Public Reporting of Cardiovascular Outcomes: 4 Questions to Test Your Savvy

National-level public reporting of clinical outcomes in cardiovascular care began in 2011 with voluntary reporting of metrics from the Society of Thoracic Surgeons’ (STS) Adult Cardiac Surgery Database. As healthcare shifts toward ever-greater transparency, new public reporting initiatives are proliferating. The editors of Consult QD thought the time was ripe for a primer on this fast-evolving area.

Q: What constitutes “publicly reported data”?

A: Less than you may think. Only audited clinical registry data contain the granularity needed to provide the meaningful information that payers, policymakers and patients increasingly demand. Such data typically include metrics for outcomes, structure and process, and they allow for risk adjustment to enable fair evaluation according to severity of patient mix.

In contrast, outcomes reports based on administrative data lack the critical clinical information about patients to provide truly credible, relevant information. As a result, these types of reports are not considered publicly reported data by key stakeholders.

Although several U.S. states have long mandated reporting of selected cardiac surgery outcomes, the only clinical registry data on cardiovascular practice that have been publicly reported at the national level in recent years are from two STS databases: the Adult Cardiac Surgery Database and the Congenital Heart Surgery Database. But new initiatives for national-level public reporting of more clinical registry data are in the works (see final question).

Q: Who participates in voluntary public reporting of clinical registry data?

A: Whoever chooses to. Public reporting from the STS registries (and soon-to-come reporting from American College of Cardiology [ACC] registries — see below) is voluntary. While the STS reports that over 90 percent of U.S. adult cardiac surgery centers participate in STS registries, not all of them voluntarily report their data.

For instance, Cleveland Clinic is the only one of the top 10 U.S. heart programs (according to U.S. News & World Report, 2014-15) with publicly reported data in all three categories of the STS Adult Cardiac Surgery Database for the July 2013-June 2014 reporting period. (The categories are coronary artery bypass graft surgery [CABG], aortic valve replacement [AVR], and combined CABG + AVR procedures.) The other nine programs either did not publicly report or did not have sufficient CABG + AVR volume to earn a rating in that category.

Q: What drives public reporting, and what are its implications?

A: The central rationale for public reporting is to provide transparency and accountability in outcomes to inform decision-making by patients, payers and policymakers. With greater demand for transparency, public reporting of outcomes should help build public trust and may encourage adoption of best practices by more healthcare organizations.

While the public benefits from these effects of public reporting, it shouldn’t lose sight of the risk of unintended consequences, including potential inducements toward risk aversion in patient selection (i.e., cherry-picking).

Q: What’s next in public reporting?

A: Various developments are underway or on the horizon:

• The STS now offers voluntary public reporting from its General Thoracic Surgery Database and later this year will introduce ratings and public reporting for mitral valve replacement and repair procedures.
• This year the ACC will begin offering participants in its CathPCI Registry and ICD Registry the option to take part in public reporting of selected metrics from these registries.
• Insurers and other payers are increasingly factoring clinical registry data into contracts with health systems, making reimbursement levels dependent on selected quality metrics.
• Public reporting of physician-specific outcomes is under active discussion by some groups and may soon become a reality.

“Public reporting is here to stay,” says Joseph Sabik, MD, Cleveland Clinic’s Chairman of Thoracic and Cardiovascular Surgery. “Cleveland Clinic is proud to be in the forefront of this movement.”