The American College of Surgeons Approach to Public Reporting

We commend Diaz et al for studying the limitations of the Centers for Medicare & Medicaid Services (CMS) Star Rating System for reporting surgical quality and agree a need exists to improve publicly reported hospital quality in surgery. Evaluating surgical quality is difficult for many reasons. For one, the source of data most used for evaluating quality is suboptimal. The CMS and other benchmarking organizations use claims data (also known as administrative or billing data) for many of their metrics, which has been shown to be inferior to clinical data for reporting surgical outcomes. Furthermore, using claims rather than clinical data for risk adjustment to control for patient comorbidities similarly has lesser accuracy. In addition, regardless of data source, several surgical outcomes cannot be reliably or validly measured, and hence different types (eg, process or composite) of metrics are needed.