ASCs Persevere for Quality … Even in the Face of Budget Cuts

Even as ambulatory surgery centers (ASCs) face additional cuts in the 2009 budget proposal sent to Congress by President Bush, owners and operators are preparing for compliance with new quality reporting requirements imposed by the Centers for Medicare & Medicaid Services (CMS). In final rules implementing a new payment system for surgical services provided by ASCs, CMS proposed that ASCs that fail to report on a set of quality measures have their annual inflationary “market basket” payment updates reduced by 2 percent. Thanks to several ASC industry groups’ continued push toward consensus on ASC-specific quality measures, CMS has delayed implementation of the quality reporting requirements until 2009.

The ASC Quality Collaboration, which was formed several years ago to address quality issues in the ambulatory care environment, drafted five ASC-specific quality-of-care measures it hopes will become part of the new CMS quality reporting requirements, says Donna Slosburg, coordinator of the ASC Quality Collaboration. These quality measures, endorsed by the National Quality Forum (NQF) last November, are national voluntary consensus standards that address patient falls, patient burns, hospital transfers and admissions, wrong-site/wrong-side/wrong-patient/wrong-procedure/wrong-implant surgeries and timing of the administration of intravenous prophylactic antibiotics to fight surgical site infections.

“The next step will be to educate surgery center staff all over the country on the measures and how to collect the (quality) data so we are all collecting the same information,” says Beverly A. Kirchner, RN, BSN, CNOR, CASC, who serves on the ASC Quality Collaboration’s experts group. Kirchner reports that the Association of periOperative Registered Nurses (AORN) has partnered with other professional organizations to develop consensus quality indicators to measure ASCs’ performance. The ASC Quality Collaboration says it anticipates these measures will be in the public domain and used in discussion on pay-for-performance, responding to state data collection initiatives, collaborating with payors and others in providing consumer information, and benchmarking information primarily for quality improvement goals in individual ASCs.

These measures come at a time when acute attention is being placed upon making healthcare more transparent, championing patient safety, and eradicating medical errors and adverse events. The 2008 National Patient Safety Goals from The Joint Commission speak to the imperatives of improving patient identification and the effectiveness of communication among caregivers, as well as improving the accuracy of medication dispensing, reducing the risk of healthcare-acquired infections, and encouraging the patient to become more involved in his/her care, among other goals. Robert M. Wachter, MD, a professor of medicine, chief of the medical service and chair of the patient safety committee at University of California, San Francisco (UCSF) Medical Center, says that awareness is the first step in embracing a new emphasis on patient safety and quality improvement. “Beginning with the publication of the Institute of Medicine report on medical errors in 2000, we now recognize how serious the problem of medical errors is — how many people are harmed and killed each year from medical mistakes,” Wachter says. “We also have discovered that our old approach to errors — just try to be really, really careful — was hopelessly flawed.”

Wachter advocates for teamwork in the fight for patient safety. “We finally have come to understand that healthcare is a team sport, and that having a system that depends on the perfection of humans is not a safety system,” he says. “Rather, safe care only happens when competent providers function as members of a team, when thoughtful rules and standards are followed, when information technology is leveraged to help when it can, and when everybody knows that they are one slip or bad break away from a devastating error. I advise (caregivers) to speak up when they think something is wrong — not just when they know something is wrong — and to look for error-prone situations and see them as opportunities for improvements, not workarounds.” 

Until next month, 

Kelly M. Pyrek 
Group Editor, Virgo Publishing Medical Group 
kpyrek@vpico.com 

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