than 15 years ago, the public awoke to newspaper headlines that Medicare
had released survival data from their administrative data base for
patients undergoing cardiac surgery in American hospitals. The
statistics indicated the existence of marked differences in mortality
rates among similar facilities. The reporting of these data initiated
immediate changes in referral patterns and program design in many
health care facilities. As we later learned however, the
risk-unadjusted data had misrepresented surgical results.
Nevertheless, the newspaper reports signaled the beginning of a public
dialogue regarding the variations—in practice, costs, and
outcomes—that existed across the American health care system.