TABLE OF CONTENTS
Executive Summary ……………………………………………………………………………………………………………..4
Introduction ……………………………………………………………………………………………………………………….5
Section I: Basic Operating Tenets of Provider Public Reporting …………………………………………………………6
Section II: General Issues in Reporting …………………………………………………………………………………….11
Section III: Audience-Dependent Issues…………………………………………………………………………………….15
Physician……………………………………………………………………………………………………………….15
Patient ………………………………………………………………………………………………………………….18
Payer/Purchaser ……………………………………………………………………………………………………..20
References ………………………………………………………………………………………………………………………23
Appendix A: Public Report Statute of Limitations ………………………………………………………………………..26
Appendix B: Glossary and Definitions …………………………………………………………………………………….27
Appendix C: Summation……………………………………………………………………………………………………..30
Appendix D: Private Feedback Reporting Audiences, Functions, and Information Flow Diagram ……………..32
EXECUTIVE SUMMARY
The SQA recognizes the importance of publicly available reports on surgical care. Public reports can facilitate
health care quality improvements by influencing physician behavior and decision-making and by informing
payers and consumers on how to best sponsor or purchase care. However, many of the guidance documents in
the public domain focus on primary care and do not sufficiently reflect important aspects of guidance for patients
who need or have experience with surgical procedures.
The spectrum of defining quality is centered on the core principle of good surgical care, which should be defined
and assessed by patients and their surgeons. However, there is no single definition of “quality.” Quality is
currently defined by payers using primarily performance indicators that are most often process measures.
Some of these measures are not fully supported by evidence and others focus on specific aspects of care that are
not applicable in many instances. Performance measures need to improve if they are to be used for quality
improvement and public accountability. Misuse of measures could lead to misclassification of care. This document
is intended to focus on public reporting of data that characterizes the processes and outcomes of individual
surgeons. However, the scope of publicly reported measures can include health-care providers or a facility. The
principles of this document broadly apply to group-based reporting as well.
In addition to a surgeon’s need for accurate information, other stakeholders including patients, purchasers, and
health plans need accurate information about quality of care; however, the needs of each stakeholder might
carry a slightly different focus. Patients seek safe, effective, accessible care in an environment where the patient’s
voice is heard. Purchasers and health plans emphasize safety, effectiveness in outcomes, appropriate use of
resources, and competition. Providers wish to avoid misclassification and seek meaningful actionable
performance feedback from reliable and valid sources. The function of a given report is determined by the
intended audience, but the data source for the reports is often the same. This concept is illustrated in Appendix D
in the Agency for Healthcare Research and Quality (AHRQ) figure titled Private Feedback Reporting Audiences,
Functions, and Information Flow Diagram.
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