Quality measurement lags in the outpatient surgery arena

April 06, 2019 / MARIA CASTELLUCCI 

Ambulatory surgery centers are scrambling to develop better quality measures for their care. 

With more surgeries now performed in outpatient settings than in hospitals, ambulatory surgery centers have few ways to demonstrate the quality of care they can offer patients. 

“We are probably 10 years behind in our ambulatory (quality measurement) journey than where we are in our inpatient journey,” said Dr. David Levine, senior vice president of advanced analytics and informatics at consultancy Vizient, which develops quality measures. 

About 60% of surgeries once performed in a hospital are now performed in an ambulatory setting and the number of measures officially sanctioned by the CMS is getting smaller instead of larger. The agency only required ASCs to report four measures this year as part of its Quality Reporting Program—or otherwise face a 2% Medicare payment penalty for 2021—which is actually half the number of measures ASCs had to report in 2017 for payment this year. 

The low number of measures leaves consumers seeking care in outpatient surgery centers largely in the dark about the quality of care they will receive. “People are entrusting their lives in these centers, someone is taking a knife to your body. You want to believe precautions are taken and quality matters and you don’t have that assurance right now,” said Leah Binder, CEO of the Leapfrog Group.

Given the dearth of measures and the rising complexity of cases moving to the outpatient setting, ASCs have initiated efforts to create more measures, focusing mostly on better outcome measures, and to go beyond CMS reporting requirements.

“We want to be able to show the quality of care we provide,” said Bill Prentice, CEO of the Ambulatory Surgery Center Association, which represents ASCs in the U.S. “We are very much interested in developing outcome measures. We have taken it upon ourselves to try and develop and pilot test measures that go through the same approval process as the measures developed by (contracted measure developers) Yale and RTI.”

As such, the association is a founding member of the ASC Quality Collaboration, an organization formed in 2006 to create measures in the setting. The collaboration, which includes roughly 1,600 ASCs, has developed measures specific to certain ASC specialties as well as measures that can be “broadly applied across all settings such as measures of patient safety,” said Donna Slosburg, executive director of the collaboration, in an email. 

The Medicare Payment Advisory Commission also advocated for this approach. “The commission believes CMS should continue to improve (the ASC Quality Reporting Program) and move toward more CMS-calculated claims-based outcome measures that apply to all ASCs,” MedPAC stated in a March 2018 report.

The ASC collaboration has developed a few measures that take this approach. For instance, it has a measure that tracks emergency department visits within one day of discharge from an ASC.

The CMS hasn’t included the measure in its quality reporting program, but Slosburg said the collaboration advocates for the measures it develops to eventually be adopted. Additionally, ASC members of the collaborative use the developed measures in their practice, including the ones not required by the CMS.


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Chris J. Stewart

Chris currently serves as Chief Executive Officer of Surgio Health as well as COO at Ortho Spine Partners. Chris has close to 20 years of healthcare management experience with an infinity to improve healthcare delivery through the development and implementation of innovative solutions that solve real problems that result in improved efficiencies, reduction of unnecessary financial & clinical variation, and help drive better patient outcomes. Previously, Chris was assistant vice president and business unit leader for HPG/HCA. He has presented at numerous healthcare forums on topics that include disruptive innovation, physician engagement, shifting reimbursement models, cost per clinical episode and the future of supply chain delivery.

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