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Power Outage—Inadequate Surgeon Performance Measures Leave Patients in the Dark

Todd A. Jaffe, BBA1; Steven J. Hasday, BS1; Justin B. Dimick, MD, MPH2
[+] Author Affiliations
1University of Michigan Medical School, Ann Arbor
2Department of Surgery, University of Michigan Medical School, Ann Arbor
JAMA Surg. 2016;151(7):599-600. doi:10.1001/jamasurg.2015.5459.
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This Viewpoint explores the limits of the methods used in the Surgeon Scorecard, uses laparoscopic cholecystectomy data to illustrate the inherent statistical challenges the Scorecard faces, and suggests improvements for future surgical performance assessments.

ProPublica created their Surgeon Scorecard, released in July, in an attempt to shed light on surgeons’ outcomes and help patients choose high-quality surgeons for 8 common, elective procedures.1 Whether the Scorecard has achieved these goals has become the subject of controversy. Its release has served as a lightning-rod for criticism, with many questioning the validity and reliability of its results. Supporters of the Scorecard argue that the ratings are an imperfect but valuable first step toward devising a transparent, accurate surgeon performance measure. Critics have questioned the use of a data set that lacks key performance indicators and potentially flawed statistical analysis, ultimately claiming that the Scorecard’s imperfections render it useless.2 Regardless of their position in the debate, most agree that the publishing of ProPublica’s Scorecard presents a golden opportunity to consider the feasibility and optimal design of surgeon-specific performance reports.

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The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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