We have a better way, but it's secret

Here’s the issue in a nutshell, as I see it.  There is a rigorous methodology available for evaluating surgical outcomes.  It is from the American College of Surgeons, and it is called NSQIP.  It is indeed the “leading nationally validated, risk-adjusted, outcomes-based program to measure and improve the quality of surgical care in the private sector.”

Look at what the program offers to surgeons:

Surgeons who use ACS NSQIP receive:

• Better data for more targeted decision-making:
  • Peer-controlled, validated data from patients’ medical charts lets surgeons quantify 30-day, risk-adjusted surgical outcomes, including post-discharge, when nearly 50 percent of complications occur.
  • A variety of program options tailored to your hospital’s size and quality improvement interests.

• Robust reports that provide performance information to guide surgical care and identify areas for improvement for the greatest return and highest impact:
  • Continuously updated hospital performance reports and benchmarking analyses available in real time.
  • Nationally benchmarked and risk-adjusted reports provided semiannually.
  • Maintenance of Certification (MOC) Part IV credit for all surgeons at hospitals participating in the program.
  • Best practices tools, including Case Studies and evidence-based guidelines developed by ACS.
  • Opportunities to participate in regional and virtual collaboratives with other hospitals.
  • Preoperative risk calculator:
    • Online tool helps clinicians make evidence-based decisions, and helps set reasonable patient expectations.
    • Takes into account patient risk factors like age and BMI for a growing number of common surgical procedures.
    • Better predictive ability than most other models.

Ideally, ProPublica or others could publish the NSQIP results, except for one thing.  Under the ACS rules, the evaluations must be held confidential.

So there we have it. We could all have a rigorously derived comparison tool, but since the profession chooses not to make it available, we must have a surrogate of the sort that ProPublica used in its article. Or nothing at all. What would be your choice?