But the report cards backfired. They often penalized surgeons, like the senior surgeon at my hospital, who were aggressive about treating very sick patients and thus incurred higher mortality rates. When the statistics were publicized, some talented surgeons with higher-than-expected mortality statistics lost their operating privileges, while others, whose risk aversion had earned them lower-than-predicted rates, used the report cards to promote their services in advertisements.
Research since then has largely supported his claim. In 2003, a study published in the Journal of Political Economy compared coronary bypass surgeries in New York and Pennsylvania, states with mandatory surgical report cards, with the rest of the country. It found a significant amount of cherry picking in the states with mandatory report cards: Coronary bypass operations were being performed on healthier patients, and the sickest patients were often being turned away, resulting in “dramatically worsened health outcomes.”