Already, CMS is working with NSQIP, and posts rates of adverse events in surgery, such as infections, blood clots, stroke, and pneumonia, for 79 hospitals that volunteered this information, on Hospital Compare.
Just collecting and feeding the data back to participating physicians and hospitals, however, "is not enough. These registries must be integrated into a quality improvement system or program, a lesson we learned early," says Ko.
"When we just sent back the data, it didn't really help anyone get better. We had to then develop the second arm of NSQIP, to help teams improve communication and culture, and integrate clinical guidelines for people who may believe in them or may not believe in them."
Ko says that without an improvement component to these registries, hospitals are left to figure it out for themselves. "That's difficult for them to do, and they don't do it efficiently."
Eventually, the system could evolve to a point where it is registry outcomes data, risk-adjusted and publicly reported, that determines major chunks of hospital and physician payment, similar to the way the process measures and patient experience scores now affect value-based purchasing algorithms for hospital reimbursement. "That's what the eventual goal is," Ko says. He concedes it may take years.
Some organizations, like the Society of Thoracic Surgeons, which began such a database 20 years ago and now boasts the largest in the country, are especially enthusiastic about using registries for federal reporting.
"We've been trying to get everyone's attention for years," says STS Secretary, Keith Naunheim, MD. "We thought we have a winning proposal here, and we think it ought to be generalized to specialties as a whole."
In heart surgery, the STS database now holds five million patient records. The registry captures rates of post surgical morbidity, such as stroke, renal failure, infections, prolonged time on a ventilator, and reoperation for any reason; in-hospital mortality; use of mammary artery in bypass procedures rather than a vein; and whether correct medications were given to patients at discharge.