These few paragraphs, to those who know they exist, are exposing some tension inside the societies that run these registries. "Remember," Wachter says, "these are member organizations. And they're therefore trying to support their members in providing good care. But I think some have a hard time sometimes making hard decisions that might make some of their members unhappy."
The outcomes being measured, for example, "may have some wiggle room or bias. Or the data aren't audited."
To the degree that registries are seen as the answer to physician accountability that leads to bonus payments, as appears to be the case, "then you have a formula that may not add up," he says.
"We have to rethink this," Wachter says, "whether the societies are the right organizations to run these registries, and if they are—and they very well might be because they have buy-in from their members—we probably need to make sure the measures are unambiguously good measures, that their definitions are unambiguous, and that there's a believable audit strategy… because there are some conflicts that are baked into this formula."
Some say there also should be some mechanism to assure these registries produce meaningful quality improvement lessons, perhaps by sharing tips from peers with better results.
This week's study by Harvard researchers Sunil Eappen, MD, and Atul Gawande, MD, in the Journal of the American Medical Associationillustrates why a careful tracking, with details of adverse events and complications, is something these registries must prove they can do well.