Big data is not big enough

Today ProPublica released its “Surgeon Scorecard” touting it as the best way to pick the right surgeon.

It took me less than a minute to discover some interesting omissions from the application.

For laparoscopic cholecystectomy, the only general surgery procedure listed, the app omits approximately one-third of the hospitals in my state including two where I have practiced.

It looks like the problem is that using Medicare fee-for-service data does not yield enough surgeons performing 20 or more cases in some categories such as laparoscopic cholecystectomy for the five years included in the database.

At one of the biggest hospitals in my state, apparently only one surgeon performed 20 laparoscopic cholecystectomies on fee-for-service Medicare patients in the five years studied; 23 other surgeons were listed as having performed fewer than 20 laparoscopic cholecystectomies on patients in the target population. I don’t see how patients who want to use that hospital for their gallbladder surgery will benefit from the Surgeon Scorecard.

In general, the complication rate for laparoscopic cholecystectomy is low, but I think I understand why ProPublica chose that procedure to review. They needed to select a procedure that was done frequently enough to yield a sufficient number of cases for analysis. Unfortunately, because of the limitations of the Medicare fee-for-service data and the low complication rate of the procedure, the Surgeon Scorecard is useless for anyone looking to compare general surgeons.

Similar problems with the scorecard may be in play for prostate surgery. Again, the procedure was chosen because of its high frequency, but in quickly looking through some searches in that area, I note that a number of urologists I know also did not perform 20 cases on fee-for-service Medicare patients.

Perhaps the next iteration of the scorecard will utilize a data set that contains enough patient and surgeon records to make a meaningful comparison.

Until then, general surgeons can relax. They will not have to explain away their complications but will simply have to explain why they aren’t listed in the Surgeon Scorecard.

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