Outcomes, however, vary wildly across a hospital. No two surgeons  have the same expertise. Employers that want the very best possible outcomes for their employees, then, can't settle on "Centers" of Excellence — they should take the extra step to find Surgeons of Excellence, too. 

Data over branding

Like all large businesses, hospitals carefully cultivate their brands. The strongest names signal weight and authority across the industry.

When employers search for provider partners, the allure of this prestige can be difficult to resist. Association with organizations like Johns Hopkins, Mayo, or the Cleveland Clinic can confer significant credibility on an employers' commitment to employee health. 

Mega-brands like these may be the first that come to mind when considering surgical quality. But, big name hospitals have no monopoly on talent. Some of the surgeons with the strongest historical outcomes work far from Baltimore, Rochester, or Cleveland. 

For instance, according to Medicare data analyzed and adjusted for patient risk, the three top performing hip replacement surgeons in the country operate out of Hoag Orthopedic Institute in Irvine, California; Rex Hospital, in Raleigh, North Carolina; and Washington Hospital, in Fremont, California. 

These surgeons see fewer avoidable adverse events than any of their peers in the US. Their affiliated hospitals may not enjoy the eminent profile of the Mayo Clinic — but the data shows that, in case of hip replacements, perhaps they should. 

Revelations like this only come from considering surgeon-level data. Judging surgeons on their outcomes can help banish the allure of the brand during the benefits and network design process.

Actual performance may vary
 

Another reason to look past organization branding: even America's best hospitals aren't the best at everything. Historical outcomes show that, while they may be excellent in some domains, in others, top-tier hospitals can actually fall well below their peers.

For example, patient risk-adjusted analysis of Medicare claims data shows that one world-famous east-coast hospital — whose name I'll withhold to avoid getting sidetracked on a systemic problem of reputation not representing reality — has some of the strongest spinal procedure outcomes in the country. However, another part of this hospital's orthopedic department doesn't have the same track record. In fact, for hip replacements, this hospital produces worse outcomes than almost any other hospital in America.

This shows that no hospital can be the first choice for every procedure. And the variance extends deeper still, down to individual surgeons. A surgeon's performance can shift across the variety of procedures they perform. World-class knee surgeons, for example, might have poor track records for shoulder arthroscopies, or vice versa.

While a single surgeon's variances typically aren't as wide as a facility's, employers should not neglect them — they can have a significant impact on a patient's outcomes.

Employers' health care benefit plans should not rely on any facility, or any surgeon, for a broad range of procedures. Recognizing the limits of each provider starts with scrutinizing individual surgeon performance.

Data-driven dividends for value-based care

Beyond smarter choices for provider-partners in benefits design, examining surgeon-level data will also yield subtler, longer-term benefits for a growing group of self-insured employers who have begun to engage in direct contracting.

Because facility-level data can obscure what really happens over the course of surgery, employers that rely on it find themselves ill-prepared for negotiations with providers. They're shopping for bargain rates on procedures, with incomplete information about what they're buying.

Individual surgeon outcomes-data resolves this information asymmetry. With a clear conception of surgeon quality, employers can understand exactly the value that a given hospital offers. This puts them in a position of strength when they start to make deals.

Even better, granular surgeon data will enable employers to track performance over time. Fluctuations in care quality may not be so apparent if a firm observes only facility-level data. Surgeon-level data, on the other hand, will reveal the state of care much earlier. Employers will be able to adjust their networks, and make better decisions about which surgeons' employees should see.

This is the best way to influence quality outcomes for employees, which, above all else, is the most important reason to screen individual surgeons.

The true value of excellence

Employers have a mandate of trust. Employees assume that their company has done the necessary due diligence, and will deliver them to safe hands if the need for surgery arises. 

To respect this vote of confidence, employers must take surgeon-level data into account as they choose provider-partners or redesign employee benefits plans. That's an extraordinarily demanding task. But employers that succeed will see cheaper care costs, more efficient networks, and safer, happier employees.