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Value-based purchasing and pay-for-performance programs are critical to the success of the Affordable Care Act.1 Despite the imminent implementation of the policy, robust indicators of hospital surgical quality have not been well described. Krell and colleagues2 elegantly assess the reliability of American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) measures of morbidity, severe morbidity, and mortality for 6 major general and vascular surgical procedures. The investigators found that the measures fail to meet even the lowest threshold of reliability, resulting in part from lack of adequate case volumes, even when most hospitals would be otherwise considered high volume. The findings are cautionary to ranking systems that use observed to expected ratios as a surrogate for surgical quality.
Rhoads KF, Wren SM. Understanding the Reliability of American College of Surgeons National Surgical Quality Improvement Program as a Quality Comparator . JAMA Surg. 2014;149(5):474. doi:10.1001/jamasurg.2013.4253