Congenital: Professional Affairs: Expert Opinion
Threats and opportunities: Public reporting in congenital heart surgery

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Assistance for Underperforming Programs With a Clinical Support Panel

With public reporting on the STS website and its amplification through use of its data in rankings schemes published by private enterprises, a subset of programs are publicly branded as underperforming. The agencies that provide these data to the public, however, have remained detached from the ramifications of these public issuances, and programs identified as underperforming are left to their own devices to address deficiencies and improve their performance. Such improvement, however, is not

Management of Risk-Adjustment Orphans With Mortality Waivers

A major unintended consequence of public reporting is the unavoidable reluctance to offer intervention to a patient with risk factors that are not recognized or insufficiently quantified in the current STS risk adjustment model. Rare comorbidities or clusters of common comorbidities are easily identifiable to an experienced clinician. Some extreme examples include a conjoined twin requiring a Norwood procedure, an infant with lower-extremity amputations and total systemic venous thrombosis

Incentivizing High-Risk Programs With Designation as an Innovative Treatment Program

Another major unintended consequence of public reporting is the current strong disincentive to develop a program to tackle clinical problems associated with a high-risk patient population. For example, at Texas Children's Hospital, a large program was established to manage pulmonary vein stenosis with a rapidly growing referral base. A comprehensive multidisciplinary team was developed providing interventions in the operating room and the catheterization lab. Patients typically undergo multiple

Implementation

As stated, professional societal oversight and sponsorship will be required to provide the expertise and infrastructure needed to manage the proposed Clinical Support Panel, the Mortality Waiver Committee, and the ITP Oversight Committee. The sponsoring professional society will need to petition the STS to accommodate the new reporting structure and work collaboratively to achieve the aims articulated here. Eventually, we should bring the private enterprises that currently rank programs into

Conclusions

The objective of this article is to provoke productive discourse focused on the management of the unintended consequences of public reporting that pose threats to our profession and compromise the care of our patients. As a specialty, we have an opportunity to redirect the power of public reporting to further incentivize provision of the best possible clinical care. As the leading advocate of congenital heart surgeons, the CHSS is ideally positioned to sponsor this discourse.

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