EP Ranking US lookup tool

[www.providerrankings.com]

This tool is a bit complex to understand. It's meant for healthcare professionals and facilities. They have a video that shows how to use it. There's a free and paid version. The paid version is pricey.

I just discovered it and I'm finding it very useful. The free version gives quite a bit of info.

2019 assessments in the page that opened for me. T'would be interesting to compare those rankings with current ones. I would hope that Dr. Andrea Natale had risen into the A+ ranking.

To get the most current year they want you to subscribe of course. It's tempting to pay for the subscription but it's $1200 a year...yikes! It also gives you much more data.

You can break it down by listed procedure and I noticed Natale rose to the top 5 in the US for some procedures in 2019. Based on his rankings for procedures, I still feel like Natale is one of the top EPs in the US. My current EP ranks an A- but when I search by procedure, he drops down in the rankings. I also saw 1 very high-ranking EP, A+, in my general area, and one within 4 hours that specializes in my specific complex condition.

One thing I really like is that you can see what procedures the EP is actually billing for and how many times in that year they did that procedure and how they ranked for that procedure. They show repeat procedure rates. That is very important since they all have certain procedures they are known for being an expert at.

I want to spend more time analyzing the data since I still need another procedure and a complex one.

Here's the link to their main website

[www.dennistondata.com]

I looked up some quacks I am familiar with and they had A- and B ratings. I don't give this list any credibility.

I know the names of most of the top EPs in the US and none of them appear at the top of any searches I ran. What does this tool use as a criteria for ranking doctors?

Of course, word of mouth can be the best way to find a great doctor.

In research, I've learned that the more sources of data you use, the more likely you are to have the correct data if your sources match. That's TMI for most people.

This is just info so take it or leave it of course. And none of it is my opinion in any way. It's just data.

In healthcare, all healthcare providers, doctors, and facilities in order to participate in any of the federal programs like Medicare or Medicaid, are required to report their data quarterly to the Centers for Medicare and Medicaid (CMS) on their patient outcomes and other quality measures (it's complicated). CMS also gathers their data by their billing practices and billing codes. This data is required to be publically available, but it's not very easy to find or get the data all in one place and broken down to be usable. Healthcare providers get paid more or less by CMS based on their numbers and data.

In healthcare, we use this data to improve our programs and outcomes and find potential problems. Everything that any healthcare provider does is tracked. The key is finding how it's tracked and how accurate the data is and which data to track. Since I'm familiar with this, I figured there must be a way to find the data for EPs. That's how I found this source. It looks to me like the data meets or exceeds the industry standards.

When you look at the rankings you will see that the data that ranks the doctors includes a lot more than their procedures. Because of that, a doctor who is great at a procedure, may not rank high if some of his non-clinical skills are not as good. You can look just at the doctor's procedures and it takes all the other data out of the calculation. This is important when you are having a procedure or surgery. If I'm hiring a doctor for a hospital it's all important, but if I'm a patient looking for a procedure or surgery, I'm just interested in their clinical skills.

Here's a link to the site and where they get their data: [www.dennistondata.com]
They also have a video demo to help you understand the data.

Hope that helps.

Carey, I know you mentioned that asking how many ablations procedures an EP and/or a center does is one criterion. How do you find out the success rate in any of these tables? There are several measures - is the arrythmia completed fixed? How long has it been fixed? If afib free for 2,5, 10 years considered a success? Are you drug free after a procedure? If so, how long? What were negative outcomes? If there were a data base out there that covers all that information that would certainly help people, make decisions on options. Not sure if every EP would be totally honest about their own stats. I have not seen any data base that answers all the questions.

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sldabrowski
How do you find out the success rate in any of these tables?

Good question. The only way I know of to obtain success rates is to ask the EP directly. Obviously, that's not useful as a broad screening tool.

I would guess that EPs don't know how many were successful, unless they count the number of patients that they DON'T see again. After my first ablation that lasted 13 years, there was no follow up other than a one-month postop visit. People move, find other Doctors, etc. so counting success rates seems doubtful.

Great points!

I do know on the federal required reporting data, CMS collects data from all medical sources so they would know if there was a repeat procedure for the same procedure code no matter which doctor did it, unless they didn't bill. They also track hospitalizations and ER visits for the same diagnosis, etc. There's a set period of time that Medicare uses for physicians which is typically 36 months before they are considered a new patient again for billing purposes. I haven't confirmed this to be true in this specific case.

If you look at the table and the procedures on the specific physician level, you can see how many times in that year that physician billed for that procedure. They may perform several procedures during ablation. You would not be capturing self-pay patients. It should be accurate because they will bill for the procedure and it's tracked. I was shocked to see how many procedures some EPs do! You also need to factor in the high-risk patient score because docs that take high-risk patients will have a higher repeat rate. I also think there's a balance of procedures vs patient care. When I looked at the very high producers, they don't seem to follow up with their patients based on their low numbers of repeat patient visits. Personally, I like a doctor who knows me enough to know if what they are doing is working or has been successful. In my experience, you want a balance. If any of the EPs are in the top 25% in the US, they are likely very good. A and A+ range according to the creators of this program.

I'm still waiting to see Natale but decided to look at the top performers in FL since I'm very symptomatic. By looking at the procedures they perform and their numbers, I was able to rule out 80% of them. For example, my issue is atrial and some billed for mostly ventricular procedures or pacemakers. They would not be a good fit for me so I save time in contacting them. I did spend hours on this to analyze the data so it is time-consuming but worth it to me. My issue is atrial but not afib, so I need to see if Natalie, who is an afib expert, feels I am a good match for his skills when I have my appointment with him. So far he's still analyzing my case.

If you look at Natalie for example, for 2020 he rises to the top 5% in the US, takes 75% afib diagnoses, and although his repeat rate is a little higher than others, although much lower than many, we know he takes a lot of patients that have had one or more ablation failures, and he follows up with his patients. He's a great example of a good mix of qualities to look for in a doc. Some may be okay with just the numbers and don't care if the doc ever talks to them. It's a personal choice. And better yet, you have word-of-mouth testimonials of people who have actually used his services.

I just moved to my area so used the tool to help me find a primary physician and general cardiologist. I liked that I could also look at the procedures they bill for and what their typical diagnosis mix is so I know where their strengths are and if I'm a good fit.

Just to add....I just found this tool by searching. I have no ties to the company that creates this tool in any way. I was just excited to find something that can be useful since I felt I was spending much too much time searching online and going to wasted doctors' appointments. I thought others may find it helpful.

You may laugh...I did...I recently went to a local appointment with an EP who is getting ready to retire. If I had the tool before seeing him, I could have seen that he really is a good EP, but has not done many ablations in recent years showing his nearing retirement. It was not all a total loss though because he gave me names of EPs he recommends in my area, and ones he doesn't, and a referral form so I could choose who I want to send it to. It has helped a lot. The data follows his recommendations.



Edited 1 time(s). Last edit at 03/01/2023 05:06PM by Amara.

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Amara
I just moved to my area so used the tool to help me find a primary physician and general cardiologist. I liked that I could also look at the procedures they bill for and what their typical diagnosis mix is so I know where their strengths are and if I'm a good fit.

Thanks for posting! My wife is in the market for an orthopedic procedure. We've had several recommendations from family & friends. So running them through this & they ranked high. Also found some other top ranked docs to check out. I have a good friend who is an orthopedic doc in a different specialty I can also pass the names by.

You're very welcome! I'm glad you found it helpful.

I emailed Denniston Data to ask them more specifically about the procedure repeat rate. Here's what they replied to me,
"The repeat percentage is calculated by how many times the provider you’ve chosen had repeated the named procedure on the same patient within the year of data you are viewing."



Edited 1 time(s). Last edit at 03/01/2023 08:24PM by Amara.

Here is another point. If you have gone to someone like Natale for an ablation and he has isolated the LAA, it means a return visit for a TEE and probable Watchman. He will repeat the mapping to check up on his lesions and I’d assume that would mean using some of the same codes. He will also “touch up” anything that looks iffy.

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Ken
I would guess that EPs don't know how many were successful, unless they count the number of patients that they DON'T see again. After my first ablation that lasted 13 years, there was no follow up other than a one-month postop visit. People move, find other Doctors, etc. so counting success rates seems doubtful.

This very phenomenon was important quite a few years ago when some bright bulb asked why so many heart patients with AF were sent home with metoprolol, or told to just live with it, and no other follow-up, and never came back. Many cardiologists and re-issuing GPs just assumed it was because their treatments were working and life went on. That bright bulb did some inquiry and found that, after about 5 years, most of those patients were pushing up daisies.

Very good points and observations. I like all the input that helps to think it through. Synergy

Daisy, I actually like the fact that an EP would do a quicker touchup rather than wait for years while the condition can progress. Good questions for an EP before a procedure. I'm going to add this to my question list. If a person had a second ablation with the same EP, that means they trusted them enough to go for the second one.

Repeat rates can go both ways, as a positive, and as a negative depending on the reason for the repeat. So really maybe not all that valuable as Ken said earlier.

Gloaming, To your point, I had 3 ablations in a 12-month period of time all by different EPs. The first 2, completely failed ablations, the EP did not have the expertise for my issue so had nothing else to offer me. The third has not given up and will likely offer me another ablation if I agree, and it will be within the 12-month period. If I decide to stick with him, I would agree to it and not find fault in him for it. My inclination is to go with an EP even more experienced so that could mean 4 ablations in a 12-month period of time all by different EPS...... yikes!


I checked with the data company and the repeat rate is not part of the calculation that ranks the docs, it stands alone.

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Amara
Gloaming, To your point, I had 3 ablations in a 12-month period of time all by different EPs. The first 2, completely failed ablations, the EP did not have the expertise for my issue so had nothing else to offer me. The third has not given up and will likely offer me another ablation if I agree, and it will be within the 12-month period. If I decide to stick with him, I would agree to it and not find fault in him for it. My inclination is to go with an EP even more experienced so that could mean 4 ablations in a 12-month period of time all by different EPS...... yikes!

Please STOP!

That's a ridiculous number of ablations in one year. Your inclination to go with a more experienced EP is correct, so follow your inclination. Under no circumstance should you undergo an ablation by any EP you've dealt with so far. You've proven yourself to be well beyond their skill levels.

Please go read how I effed up by doing exactly what you're doing.

Yes sir!

I hear what you are saying Carey and I get it. Thank you for your input. I appreciate you being straightforward.

My symptoms are constant and torturous at times, so waiting even a few months is hard to imagine. The longer it goes on, the worse it gets and the harder it is on my overall health. I'd like to have my life back one day while I'm still healthy enough to enjoy it. It's hard watching it deteriorate while I'm trying to find a doc that can help. Plus, it's very challenging to work, even at home. I'm sure a lot on people on this forum can relate.

I've heard many of you talk about how you were back to activities within a day or so after your ablation. Your symptoms returned over time or not at all. I think that's wonderful and encouraging. I look forward to that day. I've had a completely different experience and no real relief yet after 3 years of constantly being symptomatic, even after the ablations, since the issue started (post-viral infection). It's hard to be patient and not desperate for a solution at this point. Not complaining, but explaining.....

Since my issue is caused by viral damage and not a more typical diagnosis like afib or aflutter, it's very difficult to find an EP who feels confident they can solve my problem because most of them have never treated this type of problem. Even Natale wants to talk with me before letting me know if he can help. Because of that, I'm interviewing several other very experienced EPs and staying in the loop with my local EP for now. My local EP said he's seen this 2 other times in his career of >30 yrs. That's why I ended up going to him for #3. He did make some progress on the issue and identified the main problem, but more work to do. I agree that I need a skill level higher. That's my dilemma. The EP needs to be highly skilled, experienced, and a troubleshooter. To solve the issue, I may need a hybrid procedure where they do an endocardial and epicardial ablation. Not too many EP's have this skill.

I do finally have an appointment w Natale to discuss this in April. Yay! Hopefully, he will be able to help or tell me who can. If he decides he can do it, it will be another 2-3 months for scheduling an ablation after that. Ugh...

I do feel hopeful and know there's a solution with the right doctor.

Thank you for your support

When you say that the damage was done by a virus, are you referring to the dysautonomia? If so, I was in a similar position with post-viral dysautonomia. This is turning out to be a big problem in patients with long Covid, which is, of course, also post viral. In fact, most people with dysautonomia came down with it after a virus. I don’t want to be discouraging, but I have never found any solution to the autonomic dysfunction so, if that’s what you’re going to discuss with Natale, I’ll be following very closely.



Edited 1 time(s). Last edit at 03/02/2023 11:22PM by Daisy.

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Amara
My symptoms are constant and torturous at times, so waiting even a few months is hard to imagine.

I understand. Trust me, I understand all too well in a very personal way. But your local EPs have already proven that they can only prolong your torture and maybe even add to it. Every unsuccessful ablation you undergo makes the next one more difficult. Please deal only with the elite EPs in this country, no one else.

Carey, Absolutely. I agree. I'm sure you do understand well since I've read about your journey.

Daisy, it's more complicated than that. I have nerve damage as well as atrial ectopies (spelling?). They are treating me similarly to afib or aflutter since it's atrial. I'd rather not try to explain further since it's not totally well understood by the EPs at this point. I don't believe I have dysautonomia in the way most people think of it or by its medical definition. I didn't get dysautonomia post-viral, thank goodness, but did post-ablation. It resolved itself within the first 2 months.

There are several treatments in clinical trials for dysautonomia, including an ablation technique. Some doctors are good at managing it I hear, but haven't looked into it deeply to this point. There are several clinics across the US that specialize in dysautonomia. I can send you a message when I come across info that may help.

I'm glad that the post-viral problem isn't dysautonomia as that it proving to be super difficult to solve. I hope you have a really good conversation with Dr. Natale.

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Amara
There are several treatments in clinical trials for dysautonomia, including an ablation technique. Some doctors are good at managing it I hear, but haven't looked into it deeply to this point. There are several clinics across the US that specialize in dysautonomia. I can send you a message when I come across info that may help

.

Thanks, I am also following the research and have even traveled to several countries in Europe for treatment as well as having treatment with Dysautonomia specialists in the US. Dr. Natale is aware of the ablation techniques for Dysautonomia that are being trialed and I discussed them with him. (For me, they were part of his approach in any case) They are most helpful for Dysautonomia that presents differently than mine does i.e. fainting with Bradycardia, but I already had a pacemaker that prevents Bradycardia. Still, my recent ablation has allowed me to stand up for about 3 times as long without starting to faint, so I am very thankful. Since we all love to learn, please keep us up to speed on your discussion with Dr. Natale--here's hoping that he can help you...and help you soon! A lot of us have lived with a level of Afib and Flutter that takes over your life, so we get how urgent this is.

Thank you, Daisy I hope so as well.

It sounds like you have searched the extent of the planet and found some partial relief, that's great to hear. I'm glad Natale was also able to help you. Dysautonomia can be frustrating and limiting. It's good that we share here so we can speed up the learning curve. Thank you for sharing and I hope you will find a complete resolution for your dysautonomia soon. I'll let you know if I come across anything new.

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Amara
[www.providerrankings.com]

This tool is a bit complex to understand. It's meant for healthcare professionals and facilities. They have a video that shows how to use it. There's a free and paid version. The paid version is pricey.

I just discovered it and I'm finding it very useful. The free version gives quite a bit of info.

Thank you very much for sharing this very informational website.

You're very welcome

Drilling down in this, as far as I can tell, at least for the $ data, it is all based on Medicare billing. Since Medicare is ~45% of US healthcare, should be a good sample.

Yes, all healthcare companies that bill any of the federal programs are required to report this data unless they have a special exemption which is rare. The medical data is required to be reported to match the billing. They get audited periodically to make sure what they are reporting is accurate. All in all, what we are seeing should be fairly accurate unless a provider submits false data. This will include Medicare, Medicaid, and any other federal program. Medicare is also phasing in new rules that private insurance data is required to be reported. Previously it was optional.