Two decades ago, the state required mortality outcomes reporting for coronary artery bypass graft (CABG) procedures by name, he says. When the numbers were published, he says he interviewed CEOs, and heard their stories of how they came into cardiac intensive care units to ask the nurses and doctors what was going on.
"They told the CEOs: we need a dedicated cardiac anesthesiologist, we need cardiac nurse practitioners, we need to get a better cardiac ICU. And in the course of the pressure of public reporting, (these CEOs) gave them what they needed... (in some cases) resulting in a dramatic 40% reduction in (CABG) mortality almost overnight."
Additionally, the CEO was able to "look at individual physician profiles and found out there was a guy who should have retired, who had a mortality rate so high he was bringing the whole average up."
The same should happen now across the country with surgical site infection rates, he says.
But Makary's recent paper points to other problems within the emerging state reporting system, and that is the enormous variation that exists from state to state that prevents fair comparisons among hospitals.
In addition to the fact that only eight states publicly report on infections occurring in at least one type of surgery, which procedures they choose to report on varies widely. For example, only South Carolina requires reporting on spinal fusion procedures, only Ohio mandates reports on C-sections, and only Missouri requires reports on breast surgery infections. And colon surgery, which has the highest rates of surgical site infections, was only reported by two states.
"The motivation to monitor and report certain procedures over others is unclear, and further highlights the variability between states," Makary and his co-authors wrote.