Leapfrog Opens Up Survey About Ambulatory Surgery Center Quality

There are more same-day surgeries that take place in ambulatory surgery centers (ASCs) rather than hospitals, due to factors such as payer preference and patient preference. But although information about the quality of hospitals can be researched through various websites, information about ASCs is not as easy to come by.

Medicare includes data sets (national, state, and facility) collected through its Ambulatory Surgical Center Quality Reporting (ASCQR) Program, but the information is not presented in a way that is intuitive for the average consumer to understand and use. In addition, the ASC information is not as robust as what Medicare requires for its Hospital Compare site.

To that end, the Leapfrog Group has launched its first annual ASC survey on patient safety and quality. The survey opened April 1 and ends November 30. Like Leapfrog Group’s hospital survey, the ASC survey is voluntary.

Erica Mobley, Leapfrog Group’s director of operations, said in an interview with The American Journal of Managed Care^® that taking the survey will give ASCs the opportunity to benchmark their progress in improving the care they deliver.

“We have been talking about expanding the survey for at least 5 years,” she said. Their board recognized that this was a gap that had to be filled, she said. “We recognized that no one else has been doing it.”

Leapfrog created the survey and the supporting documents with a panel of experts who identified key areas to be addressed, Mobley said.

The survey goes beyond the ASCQR reporting required by Medicare, which asks about surgeries involving the wrong site, wrong side, wrong patient, wrong procedure, or wrong implant; patient burns or falls; or transfers to a hospital, among other things.

The information that Medicare does or does not require about surgery centers, as well as the mix of the level of detailed reporting required by states, was cited as a shortcoming last year in a series of articles by Kaiser Health News and USA Today. The reports found that since 2013, more than 260 patients died after care at centers that lacked appropriate lifesaving equipment, operated on very fragile patients, or sent patients home before they fully recovered.

The reports “certainly raised a lot of key issues that were already on our radar,” said Mobley.

The Leapfrog survey asks, for instance, whether or not there is a clinician trained in advanced cardiovascular life support available for both adults and children. It also asks about volume for specific procedures and what procedures are in place to follow up with patients after hours.

The survey also seeks information about how centers screen for high-risk patients. One 2013 study found that there are 7 indicators for patients who may be at risk for complications as an outpatient: overweight body mass index, obese body mass index, chronic obstructive pulmonary disease, history of transient ischemic attack/stroke, hypertension, previous cardiac surgical intervention, and prolonged operative time.¹

For the first year, however, individual centers will not be named when the report is written. Leapfrog will release an aggregate report, which will also include data about hospital outpatient facilities. For now, facilities that participate will get benchmarking information. In 2020, the report will identify individual centers.

Originally, Leapfrog was going to cap participation in the first year, but now it will keep it open. With more than 5000 ASCs in the country, Mobley said it is “tough to say” how many will participate.

The project has the support of the Ambulatory Surgery Center Association, which has its annual meeting in May in Nashville, but Mobey said that the trade association had no influence over content.

“We are looking forward to shedding light on the safety of care in these facilities which the public currently has little way of knowing,” she said.

Reference

Mathis MR, Naughton NN, Shanks AM, et al. Patient selection for day case-eligible surgery: identifying those at high risk for major complications. Anesthesiology. 2013;119(6):1310-1321. doi: 10.1097/ALN.0000000000000005.