{'fraction_non_alphanumeric': 0.02959094865100087, 'fraction_numerical': 0.0168262257035103, 'mean_word_length': 5.397031539888682, 'pattern_counts': {'":': 0, '<': 1, '<?xml version=': 0, '>': 0, 'https://': 0, 'lorem ipsum': 0, 'www.': 1, 'xml': 0}, 'pii_count': 0, 'substrings_counts': 0, 'word_list_counts': {'cursed_substrings.json': 0, 'profanity_word_list.json': 0, 'sexual_word_list.json': 0, 'zh_pornsignals.json': 0}}
Public reporting: A new threat to high‐risk patients and medical innovation

Public reporting of hospital and physician outcomes is part of the continued initiative to improve quality by informing patients and healthcare providers about these outcome data so that informed decisions can be made. With the current passage of the Patient Protection and Affordable Care Act of 2010, a national resurgence on quality improvement, accountability, and cost effectiveness in health care has stakeholders (i.e., government, insurers, and consumers) seeking a framework of transparency to help them make informed decisions regarding healthcare facilities and providers, ultimately trying to improve healthcare delivery and outcomes. In 2014, “Physician Compare,” a website developed by the Centers for Medicare and Medicaid Services (CMS), reported quality of care ratings publically for group practices with individual physician ratings to be added in the future (Medicare.gov. Physician Compare. Available at: http://www.medicare.gov/physiciancompare/search.html. Accessed August 11, 2013). However, the impetus of facilitating transparency in public reporting of individual and institutional “score cards” is complex in part related to risk adjustments of outcome that must be validated and then reported in a scientifically accurate way. If this is not done well, the effort has the potential to have significant unintended consequences on patients, society, and the medical community and can be used not to inform patients, but instead, used for a variety of marketing strategies to drive patient referral. Public reporting is not a new concept and may have other unintended consequences such as of turning away high-risk patients and inhibiting medical innovation. Public reporting of physician risk-adjusted in-hospital mortality rates has been available for cardiothoracic surgery since the late 1990s and reporting for percutaneous coronary intervention (PCI) is currently mandated in New York (1991), Pennsylvania (2001), Massachusetts (2005), and Washington (2012). Several studies in these states have demonstrated that physicians are reluctant to take on complex patients compared to those states that have not adopted public reporting [1–3]. A survey performed in Pennsylvania after the state began public reporting showed that, among cardiologists, 59% said they had difficulty locating a cardiothoracic surgeon willing to perform a surgical procedure for a patient who is severely ill. In addition, 63% of Pennsylvania cardiac surgeons reported decreased willingness to operate on patients who were most severely ill [1]. Patients presenting in New York State with acute myocardial infarction and cardiogenic shock were one-eighth less likely to have been treated with PCI than those in Michigan and one-half less likely to receive PCI compared to the rest of the country [2,3]. Moreover, cardiac surgeons performed most of their operations on cardiogenic shock patients after 72 hr (101.2 vs. 10.3 hr; P 5<0.001). This delay may have the consequence of operating on less severely ill patients because the sickest patients may have had a fatal outcome by then. The case selection bias was further demonstrated when New York medical centers were being recruited for the Should We Emergently Revascularize Occluded Coronaries for Cardiogenic Shock (SHOCK) trial [4]; sites were reluctant to participate until the state permitted submission of