Do people have suggestions or criticisms of how to handle risk-adjustment at hospital/center level when there are too few observations? NSQIP and CMS use shrinkage estimators but I worry this is a poor, unreliable assumption when there are too few observation. I would prefer to just drop centers with too few observations from being “risk-adjusted.” Are there better statistical solutions. Appreciate any formal criticisms or citations against shrinkage estimation.
Relevant discussion paper