Not enough data is available about surgeons’ outcomes.
The peak surgical body wants doctors to report their rate of poor outcomes, amid concerns that Australian patients are making decisions about their treatment in a void of information.
The Royal Australasian College of Surgeons wants to expand its audit of surgical mortality, which collects all the deaths under the care of individual surgeons, to include complication rates.
RACS councillor Guy Maddern, who chairs the surgical mortality audit, said not enough data was available about surgeons’ outcomes.
Yet the prices charged by different surgeons varied enormously, and bore no relation to their skill.
“Sydney has some very expensive surgery,” Professor Maddern said.
“There are surgeons who are outstanding and they only charge the scheduled fee and there are certain ones who certainly aren’t exceptional who charge exceptionally high fees.”
Any published information would need to be adjusted so that surgeons with difficult caseloads at public hospitals were not directly compared with those who specialised in 22-year-old athletes and it would only be useful if there was universal participation.
This could be done by the federal government refusing to accredit and provide Medicare funding to hospitals that do not collect standard data.
“I think it could be done but there has to be a will and the will just isn’t there,” Professor Maddern said.
The dearth of information is symptomatic of what one health professional describes as an “Australian trait” of non-disclosure.
Hospital performance data and surgical outcomes are routinely reported in the United States and the United Kingdom.
In Australia, the private hospital company Healthscope publishes its success rate 21 measures including patient falls, infection rates and unplanned readmissions.
Healthscope’s chief medical officer Michael Coglin said when the company launched the website in 2011 it thought the industry would follow.
“But to our amazement, five years later Ramsay [Health Care] has started reporting but only on six or seven things.”
The federal government’s MyHospital website only publishes data on three measures – infections, cancer surgery waiting times and time spent in emergency departments – for each public hospital.
“It’s an Australian trait not found in the UK since about 2000 and not found in America for 25 years, but it’s a peculiar Australian story that we would keep all this to ourselves.”
Hospitals could withdraw privileges for surgeons who refused to audit the outcomes of their procedures, he said. “This is the way of the future.”
The Fertility Society of Australia, the peak body for reproductive medicine, refuses to release the percentages of live births at each of the 71 IVF clinics that contribute to the national database because it wants to avoid league tables.
But it is planning a web-based tool that will allow patients to assess their chances of taking home a healthy baby at individual clinics according to their personal circumstances.
A NSW Health spokeswoman said the government supported the notion of increasing transparency across health care but could not compel individual clinicians to make available outcomes data.
“As part of the work of the recently announced MBS Reviews Taskforce, work will be done to ensure that patients have access to better information about health professionals’ fees,” she said.