THE NEED FOR ACCURATE RISK-ADJUSTED MEASURES OF OUTCOME IN SURGERY - LESSONS LEARNED THROUGH CORONARY-ARTERY BYPASS

Objective The authors review the Pennsylvania Health Care Cost Contain ment Council reports on coronary artery surgery and compare this repor ting structure to others, including the Society for Thoracic Surgeons database, currently used by their own program. The authors review the growing likelihood of a need for outcome measures for all of the surgi cal subspecialties. Summary and Background Data Pressure from consumer s and insurers will require surgical specialties to be graded by objec tive outcome measures. Practitioners must be prepared and become invol ved in the process. Methods The authors reviewed the data, which grade s all of Pennsylvania's hospitals at which coronary artery bypass is p erformed. Apparently, the major risk factors commonly employed in most other risk adjustment schemes for cardiac surgery have been deleted, and the practitioners might be judged unfairly. The Pennsylvania syste m appears to be insurance driven to reward low-cost providers who oper ate on patients with the lowest risk. Results Review of data suggests that the Pennsylvania Health Care Cost Containment Council's annual pu blication, A Consumer's Guide for Coronary Artery Bypass Surgery, misr epresents fair risk adjustment in favor of lower-risk patients, thereb y encouraging better score cards for those institutions with patients who are less ill. Data regarding charges for the procedure have not be en risk adjusted or related to a regional economic index. Conclusions Surgeons must prepare to better understand relevant models that evalua te outcome. Cardiothoracic surgery is one of the first specialties to feel the pressures of mandated evaluations, and the lessons learned in Pennsylvania should be applicable to other states and their practitio ners.