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PRODUCED BY AND FOR MEMBERS OF THE DEPARTMENT OF SURGERY August 2015 | Archived Issues

FDA Warns of Gilenya Risk, Name Confusion, Looks Into GBCA Use

Pharmacy Focus

The U.S. Food and Drug Administration has issued warnings regarding the multiple sclerosis drug Gilenya and about reports of confusion between the names of the antidepressant Brintellix and anti-clotting drug Brilinta. Also, the agency is investigating the risk of brain deposits following repeated use of gadolinium-based contrast agents for magnetic resonance imaging.


Mark Your Calendar


Surgery Grand Rounds

Click the "read more" to see information about upcoming Surgery Grand Rounds.


Grand Rounds

Click here to view a schedule of all upcoming grand rounds.


Education Schedule

Click the PDF link below to see the Department of Surgery's education schedule.

Education Schedule - August 2015 (PDF)


Surgery Scheduling

Click the "read more" for hours and contact information for surgery scheduling.

Share Your News

Know an interesting colleague we should profile? A story we should tell? Submit your ideas, meetings and events for consideration.

Click here to submit your news to Sutures

ProPublica 'Surgeon Scorecard'

From Chris Ng, MD, Chief of Staff, and Michael L. Langberg, MD, Chief Medical Officer and Senior Vice President for Medical Affairs

On July 14, 2015, the independent, nonprofit investigative journalism organization ProPublica released a "Surgeon Scorecard" for eight procedures. It reviewed five years of Medicare claims data (2009-13) for more than 17,000 surgeons, including more than 40 surgeons who have medical staff privileges at Cedars-Sinai. ProPublica evaluated the physicians based on "complication rates" for eight procedures:

  • Knee replacement
  • Hip replacement
  • Minimally invasive gallbladder removal
  • Lumbar spinal fusion (posterior technique)
  • Lumbar spinal fusion (anterior technique)
  • Cervical (neck) spinal fusion
  • Prostate resection
  • Prostate removal

ProPublica defined complications as death during hospitalization or readmission within 30 days based on principal diagnoses related to the surgical procedure. Rates were adjusted for patient age, sex and comorbidities. Risk-adjusted complication rates for each surgeon were then rated as "high," "medium" or "low" for each procedure performed.

The reporting and analysis of data sources such as Medicare claims is, as we all know, becoming increasingly common. While hospital-level data on a variety of measures have been publicly reported for some time, physician-specific data and analysis by outside organizations such as ProPublica, as well as by payers, is now also becoming common.

The concept of providing consumers with data about medical quality and safety is one that Cedars-Sinai has long supported and demonstrated, as evidenced by our early adoption many years ago of reporting our quality and safety metrics on our website. As you know, the institution and the medical staff, working together, also use data as a key element in continually improving our quality, with the result being that we are national leaders in quality and safety.

When data analysis and a "scorecard" are presented to the public by an outside organization such as ProPublica, we want to examine the methodology to determine its validity. We asked Cedars-Sinai's Resource and Outcomes Management Department to do so and would like to share the key findings with you.

While the analysis found that some elements of ProPublica's methodology appear sound, other elements are methodologically flawed or confusing for consumers.

Specifically:

  • ProPublica used only inpatient Medicare claims data, thus excluding from its analysis procedures performed on an outpatient basis, such as laparoscopic cholecystectomy and TURP. Such exclusions inaccurately categorize surgeons' complication rates by using incomplete case volumes. Moreover, the resulting complication rates are biased because the inpatient cases are typically performed on more risky or complex patients.
  • Wide confidence intervals surround the estimated complication rates calculated for surgeons. However, the Scorecard does not appropriately explain that surgeons with scores near the border between "medium" and "high" adjusted rates of complications should be viewed as belonging in a range that includes both classifications rather than being assigned to one of them. As a result, ProPublica inappropriately categorizes individual surgeons whose point estimates are close to the classification borders.
  • Surgeons who operated at multiple hospitals were listed under each hospital regardless of the number of procedures they performed at any single site. In other words, a surgeon who performed 99 procedures at Hospital A and one procedure at Hospital B would be listed by ProPublica as performing 100 procedures at each hospital. This double-counting makes it impossible to separate out complication rates by hospital and can be very confusing and misleading to consumers.

All of us recognize the inevitability and the benefit of transparency in healthcare. Although the ProPublica analysis was far from perfect, the goal of providing consumers with data to help them in selecting healthcare providers and hospitals is an important one. We are in the process of further enhancing how we present quality and safety data on the Cedars-Sinai website, as well as expanding the types of data we present. Our goal, as it has always been, is to do so in a way that is valid, useful and transparent to consumers.

The scorecard is available on the ProPublica website at projects.propublica.org/surgeons, sortable by hospital and by surgeon.

The Cedars-Sinai data are at projects.propublica.org/surgeons/hospitals/050625.