Circ: Public reporting doesnt impact hospital market share

Public reporting on non-emergent PCIs in New York identified very high and low performers but provided insufficient information to differentiate between most hospitals, and it appeared to have had no effect on market share or physicians' decisions to leave practice, according to study authors, who published research in the January issue of Circulation: Cardiovascular Quality and Outcomes.

Since the advent of public reporting on risk-adjusted mortality for CABG surgery, public reporting on outcomes has expanded to include a variety of dissimilar conditions and procedures. Aiming to improve quality of care, more than 10 states, including New York, California and Texas, publicly report on risk-adjusted mortality after CABG, and at least eight states have embarked on public reporting of outcomes after PCIs. 

However, the study authors noted that little evidence is published “to support such broad-based efforts.”

By using PCI as an example of a procedure that differs in important ways from CABG, yet is commonly subjected to public reporting, Lena M. Chen, MD, from the division of general medicine at the University of Michigan in Ann Arbor, and colleagues examined data from New York to address three questions:

1. How well do public performance reports on PCI forecast future performance?
2. What is their impact on cardiologists' and hospitals' market share?
3. Is report performance associated with physicians' decisions to leave practice?

To do so, they examined the quality performance of 351 cardiologists at 48 hospitals in New York, using publicly reported risk-adjusted mortality rates (RAMRs) for non-emergent PCIs between 1998 and 2007.

In the year after report release, the researchers examined the average RAMR for hospitals, the change in market share for hospitals and cardiologists and the proportion of physicians leaving practice. 

They also found that patients who picked a hospital that performed significantly better than expected in prior years had lower RAMRs (0.47, 0.61 and 0.72 for patients choosing hospitals whose prior reports were better than, as, and worse than expected). However, choosing a hospital in the top quartile (or decile) of performance in prior years did not decrease a patient's chance of dying.

Importantly, performance ranking was not associated with a change in market share for hospitals or for physicians, or with leaving practice. 

Chen et al found that New York’s reporting system for PCIs had good forecasting accuracy for hospitals at the extremes of performance, but poor capability to detect any difference in quality at most hospitals. They also found no evidence that consumers, physicians or payors are using the public reports to drive market share or that cardiologists who perform poorly are more likely to leave practice after release of a report showing that their performance is substandard.

This study was supported with resources from the Veterans Affairs (VA) Center for Clinical Management Research and VA Ann Arbor Healthcare System.