And I, I will survive...maybe

Cancer Treatment Centers of America came under some serious fire today for their reporting practices around survival rates of their patients.  For those unfamiliar, CTCA is a for-profit cancer treatment center that advertises heavily on TV about their high survival rates and has multiple locations throughout the US.

The accusation of data manipulation include:

• Not accepting patients whose prognosis is too bleak so that their death won't count in their stats
• Encouraging Medicare and Medicaid patients not to come there (approximately 14% of their patients are Medicare, your average oncology center is 50% Medicare)
• Targeting richer patients whose added resources, better overall health and (likely) earlier detection will lead to better survival all on their own
• Excluding large portions of the patients they do treat from their data
• Reporting survival rates in terms of 4 year survival, not the industry standard 5 year survival

The charges are heavy, especially because the higher than average survival rate is a cornerstone of their advertising.  I took a look at one of their survival rate pages, and it does indeed only go through year 4, rather than the standard 5.  It also appears that they toss any patient who got any care anywhere else ever in the course of their diagnosis, and more strangely "excluded any patient whose medical records had missing information".*  This left them with only 45 people to calculate prostate cancer survival rates from.

Apparently, CTCA has heard the criticism and is recalculating some of their stats:

Xiong said he is doing new survival calculations using more recent data from CTCA, trying to make sure the comparison to the national database is rigorous. The new results, Xiong said, are expected to be posted on CTCA's website this month. 

For some cancers, CTCA will still have better survival rates, he said. For others, "the survival difference in favor of CTCA is no longer statistically significant" after adjusting for several differences between CTCA's patients and those in the national database.

Now, I've talked before about hospital ranking and how difficult it is, but this story really got to me.   We're living in a time in the US where hospitals are under increasing scrutiny to lower their costs, and rightfully so.  However, in our effort to achieve the triple aim (right treatment, right time, right price), we have to make sure we're working honestly.  Increasing survival rate through innovation is awesome, increasing survival rates by only treating the population most likely to survive is atrocious.

This is why many hospitals are reluctant to release their statistics.  It's easy to skew things if you try, and it's even harder for the public to understand what this skewing means.  In education, teacher often complain their now "teaching to the test".....do you really want a doctor who's "treating for the stat"?

*Interestingly, when my workplace talks about our survival rates, we actually have a "lost to follow up" category we add in.  I'm curious what those numbers would be here....since I'm assuming that's what "missing medical records" means.  Why not release the numbers of how many that is?