Assessing Ambulatory Service Centers
Bon Secours surgical centers already track the five quality metrics that will be required this fall, but Priest says he is looking to focus on tracking clinical data rather than claims data.
"The problem we have with this is some of these pieces of data are from claims and it's not nearly as good as clinical data," he says. "We track clinical data on wrong-site surgery, antibiotics, and surgical infection rates—and there's a lot of work going on right now about how to reduce those or eliminate them."
At Catholic Health Partners, a Cincinnati-based 24-hospital healthcare system, the quality team uses a balanced scorecard that tracks operating efficiencies and quality metrics for ambulatory surgery. It also uses a Midas+ Solutions database consistent with what is collected for inpatients.
"We do expect the same level of quality and services in our ambulatory care centers as we do our inpatient surgical centers," says Marcia Messer, vice president of clinical transformation and nursing excellence. "We see the new metrics as contributing to consistency in quality outcomes and standard-of-care among inpatient and ASC settings."
As a result of the new rule, some wonder whether the industry will see a migration of increasingly risky procedures from the inpatient setting to outpatient facilities. But this migration has already begun, Priest says.
"I think we've already seen that, if you look at the procedures that were done in ambulatory centers in the past—going back eight or 10 years—and compare those procedures to what's done now," he says. "The complexity of the procedures will grow but the risk will be relatively low. When you get better in the hospital you can do it in the less monitored environment because we know how to mitigate the risk."
High case mix index patients will move to surgery centers, but the outcomes will continue to be very good because they don't move from inpatient to outpatient until physicians are comfortable to do it without all the resources in the hospital, Priest says.
For example, a gallbladder removal performed 20 years ago resulted in a large incision and a five- to seven-day hospitalization, plus another six to eight weeks of recovery, he says. But now, thanks to innovations like the laparoscope, the procedure can be done the same day.
"The same diagnosis has now moved from being a big long hospital stay to six or 10 hours," Priest says.
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