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Elizabeth Cooney is a health reporter for the Worcester Telegram & Gazette.
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Friday, July 13, 2007

On the blogs: Levy ponders surgeons' report card Catch-22

Public reporting campaign meets surgical caution on Running a Hospital today.

In this week's New England Journal of Medicine three Harvard doctors argue that making mortality rates public for individual cardiac surgeons could end up harming patients if the rankings push surgeons to avoid operating on high-risk patients.

Today Paul Levy responds in detail to the White Coat Notes post about the opinion piece in the journal, written by Dr. Thomas H. Lee of Partners Health Care, Dr. David F. Torchiana of Massachusetts General Hospital and Dr. James E. Lock of Children’s Hospital Boston.

As readers of the Beth Israel Deaconess CEO's blog know, Levy is a champion of transparency, urging other hospitals to join his in posting their performance measures. He responds to the doctors' contention that public reporting is too flawed (not adequately adjusted for risk, too small a sample) to be valid. (He also asks many questions -- it's a long entry.)

"So here's our Catch-22: No reporting method is statistically good enough to be made public," he writes. "But if a method is statistically good enough, we won't allow it to be made public."

Then Levy issues a challenge to health care providers:

"The medical profession simply has to get better at this issue. If they don't trust the public to understand these numbers, how about just giving them to referring primary care doctors? Certainly, they can trust their colleagues in medicine to have enough judgment to use them wisely and correctly."

And another to insurers:

"We hear a lot about insurance companies wanting to support higher quality care. When is an insurance company going to demand that the hospitals in its network provide these data to referring doctors in its network? How about this for an idea? If a hospital doesn't choose to provide the data, it can still stay in the network, but the patient's co-pay would be increased by a factor of ten if he or she chooses that hospital."

Posted by Elizabeth Cooney at 04:46 PM
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