Controversy over California's cardiac reports

Along with a few other states, California publicly reports the performance of individual cardiac surgeons. Los Angeles Times reported on the contrasting reactions of two surgeons rated as worse than average. The first surgeon raised a long standing argument of critics of these transparency efforts: that surgeons will be discouraged from taking on patients who have more complicated conditions. The other surgeon welcomed the public reporting, but noted the short duration covered.

Both surgeons raise legitimate concerns. The antidote for the second one is easier to address: publish more data. The first concern is more complicated. The publishers of the data already risk-adjust the outcomes, meaning that, in theory, providers who take on patients with complicated conditions are not penalized for doing so. Of course, risk-adjustment is far from settled science, and there are a variety of ways of doing so. What could help is to publish the underlying data, along with the risk-adjustment algorithms and invite comment from the academics who study it. While that won't fully address the issue in the short-term, it advances the discussion around quality metrics in hopes of at some point coming up with some usable measures. At least, that's much better than just suppressing the data.