Assessing Ambulatory Service Centers

This article appears in the June 2012 issue of HealthLeaders magazine.

In just a few months, a patient may walk into an ambulatory surgery center, pull up the organization's quality metrics on his or her smartphone, and walk right back out.

That's because starting on October 1, 2012, a new Centers for Medicare & Medicaid Services rule created under the Patient Protection and Affordable Care Act will require any Medicare-eligible ASC to submit reports on five quality measures or face a 2% payment reduction. CMS has said it will publish surgical center quality scores as reported and risk adjusted on a new website, in the vein of Hospital Compare.

The initial five quality metrics are the number of 1) patient burns; 2) falls; 3) surgeries that are wrong site, wrong side, wrong patient, wrong procedure, or wrong implant; 4) surgeries requiring a hospital transfer or admission; and 5) the number of patients who did not receive an IV antibiotic within one or two hours before incision.

One year later, the list will include facility volume for some gastrointestinal, eye, nervous system, musculoskeletal, skin, and genito-urinary codes. And the year after that, the list expands further to the percentage of healthcare personnel who receive influenza vaccination.

Another 33 metrics are listed in the CMS rule as "under consideration" such as the extent of follow-up care a patient receives after leaving the center, visual loss, patient experience scores, certain measures governing cataract surgery, unplanned ICU admission, pneumothorax, systemic toxicity from local anesthetic, reintubation, anaphylaxis, transfusion reaction, and postdischarge emergency department visit within 72 hours.

Experts agree that, although this rule will cause major changes in the ASC marketplace, it will not drastically alter outcomes in the inpatient or outpatient setting.