Public Reporting of Cardiac Data: Pros, Cons, and Lessons for the Future

  • Edward L. HannanEmail author


Beginning with the Health Care Administration mortality reports in the 1980s, public reporting of health outcomes has been controversial, and its impact has been widely debated. The first public release of provider performance using clinical registry data occurred in 1989 when the New York State Department of Health released hospital risk-adjusted mortality rates for coronary artery bypass graft (CABG) surgery. Shortly afterward Pennsylvania released similar data, and currently a few other states, the Centers for Medicare and Medicaid Services, and several other organizations and professional societies release provider outcomes to the public for a variety of medical conditions and procedures. This communication summarizes and critiques some important literature that assesses the impact of these public releases with regard to quality improvement activities resulting from public reporting, improvement in health outcomes, surgeon reactions to outlier status, avoidance of high-risk patients, ability to predict future performance, and market share. Also, the communication closes with a summary of the state of public reporting and prospects for the future.


Public reporting CABG surgery Percutaneous coronary intervention New York State cardiac registries Risk-adjusted mortality 


  1. 1.
    Krakauer H, Bailey C, Skellan KJ, et al. Evaluation of the HCFA model for the analysis of mortality following hospitalization. Health Serv Res. 1992;27(3):317–35.PubMedCentralPubMedGoogle Scholar
  2. 2.
    Hannan EL, Kilburn Jr H, Lindsey ML, Lewis R. Clinical versus administrative databases for CABG surgery. Med Care. 1992;30(10):892–907.PubMedCrossRefGoogle Scholar
  3. 3.
    Hannan EL, Racz MJ, Jollis JG, Peterson ED. Using Medicare claims data to assess provider quality for CABG surgery: does it work well enough? Health Serv Res. 1997;31(6):559–678.Google Scholar
  4. 4.
    Hannan EL, Kilburn Jr H, O’Donnell JF, Lukacik G, Shields EP. Adult open heart surgery in New York State: an analysis of risk factors and hospital mortality rates. JAMA. 1990;264(21):2768–74.PubMedCrossRefGoogle Scholar
  5. 5.
    Lawrence KA. Heart surgery death rates decline in New York. New York Times, 5 Dec 1990.Google Scholar
  6. 6.
    Coronary artery bypass surgery in New York State: 1990–1992. New York State Department of Health, Dec 1993.Google Scholar
  7. 7.
    Cardiac surgery in Pennsylvania 2007–2008. Pennsylvania Health Care Cost Containment Council, Sept 2010.Google Scholar
  8. 8.
    The California report on coronary artery bypass graft surgery: 2007 hospital data. California CABG Outcomes Reporting Program. California Office of Statewide Health Planning and Development; June 2011.Google Scholar
  9. 9.
    Adult coronary artery bypass graft surgery in the Commonwealth of Massachusetts: fiscal year 2009 report. Harvard Medical School; Jan 2011.Google Scholar
  10. 10.
    Cardiac surgery in New Jersey: 2008. Health Care Quality Assessment, Office of Policy and Strategic Planning, New Jersey Department of Health and Senior Services; June 2011.Google Scholar
  11. 11.
    Dziuban Jr SW, McIlduff JB, Miller SJ, Dal Col RH. How a New York cardiac surgery program uses outcomes data. Ann Thorac Surg. 1994;58(6):1871–6.PubMedCrossRefGoogle Scholar
  12. 12.
    Chassin MR. Achieving and sustaining improved quality: lessons from New York State and cardiac surgery. Health Aff. 2002;21(4):40–51.CrossRefGoogle Scholar
  13. 13.
    Coronary artery bypass surgery in New York State: 1996–1998. New York State Department of Health; Jan 2001.Google Scholar
  14. 14.
    Hannan EL, Kilburn Jr H, Racz M, Shields E, Chassin MR. Improving the outcomes of coronary artery bypass surgery in New York State. JAMA. 1994;271(10):761–6.PubMedCrossRefGoogle Scholar
  15. 15.
    Ghali WA, Ash AS, Hail RE, Moskowitz MA. Statewide quality improvement initiatives and mortality after cardiac surgery. JAMA. 1997;277:379–82.PubMedCrossRefGoogle Scholar
  16. 16.
    Peterson ED, DeLong ER, Jollis JG, Muhlbaier LH, Mark DB. The effects of New York’s bypass surgery provider profiling on access to care and patient outcomes in the elderly. J Am Coll Cardiol. 1998;32(4):993–9.PubMedCrossRefGoogle Scholar
  17. 17.
    Hannan EL, Sarrazin MSV, Doran DR, Rosenthal GE. Provider profiling and quality improvement efforts in coronary artery bypass graft surgery. Med Care. 2003;41:1164–72.PubMedCrossRefGoogle Scholar
  18. 18.
    Burack JH, Impellizzeri P, Homel P, Cunningham Jr JN. Public reporting of surgical mortality: a survey of New York state cardiothoracic surgeons. Ann Thorac Surg. 1999;68(4):1195–202.PubMedCrossRefGoogle Scholar
  19. 19.
    Narins CR, Dozier AM, Ling FS, Zareba W. The influence of public reporting of outcome data on medical decision making by physicians. Arch Intern Med. 2005;165(1):83–7.PubMedCrossRefGoogle Scholar
  20. 20.
    Schneider EC, Epstein AM. Use of public performance reports: a survey of patients undergoing cardiac surgery. JAMA. 1998;279:1638–42.PubMedCrossRefGoogle Scholar
  21. 21.
    Omoigui NA, Miller DP, Brown KJ, et al. Outmigration for coronary artery bypass surgery in an era of public dissemination. Circulation. 1996;93:27–33.PubMedCrossRefGoogle Scholar
  22. 22.
    Moscucci M, Eagle KA, Share D, et al. Public reporting and case selection for percutaneous coronary interventions: an analysis from two large multicenter percutaneous coronary intervention databases. J Am Coll Cardiol. 2005;45(11):1759–65.PubMedCrossRefGoogle Scholar
  23. 23.
    Dranove D, Kessler D, McClellan M, Satterthwaite M. Is more information better? The effects of “report cards” on health care providers. J Polit Econ. 2005;111(3):555–88.CrossRefGoogle Scholar
  24. 24.
    Epstein AJ. Do cardiac surgery report cards reduce mortality? Assessing the evidence. Med Care Res Rev. 2006;63:403–26.PubMedCrossRefGoogle Scholar
  25. 25.
    Shahian DJ, Edwards FH, Jacobs JP, et al. Public reporting of cardiac surgery performance: part I-history, rationale, consequences. Ann Thorac Surg. 2011;92:S2–11.PubMedCrossRefGoogle Scholar
  26. 26.
    Resnic FS, Welt FGP. The public health hazards of risk avoidance associated with public reporting of risk-adjusted outcomes in coronary intervention. J Am Coll Cardiol. 2009;53:825–30.PubMedCentralPubMedCrossRefGoogle Scholar
  27. 27.
    Hannan EL, O’Donnell JF, Kilburn Jr H, Bernard H, Yazici A. Investigation of the relationship between volume and mortality for surgical procedures performed in New York State hospitals. JAMA. 1989;262:503–10.PubMedCrossRefGoogle Scholar
  28. 28.
    Hannan EL, Siu AL, Kumar D, Kilburn Jr H, Chassin MR. The decline in coronary artery bypass graft surgery mortality in New York State: the role of surgeon volume. JAMA. 1995;272:209–13.CrossRefGoogle Scholar
  29. 29.
    Jha A, Epstein AM. The predictive accuracy of the New York State Coronary Artery Bypass Surgery Report-Card System. Health Aff. 2006;25(3):844–55.CrossRefGoogle Scholar
  30. 30.
    Glance LG, Dick AW, Mukamel DB, Osler TM. How well do hospital mortality rates reported in the New York State CABG report card predict subsequent hospital performance? Med Care. 2010;48(5):466–71.PubMedCrossRefGoogle Scholar
  31. 31.
    Hannan EL, Kumar D, Racz M, Siu AL, Chassin MR. New York State’s cardiac surgery reporting system: four years later. Ann Thorac Surg. 2004;58(6):1852–7.CrossRefGoogle Scholar
  32. 32.
    Mukamel DB, Mushlin AI. Quality of care information makes a difference: an analysis of market share and price changes after publication of the New York Cardiac Surgery Mortality Reports. Med Care. 1998;36(7):945–54.PubMedCrossRefGoogle Scholar
  33. 33.
    Romano PS, Zhou H. Do well-publicized risk-adjusted outcomes reports affect hospital volume? Med Care. 2004;42(4):367–77.PubMedCrossRefGoogle Scholar
  34. 34.
    Hannan EL, Stone CA, Biddle TB, DeBuono BA. Public release of cardiac surgery outcomes data in New York: what do New York State cardiologists think of it? Am Heart J. 1997;134:1120–8.PubMedCrossRefGoogle Scholar
  35. 35.
    Romano PS, Rainwater JA, Antonius D. Grading the graders: how hospitals in New York and California perceive and interpret their report cards. Med Care. 1999;35(3):295–305.CrossRefGoogle Scholar
  36. 36.
    Mukamel DB, Mushlin AI, Weimer D, Zwanziger J, Parker T, Indridason I. Do quality report cards play a role in HMO’s contracting practices? Evidence from New York State. Health Serv Res. 2000;35(1, Part II):319–32.PubMedCentralPubMedGoogle Scholar
  37. 37.
    Mukamel BB, Weimer DL, Zwanziger J, Mushlin AI. Quality of cardiac surgeons and managed care contracting practices. Health Serv Res. 2002;37(5):1129–44.PubMedCentralPubMedCrossRefGoogle Scholar
  38. 38.
    Hannan EL. Ensuring accuracy and completeness of data used for outcomes assessment. Ann Thorac Surg. 2012;93:1172–3.PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag London 2015

Authors and Affiliations

  1. 1.Department of Health Policy, Management and BehaviorUniversity at Albany School of Public HealthRensselaerUSA

Personalised recommendations