By Bill Prentice
As the Democratic presidential candidates continue to define their plans for delivering affordable, accessible healthcare and members of Congress on both sides of the aisle continue to explore ways to cut the cost of that care without sacrificing quality, ways of assessing and reporting healthcare quality continue to make headline news.
President Donald Trump intensified the focus on quality data collection and use back in June when he issued an executive order calling for creation of a “Health Quality Roadmap” and a set of reforms intended to make more meaningful price and quality information more broadly available to more Americans. His intent, according to the order, is “to enhance the ability of patients to choose the healthcare that is best for them.”
ASCs have long shared this goal and are continuing to do their part to refine existing programs and test new tools and techniques that can lead to greater success. One example of the work being done is the sixth annual conference of the ASC Quality Collaboration that convened in Washington, DC, this summer. This meeting brings together a wide-ranging group of stakeholders that, this year, included ASC owners and operators, health information technology vendors, physicians and representatives of several federal regulatory agencies, accreditation organizations and quality groups. The diversity of the group and the willingness of so many to return year after year to report on the progress they have made and learn from what others have achieved is testament to the ASC community’s ongoing commitment to improving the quality of care ASCs provide.
Important updates delivered at this year’s meeting include the following:
A status report on the Centers for Medicare & Medicaid Services (CMS) Outpatient and Ambulatory Surgery Survey Consumer Assessment of Healthcare Providers and Systems (OAS CAHPS) survey indicated that, in response to concerns expressed by the ASC community, the agency is conducting a survey mode experiment for the survey. Until this test, which incorporates an electronic version of the survey, is complete and the results evaluated, the survey will not be made mandatory in the ASC space.
Missy Danforth, vice president of Health Care Ratings at the Leapfrog Group, reported that the organization’s new ASC survey on patient safety and quality is proceeding as planned and is on pace to involve more than 250, and as many as 500, ASCs this year. She indicated that results for individual facilities that participated in the 2019 survey will not be made public and pointed to the value of the survey results in internal, facility-level benchmarking, value-based purchasing and quality improvement. At this time, she added, Leapfrog plans to publish results publicly for the first time in 2020 and has no plans at this time to assign letter grades to ASCs that participate in the survey as it has done for hospitals that participated in its original survey in the past. For more information on the Leapfrog Group’s ASC Survey, read a Q&A with ASCA Chief Executive Officer Bill Prentice.
Dan Pollock, MD, surveillance branch chief for the Centers for Disease Control and Prevention’s (CDC) Division of Healthcare Quality Promotion (DHQP) presented on the new CDC protocols regarding surveillance for surgical site infections (SSI). In January 2019, the CDC issued new guidance for ASCs that moved SSI surveillance under the Outpatient Procedure Component (OPC) of the National Health Safety Network (NHSN). SSIs account for an estimated annual cost of $3.3 billion and 1 million additional inpatient days, according to the CDC. A handful of states—Colorado, Nevada, New Hampshire, New Jersey and Texas—currently require SSI reporting. These states must report data manually via the NHSN web portal, but Pollock mentioned that CDC hopes to move to electronic health record (EHR) upload reporting if health IT continues to expand in the ASC space.
Some of the current challenges to meaningful quality data collection that meeting participants identified included:
- reducing the reporting burden ASCs face while the amount of data being collected continues to grow
- combatting survey fatigue as increasing numbers of product and service providers continue to institute surveys of every kind
- equalizing reporting requirements for the providers of comparable services
- defining the most important, most useful measures
- collecting survey responses from patients
Much work remains before anyone will know for certain what changes President Trump’s executive order will incite or which presidential candidate’s healthcare proposals will be adopted. Meanwhile, ASCs will continue the work they started decades ago, working inside their own facilities, with nationally recognized researchers and on Capitol Hill, to support all outpatient surgery providers in collecting relevant data and delivering user-friendly reports that give consumers the information they need to make meaningful comparisons and wise choices about where to obtain the healthcare they need.