Feasibility of Report Cards for Measuring Anesthesiologist Quality for Cardiac Surgery

Anesth Analg. 2016 May;122(5):1603-13. doi: 10.1213/ANE.0000000000001252.

Abstract

Background: In creating the Merit-Based Incentive Payment System, Congress has mandated pay-for-performance (P4P) for all physicians, including anesthesiologists. There are currently no National Quality Forum-endorsed risk-adjusted outcome metrics for anesthesiologists to use as the basis for P4P.

Methods: Using clinical data from the New York State Cardiac Surgery Reporting System, we conducted a retrospective observational study of 55,436 patients undergoing cardiac surgery between 2009 and 2012. Hierarchical logistic regression modeling was used to examine the variation in in-hospital mortality or major complications (Q-wave myocardial infarction, renal failure, stroke, and respiratory failure) among anesthesiologists, controlling for patient demographics, severity of disease, comorbidities, and hospital quality.

Results: Although the variation in performance among anesthesiologists was statistically significant (P = 0.025), none of the anesthesiologists in the sample was classified as a high- or low-performance outliers. The contribution of anesthesiologists to outcomes represented 0.51% of the overall variability in patient outcomes (intraclass correlation coefficient [ICC] = 0.0051; 95% confidence interval [CI], 0.002-0.014), whereas the contribution of hospitals to patient outcomes was 2.90% (ICC = 0.029; 95% CI, 0.017-0.050). The anesthesiologist median odds ratio (MOR) was 1.13 (95% CI, 1.08-1.24), suggesting that the variation between anesthesiologist was modest, whereas the hospital MOR was 1.35 (95% CI, 1.25-1.48). In a separate analysis, the contribution of surgeons to overall outcomes represented 1.76% of the overall variability in patient outcomes (ICC = 0.018, 95% CI, 0.010-0.031), and the surgeon MOR was 1.26 (95% CI, 1.19-1.37). Twelve of the surgeons were identified as performance outliers.

Conclusions: The impact of anesthesiologists on the total variability in cardiac surgical outcomes was probably about one-fourth as large as the surgeons' contribution. None of the anesthesiologists caring for cardiac surgical patients in New York State over a 3+ year period were identified as performance outliers. The use of a performance metric based on death or major complications for P4P may not be feasible for cardiac anesthesiologists.

Publication types

  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Anesthesia / adverse effects
  • Anesthesia / economics
  • Anesthesia / mortality
  • Anesthesia / standards*
  • Clinical Competence / standards
  • Comorbidity
  • Coronary Artery Bypass / adverse effects
  • Coronary Artery Bypass / economics
  • Coronary Artery Bypass / mortality
  • Coronary Artery Bypass / standards*
  • Data Collection / economics
  • Data Collection / standards*
  • Databases, Factual
  • Delivery of Health Care / economics
  • Delivery of Health Care / standards*
  • Feasibility Studies
  • Female
  • Heart Valve Prosthesis Implantation / adverse effects
  • Heart Valve Prosthesis Implantation / economics
  • Heart Valve Prosthesis Implantation / mortality
  • Heart Valve Prosthesis Implantation / standards*
  • Hospital Mortality
  • Humans
  • Logistic Models
  • Male
  • Middle Aged
  • New York
  • Odds Ratio
  • Outliers, DRG
  • Postoperative Complications / mortality
  • Practice Patterns, Physicians' / standards
  • Process Assessment, Health Care / economics
  • Process Assessment, Health Care / standards*
  • Quality Indicators, Health Care / economics
  • Quality Indicators, Health Care / standards*
  • Reimbursement, Incentive / standards
  • Retrospective Studies
  • Risk Assessment
  • Risk Factors
  • Severity of Illness Index
  • Time Factors
  • Treatment Outcome