There was one report from the Cleveland Clinic in Ohio that noted a higher than normal number of cardiac surgical patients came to their care from New York. These patients did have risk factors that placed them in a higher risk category than the Clinic's patients from Ohio and higher than patients who received surgery in New York.
But that increase was only from 61 to 96 patients between 1989 and 1993. "Other data suggest that out-referral of high-risk patients is not a serious problem," Romano says.
The Office of Statewide Health Planning and Development (OSHPD) in California, which has had mandatory public reporting of CABG mortality in place since 2003 and voluntary reporting before that, was concerned by sufficient numbers of reports of physician discrimination that it asked Romano to look at the issue.
"I've heard this from surgeons myself," says Joe Parker, OSHPD's director of healthcare outcomes. "Surgeons have expressed fears that their associates are choosing not to perform surgery on the sickest cases, in the belief that the risk modeling doesn't adequately adjust for that."
Romano's report was released this week, and he and his colleagues at the University of California at Davis, put much of that concern to rest.
Romano's report documented two significant findings.
The first is that overall relative CABG mortality—by hospital and by physician ? has consistently dropped since March, 2006 when the first of three hospital outcomes reports revealed mandatory mortality outcomes for 2003. Most noteworthy was a 27% drop from the average number of deaths counted during the first seven quarters and the average in the seven quarters thereafter. The latest report was issued on Monday and included hospital variation in CABG-related stroke.