Death rates per doctor to be listed

Massachusetts health officials have decided to publicize the patient death rates for individual heart surgeons, the first time the state will release information on the quality of care provided by individual doctors --not just by hospitals and physicians' groups .

Beginning Dec. 18, it will be possible to go to a website and look up the mortality rates for 55 surgeons who perform cardiac bypass operations. About 4,000 patients had bypass surgery at 14 Massachusetts hospitals in 2004, according to the state's most recent figures. It is one of the most common operations.

The decision will make Massachusetts the fourth state to release such data on heart surgeons, officials said, and follows more than a year of discussions with the state's cardiac surgeons. Many heart surgeons initially opposed publicizing their patient results but now accept the state's decision, said department chiefs. The surgeons believe it is inevitable that insurers and government agencies soon will release a wide range of performance measures in the hopes that it will create market forces to improve care.

In New York, where mortality data for individual cardiac surgeons have been released since 1991, state officials credit the program with lowering death rates, but surgeons in Massachusetts are worried that public reporting could hurt care by discouraging doctors from taking high-risk patients who are more likely to die.

Studies, however, have not reached a clear conclusion on whether such risk avoidance has occurred in New York, and Massachusetts health officials said they were unconvinced that public reporting is detrimental to patients.

"Ultimately people have a right to know the best data available on the performance of their practitioners," said Paul Dreyer, director of the Division of Health Care Quality in the Department of Public Health.

The heart bypass results will be posted on hcp.med.harvard.edu/massdac/index.htm , the web address for Mass-Dac, the Harvard Medical School center that collects and analyzes heart patient data for the state, said Amy Lischko, commissioner of the state division of Health Care Finance and Policy.

The division's website, mass.gov/healthcareqc , also will post an abbreviated form of the mortality data.

Mass-Dac does not collect mortality data for other heart surgeries such as valve replacements.

The surgeon-specific data will be similar to hospital heart surgery mortality data Mass-Dac already makes public. Mac-Dac's website will show the percentage of patients who died soon after their bypass operations and whether the death rate is higher or lower than the state average, Dreyer said.

Heart surgeons' mortality rates will be computed for 2002, 2003, and 2004 together, officials said, because it takes three years for most surgeons to accumulate enough cases to make their results statistically meaningful. State officials said they believe surgeons will not avoid high-risk cases, because they are adjusting the data to weigh each surgeon's mix of patients and the severity of their illness.

Several people who have seen the data said several surgeons are identified as "outliers" -- those who have higher-than-expected mortality rates. But Dreyer said none of the "outliers' currently practice surgery in Massachusetts.

Hospitals often become aware of problems through their internal reviews before they receive the state data. The data will be almost two years old by the time they are posted, and Dreyer said the Public Health Department is working with Mass-Dac to reduce the time lag in reporting by at least six months. But he said there always will be a lag because of the extensive work it takes to collect and analyze information from patients' charts, a delay some doctors point out makes the data less useful to the public.

The state and Mass-Dac have released the heart-bypass mortality rates at individual hospitals for three years, and a similar lag exists for those reports. The state's data collection program has not found huge variations among hospitals, with the exception of UMass Memorial Medical Center in Worcester, which temporarily suspended its cardiac surgery program last year because of a higher-than-average mortality rate, and Caritas St. Elizabeth's Medical Center, which suspended a surgeon earlier this year. UMass medical center's executives suspended the surgery program when state officials presented them with the data, shortly before it was to become public.

When the six-year-old state law that requires collection of mortality rates was enacted, Dreyer said he and other health officials decided against reporting mortality data for individual surgeons, because they believed state agencies and hospitals would bring about quality improvements by using the physician data internally to identify poor performers and push for improvements.

But they recently changed their minds, largely because of the growing push by employers, insurers, the federal Medicare program, and the Romney administration to more fully disclose medical care data. Advocates of public reporting believe that full disclosure holds providers accountable for the billions of dollars spent on healthcare annually, helps patients decide where to seek treatment, and creates market pressure on providers to improve care.

Dr. Richard Shemin, chief of cardiothoracic surgery at Boston Medical Center and president of the Massachusetts chapter of the Society of Thoracic Surgeons, said initially many heart surgeons were upset because they felt the "state was going back on its word."

But, he said, he held a conference call with cardiac surgery chiefs from the 14 hospitals several weeks ago, and they reached a consensus that they would support public reporting rather than fight the state.

When the data are released, he said, "people are going to find the providers currently practicing in the state are of good quality."

But Shemin said "it's possible early on that there could be risk avoidance when people are getting used to the system."

In New York, Edward Hannan, chairman of health policy management and behavior at the University at Albany School of Public Health, said the program has improved care.

"When you look at what's happened over time and which physicians have left the system, there's much more of a tendency for those who left to be bad performers and low-volume surgeons," he said in an interview earlier this year. "It's allowed hospitals to remove privileges without as much fear of being sued. When the data is out there, there's much more impetus for them to investigate and figure out how to improve outcomes."

But Dr. George Tolis Jr., the new chief of cardiothoracic surgery at Caritas St. Elizabeth's who was a surgeon in New York, said the program has not improved care. He said some surgeons have low mortality rates because they refuse to operate on high-risk patients.

Tolis said the problem is that states' analyses cannot fully account for all of a patient's risk factors, so that surgeons who take higher-risk patients still end up looking like they get worse results.

(Correction: Because of a reporting error, a Page One story on Wednesday about publicizing patient death rates for individual heart surgeons incorrectly described the data collected for the state by Harvard Medical School. The school collects mortality data on all heart surgeries in Massachusetts.)