Feature Story

Publicizing bypass surgery outcomes has not prompted doctors to deny surgery to higher risk elderly patients

Since 1990, the New York State Department of Health has published annual profiles, so-called "cardiovascular scorecards," of surgeons performing coronary artery bypass surgery. But apparently this profiling has not prompted New York surgeons to deny this procedure to elderly patients at higher risk for poor outcomes to avoid jeopardizing the surgeon's outcome profile.

A recent study found no evidence that New York's provider profiling limited the access of the State's elderly to this procedure or increased transfers to out-of-State hospitals for the procedure. In fact, despite an increasing number of bypass patients with higher preoperative risk profiles, bypass surgery outcomes in New York improved significantly faster than the national average after initiation of the profiling program, according to a study supported in part by the Agency for Health Care Policy and Research (HS06503, Ischemic Heart Disease PORT, and HS05635).

Led by Elizabeth R. DeLong, Ph.D., and Eric D. Peterson, M.D., M.P.H., F.A.C.C., Duke University Medical Center investigators used national Medicare data to examine trends in the percentages of New York residents aged 65 years and older receiving out-of-State bypass surgery between 1987 and 1992 (before and after program initiation). They also examined in-State procedure use among elderly heart attack patients during this period and compared surgical outcomes in New York Medicare patients with those for the rest of the Nation.

Between 1987 and 1992, the percentage of New York residents who received bypass surgery out of State actually declined, from 12.5 percent to 11.3 percent. An elderly patient's likelihood of undergoing the surgery in New York has increased significantly since initiation of the provider profiling program. What's more, between 1987 and 1992, 30-day mortality rates, unadjusted for patient risk factors, declined by 33 percent in New York Medicare patients compared with a 19 percent decline nationwide. This made New York the State with the lowest risk-adjusted bypass mortality of any State in 1992.

See "The effects of New York's bypass surgery provider profiling on access to care and patient outcomes in the elderly," by Drs. Peterson and DeLong, James G. Jollis, M.D., F.A.C.C., and others, in the October 1998 Journal of the American College of Cardiology 32(4), pp. 993-999.

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