Risk Aversion and Public Reporting. Part 2: Mitigation Strategies.

Area of Science:

• Cardiology
• Healthcare Policy
• Medical Economics

Background:

• Risk aversion is prevalent in cardiac surgery and interventional cardiology.
• Physicians perceive current risk adjustment as insufficient for high-risk patients.
• This inadequacy can negatively impact publicly reported performance scores.

Purpose of the Study:

• To explore the consequences and root causes of physician risk aversion.
• To evaluate the robustness of current risk adjustment methodologies.
• To propose strategies for mitigating risk aversion in performance reporting.

Main Methods:

• Review of observational studies and surveys in cardiac surgery and interventional cardiology.
• Analysis of provider beliefs regarding risk adjustment adequacy.
• Identification and evaluation of potential strategies to reduce risk aversion.

Main Results:

• Physician belief in inadequate risk adjustment is the primary driver of risk aversion.
• Current risk adjustment models demonstrate robustness.
• Nine strategies are proposed to mitigate risk aversion, including data optimization, patient exclusion, and revised reporting methods.

Conclusions:

• Optimizing data sources, risk models, and performance measures is the most effective and least gameable strategy.
• Addressing physician concerns about risk adjustment is crucial for accurate performance evaluation.
• Multi-faceted approaches are needed to combat risk aversion in healthcare.