of the reliability of the data used to formulate the Scorecard. Rand found the issues with methodology to be so serious that they recommended patients to not view the Scorecard as a “valid or reliable predictor of the health outcomes any individual surgeon is likely to provide.”
Rand also had concerns about the accuracy of the assignment of performance data to the correct surgeon. Rand stated that claims data submitted to Medicare is what forms the basis of the Scorecard, and that because claims data is notorious for being inaccurate in individual provider assignments, the reliability of the Scorecard is called into question.
We have also previously written on the unintended consequences of public reporting, including the very real concern that rating physicians in a public database solely on complication rates may discourage surgeons from operating on the high-risk patients that need surgeries the most. Not only does the public reporting discourage surgeons from taking on high-risk, and important, cases, it also has the potential to cause patients who desperately need a life-saving surgery to avoid it altogether, simply because their surgeon does not have the highest scores.
ProPublica’s definition of “complication rate,” which an important factor in the Surgeon Scorecard, is an overly broad definition, and includes instances such as: “the 84-year-old patient three weeks out from hip replacement who is admitted through the ER with “increasing confusion” due to insomnia and overuse of narcotic pain meds is a red mark against the orthopedic surgeon. Urinary tract infection two weeks after spinal surgery in a patient with known BPH. The anxious 27-year-old lady readmitted at midnight two days after a LC because of refractory nausea. The 49-year-old male who develops chest pains ten days after lumbar fusion surgery. All these are reportable offenses that don’t necessarily have anything to do with the quality of said procedure performed.”
Much of the pushback from industry groups on ProPublica’s Surgeon Scorecard is related to the fact that the Scorecard positions itself as a comprehensive grading system for patients to use and make actual healthcare decisions based on whether their surgeon falls in a green, yellow, or red category.
The fact that the American Board of Orthopaedic Surgery might be planning to use the Surgeon Scorecard to assess the competency of its surgeons is a cause for concern. While no other specialty boards have made an announcement on utilizing the Surgeon Scorecard to help assess and determine re-certification, we should be vigilant and keep an eye on any board decisions that might have such a serious impact on other specialty groups.