Choosing Where to have High-Risk Elective Surgery

  You’re facing non-emergency surgery, so there is time to weigh and consider the choice of a surgeon and hospital. Ideally, the choice would be based on the surgeon and the hospital with the best records. An increasing number of state health departments, consumer advocacy groups, and coalitions of employers and insurers can help by providing what is called “performance data” on hospitals and surgeons.

  But a new survey found that few elderly Americans who had recently undergone non-emergency surgery looked for performance data. Most relied on the opinions of their referring physician, family members and friends in choosing where to have surgery. The telephone survey was conducted in the U.S. and was published recently in the BMJ, the British medical journal. The 510 randomly chosen respondents had undergone high-risk elective procedures, such as heart valve replacement or cancer surgery involving the bladder, lung or stomach. All were Medicare beneficiaries, so a choice of hospital and surgeon was possible.

  The survey’s authors led by Lisa M. Schwartz, MD, Dartmouth Medical School did not see their results as a sign of the ineffectiveness of public reporting of performance data. It was well known—before this survey—that public reporting of this type of information does not have seem to affect people’s choice of hospital or doctor. Instead, Schwartz and colleagues say that the problem lies in assuming that the public is the primary target for surgical performance data. They think that the target audience should be referring physicians and purchasers of health services.

  A good example of the latter, say Schwartz and colleagues, is the Leapfrog Group, a coalition of employers and insurers that buy health care. The Group encourages its employer members to use the purchasing power of their health plans to reward doctors and hospitals for improving the quality, safety, and affordability of health care. (To see ratings of hospitals in your area, go to www.leapfroggroup.org and click “For Consumers.”)

  Still, the referring physician’s opinions loomed large in this new survey. Schwartz and colleagues acknowledged the fact that more work has to be done to ensure that referring physicians appreciate the importance of performance data. The information must be easily understandable, and doctors may need help in finding the best ways to communicate performance data to their patients.

Maryann Napoli, Center for Medical Consumers ©, November 2005