Doctor Bias Against Fat Patients; Best-Liked Insurers; More

Neil Chesanow


September 06, 2016

In This Article

Why a Hospital Volume Pledge? Practice Makes Perfect

Three prominent hospital systems have taken what's become known as "the volume pledge."[6] Johns Hopkins, Dartmouth Hitchcock, and the University of Michigan will now require their surgeons and 20 affiliated hospitals to meet minimum annual thresholds for 10 high-risk procedures, according to a recent article in Kaiser Health News. The pledge requires that each year, surgeons must perform a minimum of five pancreatic cancer surgeries in hospitals where 20 such operations are done annually, as well as 25 knee or hip replacements (with a total of at least 50 per hospital).

The pledge emanated from a long-standing debate that dates back to 1979, when a study by Stanford University found that patients had better surgical outcomes at hospitals where those procedures were performed more frequently vs where they were performed less frequently.[6]

Succeeding studies have consistently shown that the risk for complications was much greater for surgeons who performed one thyroid removal a year, compared with those who did 25 procedures or more.[6]

"We decided to use volume as a pilot case, an initial foray into setting quality and safety standards," John Birkmeyer, chief academic officer at Dartmouth, told Kaiser Health News.[6] Birkmeyer, with Peter Pronovost, director of Hopkins' Armstrong Institute for Patient Safety and Quality, devised the pledge.

Not everyone thinks that volume is a good litmus test of quality outcomes. Some observers felt that more is not necessarily better, and that using numbers alone could unfairly penalize low-volume hospitals with good outcomes.[6] Conversely, it's argued, there are high-volume hospitals with poor outcomes.

Credentialed surgeons with good records have understandably balked, which may be why only three systems have signed the pledge thus far.[6] The article notes, however, that more than a dozen others have expressed interest.