A close friend mentioned he was going to have surgery. He did the normal due diligence. He selected a well-known medical center. His surgeon was properly licensed and credentialed. Yet, he still had this niggling concern: He knew nothing about the surgeon’s technical skill. He asked if there was any way to get an insight into this issue.
I offered to help. What I found was so surprising I wanted to share it with you, even though it’s unrelated to investing. This really is information that could save your life or the life of a loved one. I couldn’t keep it to myself.
The importance of skill
According to a study published in the New England Journal of Medicine, there’s a direct correlation between the technical skill of the surgeon and fewer postoperative complications. That’s not surprising.
Here’s the shocker: An objective assessment found “huge variations” in operating skill between the surgeons observed. The lowest ranked surgeons were at a level “only slightly better than a trainee at the end of residency.” The highest ranked were “masters” in their field.
This is deeply concerning. I set out to find data that would help my friend assess the skill of the surgeon he was considering. It wasn’t easy.
Research on Hospitals
It’s fairly easy to research hospitals.
USNews publishes an annual ranking of hospitals by specialty and by state.
A lesser-known resource is published by Medicare. It bases its rankings on data from over 4,000 Medicare-certified hospitals and ranks hospitals in a number of categories from one to five stars. I was surprised by some of the rankings. The famous Johns Hopkins Hospital in Baltimore Maryland was ranked only 2 stars, although a footnote indicates the hospital reported discrepancies in some of the claims data.
Once you are satisfied with the quality of the hospital, you still need to determine the skill of the surgeon.
After much digging, I found a database of surgeon complication rates published by ProPublica. You can find details of its methodology here. It acquired Medicare billing records for in-patient hospital stays from 2009 through 2013. It limited its analysis to eight common elective surgeries, because “they are typically performed on healthy patients and are considered relatively low risk.”
It’s database reports adjusted complication rates for 16,827 surgeons, operating at 3,575 hospitals. It limits its analysis to surgeons who performed an operation at least 20 times.
When I reviewed the hospital being considered by my friend, here’s what I found.
The hospital was rated 5 stars by Medicare, which is excellent.
But the adjusted complication rate for the surgeons at the hospital doing the procedure he required ranged from a low of 3.8% (which is excellent) to a high of 5.3% (which is considered a “high adjusted rate of complications.”
The surgeon he selected was on the high end of complications. He immediately switched to one on the lower end of the complications spectrum.
Criticism of methodology
As you can imagine, the criticism of ProPublica’s database has been vigorous. It’s summarized here.
Some believe using only Medicare data skews results. Others argue that it omits crucial details. One commentator believes the results “distort[s] reality, clouds data, confuse patients and proffers no insight in how a surgeon might improve his/her results.”
Contrary views are published by ProPublica on its website. Dr. Thomas Lee, a professor at the Harvard School of public health stated: “I think the methodology was rigorous and conservative. I would be surprised if any experienced clinician challenged the basic finding, which is that there is real variation among surgeons.”
Most of us don’t have the expertise to evaluate these competing views. How and whether you use the surgical database is entirely your choice. Personally, I found it helpful.
Resource of the week
I recommend this article, which summarizes the views of experts on the ProPublica database.