Risk Aversion and Public Reporting. Part 2: Mitigation Strategies.
Publication/Presentation Date
12-1-2017
Abstract
Part 1 of this review summarizes the consequences of risk aversion and the observational studies and surveys relevant to this phenomenon, almost all of which are derived from cardiac surgery and interventional cardiology. In Part 2, we describe the root cause of risk aversion-the belief by providers that current risk adjustment is inadequate to account for the severity of their highest-risk patients, thereby prejudicing their publicly reported performance scores. Evidence supporting the robustness of current risk adjustment is presented, as well as nine potential strategies to further mitigate risk aversion: optimization of data source, risk models, and performance measures; exclusion of high-risk patients; exclusion of non-procedure-related end points; separate reporting of high-risk patients; reporting by condition or diagnosis rather than by procedures; reporting at the hospital or program level rather than the physician level; collaborative, cross-disciplinary decision making; active surveillance for risk aversion; and improved stakeholder education. Of these, the first is most desirable, widely applicable, and resistant to gaming.
Volume
104
Issue
6
First Page
2102
Last Page
2110
ISSN
1552-6259
Published In/Presented At
Shahian, D. M., Jacobs, J. P., Badhwar, V., D'Agostino, R. S., Bavaria, J. E., & Prager, R. L. (2017). Risk Aversion and Public Reporting. Part 2: Mitigation Strategies. The Annals of thoracic surgery, 104(6), 2102–2110. https://doi.org/10.1016/j.athoracsur.2017.06.076
Disciplines
Medicine and Health Sciences
PubMedID
29100640
Department(s)
Department of Surgery
Document Type
Article