Surgical Quality Difficult for Health Plans to Assess: Study

Health plans face significant challenges in reliably assessing the quality of individual surgeons’ patient outcomes, and need better ways to measure physician quality when selecting the best surgeons for their members, according to a study published in the December American Journal of Managed Care.

The study examined the results of more than 220,000  coronary artery bypass graft (CABG) procedures performed in 75 Florida hospitals between 1998 and 2006. 

Marco Huesch, a physician and assistant professor of strategy at Duke University’s Fuqua School of Business, conducted the analysis. “While it might be natural to assume that health plans select surgeons based on the quality of their patient outcomes, as it turns out, it’s generally almost impossible for an individual company to do so,” Huesch said in a statement.

Huesch’s analysis of rates of in-hospital mortality did find differences in outcomes between surgeons. However, it also confirmed that the law of small numbers, a situation where there are too few items in a sample to draw reliable conclusions, would prevent insurers from accurately assessing the quality of the Florida surgeons’ care.

“While we found differences in mortality rates across physicians, no single insurance provider had enough patients undergoing surgeries by the same physicians in order to generate statistically significant data against which it could judge outcomes,” Huesch said. He said the current effort to reform U.S. health care is likely to exacerbate the situation. “As we create new insurance entities to cover previously uninsured Americans, we’ll simply have even more data being collected by separate companies, none of which is being combined in a way that it can be usefully evaluated.”

CMS reports results of 2008 Medicare Physician Quality Reporting Initiative (PQRI)

The Centers for Medicare & Medicaid Services (CMS) today announced the results for the 2008 Physician Quality Reporting Initiative (PQRI).  More than 85,000 physicians and other eligible professionals who satisfactorily reported quality-related data to Medicare under the 2008 PQRI received incentive payments totaling more than $92 million, compared to $36 million in 2007.

Providers can access their confidential feedback reports at the Tax Identification Number (TIN) level by visiting the secure PQRI portal at  Trained Help Desk staff will assist providers with accessing their feedback reports at 1-866-288-8912 or at  Support is available on Monday through Friday from 7:00 a.m. to 7:00 p.m. Central Time.  In addition, individual professionals can access their feedback reports by contacting their Part A/Part B MAC at its Provider Contact Center.