Those of us who work in healthcare know a simple truth: The more often a hospital or surgeon performs a particular procedure, the better the outcomes and the lower the cost. It’s common sense: Volume, practice and experience all matter, especially in the high-stakes world of healthcare.

In fact, for nearly every surgery, the relationship between the number of cases performed and the quality of outcomes follows a logarithmic curve. At low volumes, the risk of complications skyrockets — like the sharp climb of a roller coaster just before the drop.

And yet, patients almost never have access to this basic, lifesaving information about surgical and procedural volumes. States do collect it. The Agency for Healthcare Research and Quality, a component of HHS, also has it. But data-use agreements shield the facts from the public. As a result, healthcare consumers are often left flying blind, experiencing preventable harm, unnecessary costs and even sometimes regrettable deaths.

Emerging efforts and issues

There are some promising efforts with public access to surgical volumes reporting. The Leapfrog Patient Safety Survey is the only publicly available data on surgical volumes, which hospitals can voluntarily complete. In this survey, hospitals enter their volumes for 10 high-risk procedures and must attest that the data is accurate. The Leapfrog Group then makes their answers public. This is an important first step, but transparency demands that these 10 procedures be expanded to include most procedures patients undergo.

Another complicating factor in this equation is the role of smaller, low-volume hospitals. There is, of course, a vital role for emergency surgery in small rural hospitals. Plus, some patients and families will opt to be treated at a lower-volume hospital to be close to home for the procedure and recovery. They trust their doctor and hospital or want to minimize the burden on their loved ones by traveling to another town. Yet the goal of making volumes transparent is so patients can consider these factors, along with surgical and procedural volumes, to make an informed decision about where to seek care.

It’s also a bit of a misconception that all low-volume surgeries are occurring at small rural hospitals. In fact, most are occurring within 30 miles of a high-volume hospital.

When hospitals like these are part of health systems, surgeries can be “decanted” and concentrated at specific hospitals that are centers of excellence for particular procedures.

The way forward

How can we improve transparency in surgical volumes, as our patients deserve?

First, make the data public. If HHS refuses, private sector companies like Premier can. They have the infrastructure and capabilities to do this. Premier tells me it has agreed to work with its member health systems on a transparency initiative around the volume outcomes correlation. It’s essential to also expand beyond the Leapfrog procedures, which are just a beginning. Healthcare will need to create a new taxonomy of surgical cases at an appropriate level of detail. Existing DRGs (diagnosis-related groups) are too broad and hard to use for these purposes, and individual ICD-10s are too granular.

Second, we need a standard way to define surgical cohorts so we can compare apples to apples across the country. Absent this, health systems and companies may create their own cohorts, creating confusion and misinforming the public. The American College of Surgeons is perfectly positioned to lead this effort — bringing their expertise, credibility and deep knowledge to create a national standard for surgical cohorts.

Third — and most importantly — we need leadership. We need health systems willing to commit now that when the data is ready, they will share it openly so every patient can make an informed choice.

Real-life consequences

This isn’t an abstract policy debate — it’s about real people. A woman once told me about her husband, who underwent an esophagectomy. She chose a four-star CMS-rated hospital, believing she was making the safest choice. What she didn’t know — what she couldn’t know — was that this hospital had performed just one such surgery in the last two years. Two high-volume hospitals were within 15 miles. Her husband suffered devastating complications and ultimately passed away.

Through her grief, she asked me: Why didn’t I know that? Why didn’t anyone tell me? She should have known. Everyone should. And together, we can make sure they do.

This is a moment to lead, to turn hidden data into lifesaving knowledge. We have the technology. We have the expertise. Now, we need the courage.

Let’s make surgical volume data public, standardize it nationwide, and give every patient the information they deserve — so the next time someone faces surgery, they choose with confidence, not guesswork. The lives we save and the suffering we suppress will be our measure of success.

Peter J. Pronovost, MD, PhD, is Chief Quality & Clinical Transformation Officer and the Veale Distinguished Chair in Leadership and Clinical Transformation at University Hospitals in Cleveland.

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