The American Heart Hospital Journal
Limitations. Although the General Accounting Office has recommended the use of per capita analysis as a means to identify resource-intensive providers, such analyses have their limitations.25
Conclusion In particular, observational per capita
studies are not designed to determine causation. To determine whether government-published cardiac surgery report cards cause a reduction in CABG volume will require further studies. A second limitation to this study is the use of CON certification as an index to state market regulation. From a legal perspective, CON certification is only a crude index of the degree to which a state regulates its healthcare market. Finally, like all report card studies, this study assumes that the currently published report cards affect the market. This may or may not be true, because the most recent provider- specific report card data available to the public often reflect market conditions two to three years previously. This is unfortunate because Jha and Epstein have observed that the composition of cardiac surgeons in RS is not stable over a three-year period.26
1. Report cards on cardiac surgery – New York State’s approach, N Engl J Med, 1995;332(18):1229–33.
2. Institute of Medicine, Leadership by Example: Coordinating Government Roles in Improving Health Care Quality, Washington, DC: NAS Press, 2002.
3. McLean TR, Will reputational incentives stimulate a reversal of the physician brain drain?, J Health Serv Res Policy, 2008;13:50–52.
4. McLean TR, Reputational Incentives: How improving transparency can drive competition, Am Heart Hosp J, 2009;7(1):27–32.
5. Department of Health and Human Services, Hospital Compare. Available at:
www.hosptialcompare.hhs.gov (accessed June 2, 2009).
6. Peterson ED, DeLong ER, Jollis JG, et al., The effects of New York’s bypass surgery provider profiling on access to care and patient outcomes in the elderly, J Am Coll Cardiol, 1998;32(4):993–9.
7. Hibbard JH, Stockard J, Tusler M, Hospital performance reports: impact on quality, market share, and reputation, Health Aff, 2005;24(4):1150–60.
8. Heart Rhythm Society: 2009 Medicare Physician Fee Schedule Proposed Rule. Available at:
www.hrsonline.org/Policy/Coding Reimbursement/reimbursement/physician/mpfs_proposed_rule_
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9. US Census Bureau, Quickfacts. Available at:
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53000.html (accessed January 3, 2010).
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www.healthgrades.com/local-doctors-directory/by-specialty/ interventional-cardiology (accessed January 7, 2010).
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13. McLean TR, In New York State, do more percutaneous coronary interventions mean fewer or more complex referrals to cardiac surgeons?, Am Heart Hosp J, 2008;6(1):30–36.
14. Dranove D, Kessler D, McClellan M, et al., Is more information better? The effects of report cards on health care providers, NBER
From the CMS’ perspective, state-sponsored provider-specific report cards are an inadequate tool to implement VBP. In particular, patients and physicians are mobile, while state-based report cards have limited geographic impact. Moreover, most states do not publish cardiac surgery report cards. Thus, one reason Medicare patients in McAllen Texas have the highest per capita consumption of cardiac services in the nation is that Texas is an NRS.27
Therein lies the appeal of
Hospital (and Physician) Compare as provider-specific report cards: these report cards are designed to make all Medicare providers who offer CABG-only services more risk-averse. n
Acknowledgments
The author wishes to thank Louisiana State University (LSU) Law Professor Edward P Richards and Department of Veterans Affairs Surgery Director Dr William Gunnar for their thoughtful comments on this paper. Nothing in this article should be construed as representing Department of Veterans Affairs policies or procedures.
Working Paper No. 8697, January 2002. Available at: www.nber. org/papers/w8697 (accessed September 8, 2009).
15. Cutler DM, Huckman RS , Landrum MD, The role of information in medical markets: an analysis of publicly reported outcomes in cardiac surgery, American Economic Review, 2004;94(2):342–6.
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20. Pub. L. 108-173; §501. 21. McLean TR, Using the market to regulate health care price: Why heart hospitals will have an advantage in the world of post Diagnostic Related Group pricing, Am Heart Hosp J, 2004;2(3):165–9.
22. Tax Relief and Health Care Act of 2006 (H.R. 6111). 23. McLean TR, Big Brother and need for a Performance Measure Integrity and Fraud Detection Act, Law/Technology Journal, 2009;42(2):10–37.
24. Omoigui NA, Miller DP, Brown KJ, et al., Outmigration for coronary bypass surgery in an era of public dissemination of clinical outcomes, Circulation, 1996;93:27–33.
25. General Accounting Office, Per Capita Method Can Be Used to Profile Physicians and Provide Feedback on Resource Use, 2009; GAO-09-802.
26. Jha AK, Epstein AJ, The predictive accuracy of the New York State coronary artery bypass surgery report-card system, Health Aff, 2006;25(3):844–55.
27. Gawande A, The cost conundrum, The New Yorker, June 1, 2009. Available at:
www.newyorker.com/reporting/2009/06/01/090601 fa_fact_gawande
Original Contribution
Summer 2010
Provider-specific Report Cards
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