When I was doing this stuff for a health plan, most of the quality incentives were for processes (e.g. did your diabetic patients get an annual eye exam, nephropathy screening and hba1c test?) so the results were driven by doctors and not at the mercy (mostly) of flaky patients.
I believe surgical report cards/grades are publicly available, though there is no elaboration on how/why the score is obtained. Obviously, surgery has inherent risk and some procedures have higher rates of complications than others. That, is before considering any patient factors. Also, some procedures have very well known, and even, "expected" complications. Beaurocrats don't understand this concept and Obamacare penalizes surgeons (and hospitals) for them, regardless.
The health plan work you are referencing (A1C, BP, BMI, et al) is more about primary care outcomes. The model involves "risk sharing." Basically, the government/private insurers will pay more to the physician if more patients are compliant and have values within the normal range, or "at goal." On the patient/consumer side, you will eventually pay lower premiums if you take your pills, exercise, stop smoking, etc. If you are non-compliant, your numbers will be worse, you will pay higher premiums, and your doctor will make less money (which by the way is counterproductive, as docs generally spend more time and energy on the sicker people). In some cases, the doctor would have to pay back some of his income to Medicare/Medicaid if the patient's care costs more than what was allotted. So if Jim keeps smoking, "forgets" his BP pills often, etc., and has a massive coronary, with a hospital bill over $250K, his MD could be on the hook for a (large) portion of the bill. Guess how long Jim will remain in his doctor's practice, in this scenario?
It's typical Obama-logic. Make others responsible for the crimes/sins committed by the individual. It goes the other way as well, as in, "you didn't build that." It also attempts to turn physicians into police, similar to the reports about "turning in" gun owners who might have mental health issues. It seems the old code about, "not being a rat" doesn't jive with progressive dogma. Obama wants you to narc on your neighbors, your coworkers, your friends, and your patients.
It also doesn't jive with HIPPA, as in the recent CVS employee revolt. Since employers pay some or all of employee health costs, they have an interest in your lifestyle as well. Some companies in MA and RI make you complete a form saying you saw your doctor for an "annual" exam. Some also ask for your BMI, BP, smoking status, cholesterol, etc. They even pay people $200 (coercion) to do it.
This is basically a violation of privacy as your employer could never ask your HIV status. They have
zero right to know this information, and could use it against you at some point. "You're too fat, you smoke, and you're costing us a fortune in Blue Cross premiums, Jim, so we have to let you go."
So the party of anti-discrimination policies is building a tangled beaurocracy of medical discrimination and coercion to institute policy. Somehow these issues elude them. As far as I am aware, HIV is one of the most expensive diseases to treat. If CVS is justified in knowing your cholesterol and BP, since they have "skin in the game" as far as your healthcare costs, surely they are justified in knowing if you have HIV disease as well?
