dr sanghavi castigates former president clinton for "overlooking" mortality rates published for the surgeon and hospital where he had cardiac surgery.

this castigation, although well intentioned, is simply ignorant.

the simply truth is that the most challenging patients are frequently referred to the same 2 or 3 "top centers" and "top docs" in the nation. these are patients whose conditions may have progressed to the most risky stage, or they may have other complications such as extreme age, obeisity, liver failure, cancer etc.

in short, not all heart conditions are created equal.

if we're willing to concede that the graduation rate of well funded public schools in highly affluent areas (beverly hills 90210, princeton new jersey, stamford connecticut, etc) have less to do with the amount spent than the "condition" of the arriving "patients" (er, students, excuse me) then shouldn't we make a qualitative adjustment for who gets referred to hospitals too?

schools starting out with kids of wealthy, college educated parents will show superior graduation rates to the general average. hospitals starting out with the most challenging cardiac cases will show inferior survival rates to the general average.

i concede dr. sangria's basic premise - that the average consumer is likely to be overwhelmed at the notion of "shopping" for a good outcome while their mom or dad is dying of heart disease.

but we trust our local physician to be up to speed on the best available hospitals.

we do not trust some GS10 federal drone in washington DC

Then again, maybe it's you who doesn't know shit:

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short version: the "harder cases" myth is just that.

As an aside to you personally, it is not actually essential to the continued existence of the republic that you post a comment on each and every article posted to Slate, whether or not you have anything intelligent or interesting to say (which, by the way, rarely seems to be the case).

Do you have absolutely nothing else to do?

Considering that the referring doctor typically gets a cut from the specialist, I'll put my trust in the GS10 drone to give me unbiased info.

without BA's penetrating insights (a.k.a. statistical arguments she pulls out of her ass, hoping that no one reads them carefully enough to mount a challenge).

Mangrovensumpf:

Considering that the referring doctor typically gets a cut from the specialist, I'll put my trust in the GS10 drone to give me unbiased info.

I haven't seen any referring docs getting a cut from the specialist. In fact, if they did, they'd end up in prison for violating Stark laws. Care to tell what country or planet you're posting from?

That would be planet earth. Also, my understanding is the Stark laws only apply to referrals for Medicare and Medicaid patients.

I'm kind of curious too. I'm a specialist. Patients are sent to me for surgery. I don't give the referring physician a cut of the fee. I send them a nice letter, but no cash. I don't know anyone that has that sort of relationship. Source, please?

Source: Personal observations.

Source: Personal Observations = Source: Thin Air

Dear Ms. Aureole:

Like you, I would also trust the advice of a cardiologist more than a mortality rate in choosing a hospital and surgeon. Here are three reasons:

As "entdoc" points out in another post (see "Is this relevant") re Dr. Sanghavi's article, other factors, relating to quality of life may be more important, since CABG mortality rates are generally low.

Dr. Sangavi cites a "Health Affairs" article* as showing that your referral bias hypothesis is wrong. On reading the article, I do see that mortality rates are adjusted for risk. However, one citation in the article's reference list points out that the quality of risk adjustments may not be good**. I don't see good data on how well CABG mortality rate risk adjustments work. So, while the ratings may be useful to a cardiologist, we don't know how useful at all.

Third, an interesting (and honest) aside in the Health Affairs article was that "Two low-mortality surgeons reported leaving (practice) because pressure to reject high-risk patients and focus on documentation made practicing surgery less enjoyable." If surgeons' mortality ratings were truly adjusted for the risks, they'd not be pressured to reject such patients. (Although they might be pressured anyway because no intervention, or less invasive cath procedures, is preferred in the riskiest cases.)

This is analogous to schools who improve their standard scores by cherry-picking their students. In California, the State is beginning to track student's scores over their k12 career, so that, theoretically, you could adjust a school's score for the grades of the incoming students. It's a work in progress, however. Bureacratic drones do have something to contribute, if you give them a chance.

I would like to see more and better data on outcomes, for different risks, techniques, etc. However, high-stakes scores which increase paperwork and force defensive medicine are a temptation to avoid.

* "The Predictive Accuracy Of The New York State Coronary Artery Bypass Surgery Report-Card System"

** "The risks of risk-adjustment"