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Mandatory Adverse Outcome Reporting Makes Doctors Shy Away From Treating High Risk Patients

One of my favorite healthcare policy blogs is Dr. Rich’s Covert Rationing. In his most recent post he discusses a research study linking New York State’s public report card system to increased heart patient death rates. Doctors’ names are published alongside their procedure-related mortality figures, so if a patient dies while undergoing a risky (though potentially life-saving) procedure, the doctor’s grade suffers.

It’s no surprise that doctors are more hesitant to operate on high risk patients if their professional reputation is on the line. The result is that patients with heart problems in New York State are less likely to receive life saving therapies.

Now here’s where my outrage increased exponentially – Dr. Rich argues that report cards are actively promoted by payers (health insurance companies and the government) under the guise of patient empowerment (they deserve transparency about their doctors’ performance record, right?) But the real truth is that the payers are benefiting financially from the report card system. Fewer procedures mean lower pay outs, and if high risk patients die sooner, then they save even more on care costs.

Man, that’s depressing. So many reforms with “good intentions” result in unanticipated harm. Though strangely I can’t think of too many reforms that harm the payers. Can you?This post originally appeared on Dr. Val’s blog at

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One Response to “Mandatory Adverse Outcome Reporting Makes Doctors Shy Away From Treating High Risk Patients”

  1. AnnaS says:

    There is a way to have an adverse event reporting system without penalizing those who report the adverse events. The Federal Aviation Administration (FAA) did just that. Knowing that pilots would be reluctant to report errors if they knew they could face fines and revoked licenses, the FAA asked NASA to create and administer the system. The FAA pays for the system, but all the data is collected, analyzed and deidentified by NASA. The system has been in place and considered to be highly successful since 1976. Is there any reason why health care can’t learn from another industry where safety is paramount?

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