Risk Aversion and Public Reporting. Part 2: Mitigation Strategies

The Annals of Thoracic Surgery
David M ShahianRichard L Prager

Abstract

Part 1 of this review summarizes the consequences of risk aversion and the observational studies and surveys relevant to this phenomenon, almost all of which are derived from cardiac surgery and interventional cardiology. In Part 2, we describe the root cause of risk aversion-the belief by providers that current risk adjustment is inadequate to account for the severity of their highest-risk patients, thereby prejudicing their publicly reported performance scores. Evidence supporting the robustness of current risk adjustment is presented, as well as nine potential strategies to further mitigate risk aversion: optimization of data source, risk models, and performance measures; exclusion of high-risk patients; exclusion of non-procedure-related end points; separate reporting of high-risk patients; reporting by condition or diagnosis rather than by procedures; reporting at the hospital or program level rather than the physician level; collaborative, cross-disciplinary decision making; active surveillance for risk aversion; and improved stakeholder education. Of these, the first is most desirable, widely applicable, and resistant to gaming.

Citations

May 19, 2020·The Annals of Thoracic Surgery·John S IkonomidisPavan Atluri
May 5, 2021·World Journal for Pediatric & Congenital Heart Surgery·Jürgen HörerBohdan Maruszewski
Feb 18, 2019·The Journal of Thoracic and Cardiovascular Surgery·David M ShahianSharon-Lise T Normand
Jul 9, 2021·The Annals of Thoracic Surgery·Nicholas SchreiterPetros V Anagnostopoulos

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