By William Prentice, ASCA CEO
In my last column, I talked about the importance of identifying, capturing and using quality measures for all sites of service. I discussed the ASC industry’s unique experience with quality measures, from the collaborative development of a quality program through the ASC Quality Collaboration (ASC QC) to the difficulties comparing the quality data ASCs report to quality data from others.
Now, I’d like to share some of the data we have seen recently that presents compelling evidence that ASCs offer a quality of care that is on par with, and often superior to, the care available from other outpatient surgery providers.
Please keep in mind that while I am sharing data regarding quality here, to determine value, you need to look at quality and cost. Multiple studies show that ASCs provide significant cost savings to both the federal government and commercial payers. This is important. Even if ASCs could demonstrate only that they provide equal, rather than exceptional, quality performance relative to other outpatient settings, they would still represent remarkable potential for tremendous cost savings in the U.S. health care system. The studies I am discussing here are just one piece of what health care professionals, policymakers and business managers need to know to understand ASCs’ overall value proposition.
Let’s begin with a study published last December in the Journal of Health Economics. That study looked at patient outcomes in ASCs vs. hospital outpatient departments (HOPDs). The researchers found that patients undergoing procedures in an ASC were less likely to experience a subsequent inpatient hospital admission than those who underwent the same procedure in HOPD. Not only that, a reduction in post-procedure adverse events was seen in patients at all risk levels, leading the authors to conclude that there is “no evidence that patients of any risk level … are made worse off by treatment in ASCs.”
A study published in Health Services Insights in April 2017 found similar results. Using private claims for 88 outpatient procedures, the authors found ASCs to have a significantly lower risk-adjusted readmission rate after procedures than physician offices or HOPDs. In particular, the researchers found, patients who undergo surgery in an HOPD are twice as likely to require a hospital readmission within seven days of their procedure than patients who undergo the same procedure in an ASC.
Recently, there has been a great deal of discussion about total joint procedures moving to the outpatient space. ASCA was encouraged by CMS’ movement of total knee arthroscopy (TKA) off the Medicare inpatient-only payable list in their CY 2018 OPPS Final Rule – a signal of federal recognition that such procedures will eventually be eligible for reimbursement in ASCs. Quality and outcome data supports that movement. For example, a February 2017 study in the Journal of Elbow Surgery examined a sample of patients undergoing total shoulder arthroplasty (TSA) in an ASC against a similar sample (in age and comorbidities) in a traditional inpatient setting. The study found no significant difference in complication rates and concluded that “outpatient TSA is a safe alternative to hospital admission in appropriately selected patients.” Another recent study published in the Journal of Arthroplasty concluded that “TKA can be performed safely as an outpatient [procedure] … with a complication rate similar to an inpatient stay.”
I mentioned that we are just at the beginning of understanding the exceptional value and quality of care ASCs provide, and I’ll end on a study that represents that idea nicely. A literature review published in March in Neurosurgery, the official journal of the Congress of Neurological Surgeons, systematically reviewed any clinical studies that dealt with morbidity or outcomes for certain major spine procedures from the last 25 years. After reviewing all the available literature, the authors conclude that there exists a “plethora of real-world clinical data [that] creates a formidable argument for serious investments in ASCs for multiple spine procedures.” Though they caution that further understanding patient selection will be key, the authors nonetheless see “robust and growing” evidence for the safety and utility of outpatient spine procedures in ASCs.
These studies illustrate what many health care providers and health policy makers have known, intuitively, for a long time. It makes sense that by focusing on a smaller number of outpatient procedures ASCs can find greater quality, efficiency and savings than sites of service that are responsible for delivering wide-ranging care. Everyone who takes an interest in health care policy – including patients, insurers and state and federal government officials – can also see massive untapped potential for a greater diversity of procedures, greater savings and greater patient satisfaction yet to come.
At ASCA, we are encouraged to see a growing number of independent researchers delve into ASC quality data in recent years and hope to see that trend continue as the volume and range of procedures performed in ASCs continues to grow.
We look forward to seeing what future researchers will be able to discover as ASCs and outpatient surgery continue to become ever more prominent parts of the American health care system.
William Prentice is the Chief Executive Officer for the Ambulatory Surgery Center Association