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The Overarching Challenge*

John E. Heffner, MD, FCCP
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*From the Division of Pulmonary and Critical Care Medicine, Medical University of South Carolina.

Correspondence to: John E. Heffner, MD, FCOP, Department of Medicine, Medical University of South Carolina, 96 Jonathan Lucas Street, Suite 812, PO Box 250623, Charleston, SC 29425; e-mail: heffnerj@musc.edu



Chest. 2000;118(2_suppl):1S-3S. doi:10.1378/chest.118.2_suppl.1S
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More 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.

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