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Health Care Quality: A shared responsibility

By William Prentice

Regardless of the setting or specialty in which they work, health care providers continue to face a common challenge: measuring and communicating the quality of care they deliver in meaningful ways.

Done right from start to finish by all involved, quality reporting can drive improvement within a facility, help patients make informed decisions about their own health care and lead to advances in care that affect an entire specialty, practice setting or field of care. Done wrong, it can lead to confusion, mixed messages and public policies that place roadblocks in the path of progress and even cause or exacerbate the very problems they are trying to solve.

While it is easy to identify the results that health professionals, patients and policymakers want from measuring and reporting quality, finding the tools and techniques needed to achieve those goals is not so simple. Still, health professionals across the country remain committed to that ideal and continue to define and refine programs that collect and share data about the quality of health care available in the U.S.

The ASC community remains at the forefront of these efforts.

ASCs advocated for a national quality reporting program that they could use to help demonstrate the high-quality, high-value care they provide for nearly a decade before the Centers for Medicare & Medicaid Services (CMS) put a program in place in 2012. To help support the development of that national program, in 2006, the ASC community formed the ASC Quality Collaboration (ASC QC). Supporters of the new organization included many well-known ASC management companies, the ASCA Foundation, the Outpatient Ophthalmic Surgery Society and the Association for periOperative Registered Nurses. Both the Accreditation Association for Ambulatory Health Care and The Joint Commission also backed the group.

One of the ASC QC’s first priorities was to develop quality measures for the outpatient surgery setting that were tied in meaningful ways to both the range of services provided there and the highest standards of care. After careful study and a hand-in-hand effort with the National Quality Forum, which had prior experience developing comparable measures with other providers, the set of measures the ASC QC developed continues to serve as the basis for Medicare’s ASC Quality Reporting (ASCQR) Program. In 2018, that program entered its seventh year.

More than 95 percent of Medicare-certified ASCs continue to comply with this program’s reporting requirements each year. Some with experience managing and interpreting quality data consider the ASC quality reporting program to be better targeted to patient interests than some of the quality reporting programs introduced earlier since it contains a higher percentage of outcomes measures. Those measures look directly at patient results, unlike process measures, which focus on the way care is delivered.

Before the national ASCQR program could begin, the ASC QC also began aggregating quality data provided by nearly 1,500 ASCs representing every state except Vermont. That effort continues today, and results remain in line with those produced in the national program. Both programs find that the incidences of adverse events that occur in ASCs is extremely low.

Currently, comparing the quality data ASCs report with quality data from other outpatient settings remains difficult since the measures others report are rarely the same as those that ASCs report. Another complicating factor is that even where some overlap exists, the different processes used to collect the data deliver results that are not comparable. The ASC community continues to advocate for transparency in quality reporting and more standardized measures that will allow patients to compare sites of service more effectively.

Along with these quality reporting programs, work aimed at more fully investigating and demonstrating the quality of outpatient surgical care available to patients today continues in many other areas. For example, we continue to rely on and work with the accrediting bodies to define and evaluate health care quality. We also continue to rely on professional, peer-reviewed research to evaluate current standards of care and uncover trends.

To help build additional data banks that can be used to evaluate and improve quality, the ASC community continues to participate in and encourage others to participate in voluntary registries like the American Joint Replacement Registry (AJRR). Continuing support for all these efforts is essential if we are going to attain our goals.

Finally, whenever and wherever health care quality is discussed, everyone involved in those discussions – including patients, health professionals, insurers, policymakers and the media – has an obligation to use the health care data that is available to them responsibly. That means taking every possible precaution to maintain patient privacy, of course, but it also means managing and analyzing the available data carefully. Outliers need to be identified for what they are rather than used to inflame the conversation or sensationalize a story. Data needs to be collected and analyzed carefully, and context needs to be provided. Lessons learned need to be tested, re-evaluated and refined.

When it comes to measuring, reporting and talking about health care quality, the health care community’s work has just begun.

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