Not Transparency

Several months ago, the state of Massachusetts started a website (click on the box in the lower right of the home page that says Health Care Quality and Cost Information, and then click "physicians") with data on the volume of certain procedures done by individual surgeons at hospitals in the state. There are several problems with this website.

First, the state is using administrative datasets (i.e., billing information) to generate the numbers. Those datasets only allow for a certain number of "operators" to be listed as part of an admission. So, for a person who has multiple operations during the same hospital admission, not all of the procedures will be captured.

Second, the coding logic that the state uses has some oversights. Mass General Hospital and Boston Medical Center, for example, note that the category of abdominal aortic aneurysms (AAA) does not include endovascular repairs, which represent a significant portion of those types of surgeries. MGH points out, "The conventional surgery involves a major incision and the AAA is repaired by the surgeon sewing in an artificial aorta. The stent graft (or minimally invasive operation) achieves the same goal (eradication of the AA) by working up through the arteries in the groin. In the past year the percentage of AAA repaired with the minimally invasive approach has grown to 70% at the MGH." BMC states, "The ... definition allows us to report only on the volume of direct aortic aneurysm repairs. At Boston Medical Center, we do both endovascular aortic aneurysm repairs as well as direct repairs; adding the endovascular cases would more than double the volume reported for FY04."

Third, the numbers are out of date and do not represent the latest volume of surgeries carried out by doctors. I have suggested to people in the state and to insurance companies that it would be very, very easy to have real-time information on these topics: The state could set up a website and give password access to each hospital, and we could update the website from our own databases virtually every day of the year. We all keep track of our doctors' clinical volumes.

To keep us from "cheating" -- as if we would! -- the data submitted by us could be printed in italics and listed as unaudited until the state actually caught up with the figures in its own reports. At that point, the font could switch over to plain type.

And, finally, to persist with one of my favorite topics (see below), why doesn't the website include solid organ transplant surgical volumes? These are easily counted and reported. Wouldn't you want to know these figures if you needed a new liver or kidney?

We all appreciate the steps the state is taking, but if we are going to be serious about transparency, let's improve what is posted so consumers have up-to-date and accurate information.