5. Public Reporting as a Quality Improvement Strategy

• A survey sent to all cardiologists (36 percent response rate) asked whether they discussed
the NYS CSRS data on CABG with patients when referring them to surgeon (78 percent
replied “no”). Responses to items about accuracy and format were generally critical (e.g.,
33 percent replied that the report was not at all accurate, 37 percent said the report was
very misleading, while 46 percent said “somewhat” misleading) (1997). 139
• In response to a survey fielded in 1996, 88 percent of 1,444 interventional cardiologists
(28 percent response rate) said they would be somewhat or much less likely to treat highrisk
patients if physician-level outcomes were publically reported (1999). 168
• All active cardiac surgeons were surveyed in New York State and 67 percent reported
refusing treatment to at least one high-risk patient in the previous year. They also
reported that their practice (30 percent) and the practice of their peers (37 percent)
changed due to public reporting (1999). 169
• Narins et al. sent a mail survey to all interventional cardiologists included in a New York
State public report about PCIs. Physician responses indicated that public reporting is
perceived as influencing practice so that access to care is restricted: 83 percent agreed
that patients who might benefit were not getting the procedure and 79 percent agreed or
strongly agreed that knowing their data will be public had influenced their decisions
about specific patients (2005). 170
• A survey explored the views of rank-and-file physicians about public reporting and
financial incentives linked to quality measures. 171 Five hundred fifty-six of 1,168
randomly selected general internists from the AMA master file practicing in one of 12
selected metro areas completed questionnaires (48 percent response rate). Thirty-two
percent were in favor of releasing individual physician data and forty-two percent were in
favor of releasing medical group data. Their reservations seemed to link to views that
quality measures are not adequately adjusted for a) patients’ medical conditions (36
percent strongly agree, 52 percent somewhat agree) nor for b) patients’ socioeconomic
status (38 percent strongly agree, 47 percent somewhat agree). Respondents also thought
that measuring quality (to be used for public reports or financial incentives) will divert
attention from important care that is not measured (22 percent strongly agree, 39 percent
somewhat agree) and may lead physicians to avoid high-risk patients (40 percent strongly
agree, 42 percent somewhat agree) (2007).
• The one provider survey with a different focus was a mail survey of 236 (29 percent
response rate) Taiwanese health care providers that collected data on doctors’ preferences
for public report content, format, and frequency. Respondents preferred reporting that
was updated yearly, was risk adjusted, provided detailed scores, and labeled charts so
ranges of value could be identified as good or bad (2010). 164
• A survey of cardiac surgeons in the United Kingdom was conducted in 2005 and repeated
in 2009 in order to measure changes in attitudes toward public reporting of performance
tables. 167 One hundred and nine out of 206 surgeons sent surveys responded (52.9
percent). The results documented that while many respondents still do not welcome
public reporting of individual surgeon results (68.8 percent in 2005 and 43.3 percent in
2009), an increasing number believe the reporting improved standards (42.2 percent in
2005 and 64.9 percent in 2009, p