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Thomas R McLean
American Heart Hospital Journal Volume 8 No.1

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Purpose:
Reporting states (RS) publish hospital-specific report cards for coronary artery bypass graft (CABG) (MS-DRG 235 and 236) surgery. When RS are compared with non-reporting states (NRS), do report cards influence the volume of CABG surgery performed?

Methods:
Using publicly available Medicare data (hospitalcompare.hhs.gov) for CABG-only procedures, the volume of CABG procedures performed in RS (CA, MA, NJ, NYS, and PA) was compared with the volume of these procedures performed in NRS. Results: In the continental US during the financial year 2008 a total of 41,589 Medicare patients underwent a CABG (33,318 CABGs in NRS versus 8,272 CABGs in RS). A similar percentage of states in each group regulated their markets with certificate-ofneed statutes (30% NRS versus 40% RS). Per million capita (pmc), the number of CABG providers in the two groups was similar with respect to hospitals (4.1±1.6 hospitals pmc in NRS versus 2.9±1.2 hospitals pmc in RS); cardiac surgeons (2.4±1.5 surgeons pmc in NRS versus 5.1±2.9 surgeons pmc in RS); and interventional cardiologists (ICs) (18.3±5.5 ICs pmc in NRS versus 21.2±5.0 ICs pmc in RS). However, pmc, NRS performed significantly more CABG procedures (152.0±62.6 CABGs pmc in NRS versus 113.8±31.6 CABG pmc in RS; p=0.05).

Conclusions:
States that publish hospital-specific report cards perform significantly fewer CABGs per capita than states without report cards. As the government’s national hospital-specific report card becomes more popular, the per capita performance of CABGs in NRS could fall to the level found in RS due to the reputational incentives created by the use of hospital-specific report cards.

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The modern era of government-sponsored providerspecific report cards began two decades ago with the settlement of a freedom of information lawsuit. After New York State (NYS) began collecting coronary artery bypass grafting (CABG) outcomes data, Newsday sued the State to compel disclosure of provider-specific mortality statistics.¹ After a compromise on disclosures settled this lawsuit, NYS enacted a reporting statute that defined precisely which provider-specific (hospital and surgeon) data the State would henceforth disclose publicly. Subsequently, four other states (California [CA], Massachusetts [MA], New Jersey [NJ], and Pennsylvania [PA]) have enacted similar reporting statutes for cardiac services.

Less appreciated is the fact that government-sponsored provider-specific report cards are a key component of value-based purchasing (VBP).² In 2002, the Institute of Medicine (IOM) argued that governmental report cards could favorably influence medical inflation by the creation of reputational incentives that encouraged healthcare providers to become more risk-averse,³ and improve market transparency to drive competition.⁴ The Center for Medicare and Medicaid Services (CMS) responded three years later by adopting a system of VBP (composed of payfor- performance [P4P] bonuses and the creation of Hospital Compare, an online hospital-specific report card) for determining Medicare reimbursement.⁵

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