The problem, Naunheim says, is that the STS database only captures what happens inside the hospital. "What's also exceedingly important is what happens when (the patient) steps outside the hospital," he says.
Did the patient get readmitted? Is the patient off angina medications or did they have to go back on? Did they go to rehab? How long did they live — three or five years after surgery? And when you compare a stent patient with a bypass patient, how much did it cost?
"All that information we could only get if we could link our databases with the CMS administrative database," says Naunheim, who also is Chief of Cardiothoracic Surgery Saint Louis University Medical Center.
Ko says several big questions must be answered before CMS comes to a decision. Should CMS receive this data from these registries, and interpret it for the public, or should it leave that up to professional societies, like the ACS or STS, to run the numbers and feed it back to the providers.
"Or do we give them all the data, and they do the analysis?" Ko says.
And at what point will reporting on Hospital Compare begin, so the public and payers can know what now is only known to these societies and their participating providers?
In its letter to CMS, ACS Executive Director David Hoyt, MD, wrote that its four other programs, the Surgeon Specific Registry, its Metabolic Bariatric Surgery Accreditation program, and its National Cancer Data Base, and its Trauma Quality Improvement Program, all keep statistics on millions of cases, including patient outcomes.
The American Hospital Association's Ashley Thompson, Vice President and Deputy Director, wrote that CMS "should develop criteria ensuring registries have the technical capabilities needed to report quality data. Moreover, those registries must be transparent in their methodologies and able to provide timely feedback to providers on performance."