Search tips
Search criteria 


Logo of hsresearchLink to Publisher's site
Health Serv Res. 2000 April; 35(1 Pt 2): 319–332.
PMCID: PMC1089104

Do quality report cards play a role in HMOs' contracting practices? Evidence from New York State.


OBJECTIVE: To answer two related questions: (1) Do managed care organizations (MCOs) in New York State (NYS) consider quality when they choose cardiac surgeons? (2) Do they use information about risk-adjusted mortality rates (RAMR) provided in the New York State Cardiac Surgery Reports? DATA SOURCES: (1) Telephone interviews with and contracting data from the majority of MCOs licensed in NYS; (2) RAMR, quality outlier designation, and procedure volume for all cardiac surgeons, as reported in the Cardiac Surgery Reports. STUDY DESIGN: Interview data were analyzed in conjunction with patterns revealed by contracting data. Null hypotheses that MCOs' contracting choices were random with respect to the information published in the Cardiac Surgery Reports were tested. PRINCIPAL FINDINGS: Sixty percent of MCOs ranked the quality of surgeons as most important in their contracting considerations. Although 64 percent of MCOs indicated some knowledge of the NYS Cardiac Surgery Reports, only 20 percent indicated that the reports were a major factor in their contracting decision. Analyses of actual contracting patterns show that in aggregate, the hypothesis of random choice could be rejected with respect to high-quality outlier status and high procedure volume but not for RAMR or poor-quality outlier status. The panel composition of the majority of MCOs (80.2 percent) was within two standard deviations of the expected mean under the null hypothesis. CONCLUSIONS: Despite a professed preference for high-quality surgeons, the use of publicly available quality reports by MCOs is currently low, and contracting practices for the majority of MCOs do not indicate a systematic selection either for or against surgeons based on their reported mortality scores. This study suggests that policy initiatives to increase the effective use of report cards should be encouraged.

Full text

Full text is available as a scanned copy of the original print version. Get a printable copy (PDF file) of the complete article (1.2M), or click on a page image below to browse page by page. Links to PubMed are also available for Selected References.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Chassin MR, Hannan EL, DeBuono BA. Benefits and hazards of reporting medical outcomes publicly. N Engl J Med. 1996 Feb 8;334(6):394–398. [PubMed]
  • Epstein A. Performance reports on quality--prototypes, problems, and prospects. N Engl J Med. 1995 Jul 6;333(1):57–61. [PubMed]
  • Hannan EL, Kilburn H, Jr, Racz M, Shields E, Chassin MR. Improving the outcomes of coronary artery bypass surgery in New York State. JAMA. 1994 Mar 9;271(10):761–766. [PubMed]
  • Hannan EL, Kumar D, Racz M, Siu AL, Chassin MR. New York State's Cardiac Surgery Reporting System: four years later. Ann Thorac Surg. 1994 Dec;58(6):1852–1857. [PubMed]
  • Hartz AJ, Kuhn EM, Pulido J. Prestige of training programs and experience of bypass surgeons as factors in adjusted patient mortality rates. Med Care. 1999 Jan;37(1):93–103. [PubMed]
  • Hughes RG, Hunt SS, Luft HS. Effects of surgeon volume and hospital volume on quality of care in hospitals. Med Care. 1987 Jun;25(6):489–503. [PubMed]
  • Mukamel DB, Mushlin AI. Quality of care information makes a difference: an analysis of market share and price changes after publication of the New York State Cardiac Surgery Mortality Reports. Med Care. 1998 Jul;36(7):945–954. [PubMed]
  • Peterson ED, DeLong ER, Jollis JG, Muhlbaier LH, Mark DB. The effects of New York's bypass surgery provider profiling on access to care and patient outcomes in the elderly. J Am Coll Cardiol. 1998 Oct;32(4):993–999. [PubMed]
  • Romano PS, Zach A, Luft HS, Rainwater J, Remy LL, Campa D. The California Hospital Outcomes Project: using administrative data to compare hospital performance. Jt Comm J Qual Improv. 1995 Dec;21(12):668–682. [PubMed]

Articles from Health Services Research are provided here courtesy of Health Research & Educational Trust