Do Bad Report Cards Have Consequences? Impacts of Publicly Reported Provider Quality Information on the CABG Market in Pennsylvania

Study Questions:

What is the impact of coronary artery bypass grafting (CABG) report cards on a provider’s aggregate volume and volume by patient severity?


The investigators employed four different data sets in this study. The primary data are the Pennsylvania Inpatient Hospital Discharge Data collected by the Pennsylvania Health Care Cost Containment Council (PHC4). This data set contains clinical and utilization information at the patient level. Data elements include patients’ race/ethnicity, gender, age, zip code of residence, severity of illness, insurance type, the type of admission, the quarter of admission, the principal diagnosis code and secondary diagnoses codes, the principal procedure code and secondary procedure codes, discharge status, a four-digit unique facility identifier, and the license number of the operating physician. To test the effects of report cards on hospital-level volume, the authors use the number of CABG procedures performed in a hospital in a quarter as the dependent variable. They use regression equation using the number of CABG procedures performed by a surgeon in a quarter as the dependent variable to test the effects of report cards on surgeon-level volume.


The results suggest that being identified as a high-mortality hospital in the most recent report card is associated with a decline of nine CABG surgeries per quarter. This decline is not statistically significant. For all CABG cases, being identified as a high-mortality surgeon was associated with a decline of 4.76 CABG surgeries per quarter, and the coefficient was significant at the 1% level. Being identified as a low-mortality surgeon was associated with an increase of 4.63 CABG surgeries per quarter, though this coefficient was not precisely estimated.


The authors concluded that they found a reduction in volume of poor performing and unrated surgeons’ volume, but no effect on more highly rated surgeons or hospitals of any report card rating.


The study reports that public reporting led to a decrease in volume for unrated and poor performing surgeons, but interestingly, the volume of the high performing surgeons does not increase by an offsetting amount. Results of the patient choice modeling suggest that public reporting leads to avoidance of poor performing or unrated surgeons. Hospital report cards appear to have no significant impact on surgical volume at the hospital-level, and do not appear to change the population of patients who received CABG surgeries. Additional research is needed to assess the degree to which report cards affect total welfare, as well as examining the mechanisms by which the report cards lead to the sorting and avoidance behavior reported in this study.

Clinical Topics: Cardiac Surgery, Invasive Cardiovascular Angiography and Intervention

Keywords: Pennsylvania, Ethnic Groups, Hospital Mortality, Quality Indicators, Health Care, Information Services, Cardiovascular Diseases, Cost Control, Inpatients, Coronary Artery Bypass

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