Will Orthopedic Registries Improve Joint Surgery Outcomes?

Laird Harrison

Disclosures

February 04, 2016

In This Article

Interpreting the Data: Some Caveats

"The problem is that the data used in both approaches are very rudimentary," says Dr Bozic. As measures of quality, insurers are accounting for such factors as whether the physician is using an EHR, antibiotic prescriptions before and after a procedure, and patient surveys, he says. A few orthopedic surgeons have used such outcomes data on complications and readmissions to tweak how they perform hip and knee replacements to improve their outcomes, he says.

But data on complications and readmissions can be also deceptive. For example, Dr Lewallen points out that some doctors may work with patients who have more comorbidities (as is often the case with Medicare patients) or who are impoverished (as Medicaid patients may be). These patients are likely to have worse outcomes despite the skill of the surgeon.

And the results can be manipulated. "If you tell me tomorrow that my infection rate is going to be published, I know which patients to take care of and which patients not to take care of," Dr Lewallen says.

Dr Bozic doesn't think orthopedic surgeons should try to appeal ratings by payers. "I don't recommend to a provider to go chasing after a bunch of metrics that you or your patients may not feel are important," he says. "If you're comparing yourself to yourself, and you demonstrate that you've improved in a certain area, that's demonstrating that you are a value-oriented provider."

As the registry produces more nuanced data, physicians may decide to publicize their own rankings, says Dr Bozic. For example, the Society of Thoracic Surgeons is collaborating with the magazine Consumer Reports to rate physicians using data from the society's registry.[9]

The best defense against bad data, he hopes, will be better data.

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