Publicly reported provider outcomes: the concerns of cardiac surgeons in a single-payer system

Provider outcomes reports are an important part of quality improvement efforts. The positive and negative impact of such reports on the delivery of care has not been extensively explored.

A survey of Ontario cardiac surgeons was performed in September 2003 to understand their concerns regarding performance reports. The questionnaire addressed the use of evidence-based practices, the impact of public-provider profiling on clinical practice and the improvement of current report cards. The survey was conducted with the distribution of a fiscal 2000/2001 cardiac surgery report card.

There was a 95% (52 of 55 cardiac surgeons) survey response rate, of which 80% were high-volume surgeons with a case volume of more than 200 cases per year. Seventy-four per cent of surgeons had more than five years of experience. The majority of surgeons believed that performance reports influenced cardiologist referrals (84%) and patient choices (80%). A minority (48%) of surgeons believed that the reporting of inhospital mortality was very or extremely useful, but a majority (83%) believed mortality rates indicated the relative performance of a cardiac surgeon. The majority of surgeons believed that routine upcoding of data (84%) and inadequate risk adjustment (75%) were weaknesses of present performance reports. Surgeons were divided regarding whether the institutional performance should continue to be publicly reported (51% agreed with public reporting).

In a single-payer system, performance reports breed provider concerns similar to those seen in market-driven systems including high-risk patient avoidance and upcoding of data. Regardless, providers recognize that institutional performance reports, irrespective of public or confidential reporting, are important in continuous quality improvement.