Publicly Reporting Implantable Cardioverter Defibrillator Outcomes

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The past decade has seen a dramatic increase in efforts by both payors and governmental agencies to measure and publicly report patient outcomes to ensure that patients receive appropriate, high-quality care. As a result, terms such as outcomes, quality, report cards, and benchmarking have entered the lexicon of clinical medicine, and both physicians and hospitals are increasingly being held accountable for the outcomes of their patients. This movement shows no sign of slowing down. In May 2008, the Centers for Medicare and Medicaid Services proposed increasing the total number of inpatient hospital measures from 40 to 73,1 and numerous physician measures are in various phases of development. In the current environment, it is likely that implantable cardioverter defibrillators (ICDs), which reduce the risk of sudden cardiac death,2 will soon emerge as a high-priority target for the development of performance measures, given that the procedure is expensive, performed on severely ill patients, and associated with significant risk of complications. Article see p 240 Accordingly, the findings published by Al-Khatib et al3 in this issue of Circulation: Arrhythmia and Electrophysiology warrant consideration in the context of current efforts to publicly report patient outcomes using Medicare claims data. In this excellent article, the authors used data from Centers for Medicare and Medicaid Services standard analytic files to determine the 90-day postprocedure complication rates and 1-year mortality rates of 8581 Medicare beneficiaries who had an ICD implanted by one of 1959 implanting physicians. The authors note that the complication rate declined from 18.8% in 2002 to 14.2% in 2005 and further identified specific factors associated with an increased risk of complication such as chronic lung disease, dementia, and renal disease. Of interest, physician experience as measured by procedure volume was not significantly associated with the risk of complication, although an earlier …