A Healthy Blog

Massachusetts health care — wonky, with a healthy dose of reality

The Limits of Transparency

The Limits of Transparency

May 20, 2006

One other fascinating article in the May/June Health Affairs (subscription required) offers a sobering judgment to folks who think "transparency" is a silver bullet for cost and quality problems in our health system. Ashish Jha and Arnie Epstein from the Harvard School of Public Health took a look at the 15 year old New York Cardiac Surgery Reporting System -- "arguably the gold standard for the public reporting of hospital and physician quality."

Their conclusions:

1. "... users who picked a top-performing hospital or surgeon from the latest available report had approximately half the chance of dying as did those who picked a hospital or surgeon from the bottom quartile."

2. "Nevertheless, performance was not associated with a subsequent change in market share. ... We found no evidence that purchasers or patients are using these reports to drive market share to higher performing providers."


3. "Surgeons with the highest mortality rates were much more likely than other surgeons to retire or leave practice after the release of each report card."

Remember when Bill Clinton had his heart surgery several years ago? Apparently, he didn't look at the list either, picking both a lower performing hospital and surgeon.

Just like electronic health records, transparency is a good idea that makes sense. Let's not overestimate its likely benefit which will be far less than we might like.

One other thing -- public reporting of individual physician performance is coming. Docs will hate it. But the smoke from that train can now be seen on the horizon, and it's heading our way.