Understanding Outcomes

SpineNevada believes that data provided by high profile rating sites such as Physician Compare, Consumers' Checkbook's Surgeon Ratings and Propublica's Surgeon Scorecard is just one piece of information that can guide, but not command, decisions made about treatment. Other important details to consider are how many of a particular procedure has your surgeon performed, other risks to the surgery besides hospital re-admission and death, and are you a good candidate for a procedure. Open communication between the physician and patient along with seeking a second opinion before spine surgery are among the best ways to determine if a particular treatment or surgery is the right selection for you.

SpineNevada, as a spine center of excellence, is referred the most complex cases of back and neck pain from across the Northern Nevada and Northern California region. In a recent study of the new patients coming in the front door, 36% have had previous back or neck surgery at other clinics. Additionally, more than half of new patients coming to SpineNevada have symptoms like numbness into a leg or arm, which implies disc-related symptoms, rather than simple acute back or neck strain. Another 76% of these new patients had suffered from back or neck pain for 4 months or longer. This severity of new patients presents a challenge for a spine center. Still, the spine center emphasized non-surgical options first, holding surgery as the last resort.

understand quality outcomes studies, spine nevada reno, sparks, carson city

An article published in an issue of the Journal of the American Medical Association (JAMA) provides an explanation of several high profile doctor quality rating resources. The article is authored by Dr. Aria Razmaria and Dr. Edward Livingston and entitled, “How to Use Online Clinician Rating Systems*.”

In the JAMA article, the authors outline that Medicare’s Physician Compare may be the most accurate resource for consumers because it pulls from data that is provided by the physicians themselves.  It’s important to note however that Physician Compare only shows 1) if the doctor participates in Medicare’s Physician Quality Reporting System (PQRS), 2) if the providers uses electronic health records and or 3) if the physicians utilize electronic prescribing to pharmacies.  Physician Compare has general information like practice location, hospital admitting privileges, board certification, etc.

Below is an overview explaining why Consumers’ Checkbook’s Surgeon Ratings and Propublica’s Surgeon Scorecard are of limited use for physician selection**.

  • The Medicare data used to rate the doctors is historical, at least 1-2 years old.
  • The metrics or scores in use are not ‘Universally Accepted’ in the medical field.
  • The Medicare data is planned for billing purposes and only secondarily used for measuring quality. The reporting does not include important clinical information necessary to fully rate quality.
  • The entities publishing the doctor quality ratings are private and not held publicly accountable if there are errors.
  • Surgical complications leading to particular ratings of doctors may have been caused by another physician or healthcare provider, for instance a nurse or other hospital employee.
  • The quality ratings are not ‘fully risk adjusted.’  To be Risk-Adjusted means that doctors who take care of “more severe” patients that are more prone to complications are not penalized, i.e. the complication rate is ‘adjusted’ for the ‘risk’ they take in caring for the more severe patients.

Because spine surgery is a serious decision, it is a good idea to obtain a second opinion.

A second opinion from Spine Nevada can provide you the following benefits:
  • Determine if you have considered all possible treatment options and if there are any other non-surgical options that can relieve symptoms without the need for surgery.
  • If spine surgery is necessary, what type of spine surgery should be performed. You may not need a complex fusion procedure that was initially recommended.
  • Are you a candidate for new artificial disc technology that would provide a better outcome?
  • Do you qualify for minimally invasive spine surgery in day surgery? This would allow you to be home later that same afternoon, for a faster recovery and return to activity.
  • Could you benefit from a second opinion? And is it worth the time and expense to travel to a spine center?

Quality is a journey, however, rather than a destination, and we are committed to continually improving. Click here to view a recent Clinical Outcome Report card.

The following resources were referenced in this content:
* http://jamanetwork.com/journals/jama/fullarticle/2449187
** http://www.compassphs.com/blog/health-navigation/6-reasons-doctor-quality-ratings-have-limited-utility/









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