"Making public access a condition of taxpayer funding" of national outcome registries "is one simple reform which would allow the free market to identify and eliminate waste in healthcare," he said in his April testimony before the House Oversight and Government Reform Subcommittee on Energy Policy, Healthcare, and Entitlements. Another strategy is to provide more federal funding of those registries to ensure independence and transparency.
"The procedure for reporting measures [in these registries] needs some oversight," he says.
"We have a Sarbanes-Oxley law for business, where a CEO can be accountable for misstating the company's earnings to the public; what we need is a Sarbanes-Oxley for medicine, so reporting can be standardized and there can be accountability. Does the public have a right to know about the quality of their hospitals? Many of us have said, 'Yes.' "
One area of particular interest is appropriateness of care and overtreatment, especially in surgery. Makary serves as director of quality and safety for the Johns Hopkins Hospital Department of Surgery, and leads his own research team exploring the widespread problem of overtreatment, which he called "the next big frontier in quality."
"About $750 billion, or one-third of healthcare expenditures may be going to things that don't improve health outcomes at all, and they're attributed to fraud, opportunities for overtreatment, and unnecessary tests," he says. "We focus on things that are easy to measure, like patient satisfaction. But you can have a totally satisfied patient who had unnecessary surgery. Patient satisfaction is an important measure, and it should be publicly reported, but we shouldn't be fooled into thinking it's a comprehensive measure."