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FEATURE

BACK TO

SCHOOL

…here we go again

By Robert G. Johnson, MD

Checked your report card lately? Hmmm… Didn’t even know judged fell into three categories: prolonged lengths of stay / read-
you had a report card? Double Hmmm… Mom and Dad are look- missions / deaths. Readmissions and deaths extended out to 90 days
ing at it. So is big brother. So are your patients. from the first admission.
Just got a letter from Baptist Health System Ongoing Professional Double wow!!! Where does one start the repeal and replace of this mess?
Practice Evaluation (OPPE): “The ongoing data regarding your Here’s a scary example. A group of anesthesia/pain management
practice and performances have been evaluated based on the ap- doctors recently faced a five figure fine from Medicare because of
proved, specialty specific OPPE metrics. These findings will support the ‘death’ criterion. Cancer patients (in terminal phases and with a
the credentialing and privileging recommendations that are made lot of pain) underwent pain management (injections, pain pumps,
by the Credentials Committee, Medical Executive Board and Board celiac blocks) procedures and these doctors were held responsible
of Trustees.” There follows a table with three headings: % Compli- for their deaths (which was due to their cancer, not the procedure).
cations of Care / Mortalitity Observed/Expected Ratio / Packed Oncologists must flunk this exam miserably. Which brings up an-
Cell Transfusion Rate (what does this have to do with competence?). other point: Are both pain doctor and oncologist penalized for the
Wow!!! Since there’s no actual exam I took, it seems that my mark same death? (double-dipping). What about consultants on the case?
is based on classroom participation and weekly quizzes. My secre- Do they share the blame?
tary spent two hours on the computer and telephone trying to log Here’s the point: it appears that this country’s finest doctors are
onto crimsonservices.com to obtain and review the data used for being held responsible for the natural history of a disease that, not
my Baptist ‘report card’. I was eventually told that I was not ‘regis- only did they not invent, but have dedicated their careers to treating
tered’ and that my data was unavailable to me. Despite my best ef- (I’m not making this stuff up).
forts to register, at the time of this writing, I have no idea how Another example: Hip fractures in the elderly are associated with
OPPE works. Turns out I passed their performance standards, but a significant mortality rate (50%) going out 90 days. This is due to
who knows about next year or the next. the complications inherent in the injury in a compromised patient—
Our next contestant goes by the name SURGEONRATING.org not the treating physician’s incompetence. Orthopedists will flunk
by Consumers Checkbook. This is a website available to the public. this quiz just because they take ER call.
Its ‘Overview’ states: “This is the first-ever website to report na- Back to SURGEONRATING.org. Read these inane statements
tionwide on such a range of procedures (12 major types of surgery), on their website: “you (the patient) might prefer a more recent grad-
estimates of specific surgery results in terms of patient deaths, com- uate who may be more up to date on recent developments…” Ha!
plications (which we identify based on prolonged lengths of stays), These buffoons don’t get it. Surgery is an experiential-critical spe-
or need to be readmitted to a hospital.” cialty. You want the oldest, grayest surgeon who’s still breathing to
The government has such data on millions of patients (Medicare) do complex operations. Here’s another fallacy they propagate: “a
over a five year period (2000-2014) and recently, individual doctor’s well known university might provide some reassurance…” Double-
names were released. By this system a doctor is assigned from one ha! Not all the best doctors are at universities.
star (horrrible!) to five stars (grrreat!). The criteria by which we were SURGEONRATING provides great detail into how death rates

36 San Antonio Medicine • February 2018