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Orthopedic Board Hasn’t Adopted Surgeon Scorecard After All

A new statement by the American Board of Orthopaedic Surgery says its executive director “miscommunicated” his own preference without getting necessary approval.

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The American Board of Orthopaedic Surgery has not decided to use ProPublica’s Surgeon Scorecard to help identify specialists with high rates of post-surgical complications, according to a new statement posted on the organization’s website.

The posting reverses a prior statement by Dr. Shepard Hurwitz, the board’s executive director, who said Surgeon Scorecard complication rates would be used in re-certifying surgeons.

That account was the basis of a ProPublica story published Oct. 13. According to the new statement, however, the issue had not been brought to the group’s other officers or board.

In what it described as the “unfortunate result of a misunderstanding,” the statement said Hurwitz had “miscommunicated his own personal preliminary willingness to consider using the [S]corecard as a more formal decision by the ABOS.”

Hurwitz could not be reached for comment. Dr. J. Lawrence Marsh, president of the orthopedists’ board, said that until ProPublica’s story was published there had been no discussion by the board about using Surgeon Scorecard to help vet surgeons.

Surgeon Scorecard reports complication rates for more than 16,000 surgeons who performed eight common operations on Medicare patients over five years. The ratings cover about 11,500 orthopedic surgeons on three types of spinal fusions and knee and hip replacements.

Publication of the Scorecard in July prompted plaudits and criticism. Some in the medical profession questioned its reliability while others praised it as an important tool for patients. In conversations with this reporter, Hurwitz acknowledged both the controversy and the potential value to his group, which has about 28,000 members, as a source of independent performance data.

In September, Hurwitz said he would discuss integrating the Surgeon Scorecard findings into the oversight process at his board’s early October meeting. Notes show that said he spoke with the “leadership of our board, the executive committee,” and with the leader of the group’s credentialing committee, which might issue a recommendation.

Responding to a follow-up email after the board’s October session, Hurwitz wrote: “The oversight committee is going to adopt your methodology as a means of identifying problem surgeons.”

In subsequent interviews, Hurwitz said the organization was going to move forward using Surgeon Scorecard when surgeons apply for re-certification. No decisions would be made based on ProPublica’s ratings alone, he said, but knowing each surgeon’s complication rate would inform the process and could lead to further investigation.

After ProPublica wrote about the development, the surgical group posted a message saying its board hadn’t signed off. At that point, Hurwitz told ProPublica he had only spoken informally with board members and that the decision to use the Scorecard was his alone.

Marsh said that Hurwitz did not have informal discussions with board members about using Surgeon Scorecard. Asked about the apparent contradiction with Hurwitz’ account, Marsh said: “I understand this dilemma. We’re trying to sort it out the same as you are.”

The group’s new statement said Hurwitz has no authority to act alone.

“The ABOS makes changes to its certification, credentialing and MOC rules and procedures only after thorough and thoughtful review,’’ the statement says. “Neither the Executive Director, nor any individual member or officer of the Board of Directors, has the authority to implement any changes without full Credentials Committee and Board of Directors review and approval.”

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