Becker's ASC Review

19 Thought Leadership Consumer Assessment of Healthcare Providers and Systems Outpatient and Ambulatory Surgery Survey to collect patient-reported data. What Leapfrog didn't note, according to Mr. Prentice, is that the OAS CAHPS isn't required of surgery centers at the federal level — it was deter- mined to be too burdensome, at 37 questions long and entirely manual. "We thought there was a better way to do that and that there needed to be an electronic option. So we've been talking to CMS about trying to [develop one], and they're apparently pilot testing exactly that," Mr. Prentice said. At ASCs that use the OAS CAHPS, patients do tend to report higher satisfaction than HOPD patients, Leapfrog found. But if they're not using the OAS CAHPS, almost every ASC still sends out a patient satis- faction survey aer care is provided, Mr. Prentice said. Regardless, Leapfrog holds OAS CAHPS as a standard of care, advising both ASCs and HOPDs to prioritize it. A focus on processes e focus on processes instead of outcomes frustrated Mr. Prentice. "I believe the standard of care in the quality world is to focus more on outcomes rather than processes," he said. "So what we need through the CMS quality reporting program are more outcomes-based measures and measures that can be applied across settings." e focus on process didn't necessarily put ASCs in a bad light; across the board, more ASCs than off-campus HOPDs had transfer agreements and policies for patients requiring a higher level of care. But it didn't showcase the data that ASC administrators consider to be most valuable. "What I would find interesting, in terms of comparison, is use of the same-surgery checklist [and] measurements of perioperative time, OR time, hospital transfer, infection rates, falls, never events," said Mr. Mc- Clain of Providence. "I'd think we'd want to start by comparing things we're both held accountable to by regulatory and state organizations, then move to things that we can agree make sense to cover for both types of locations." Outcomes are largely absent from the survey because there's a lack of vetted and tested measures, according to Ms. Binder. e group looks for measures endorsed by the National Quality Forum, used by e Joint Commission or otherwise verified and tested in the field. "We are asking about things that are most important to safety and for which we can get good data. Unfortunately, we don't always have a good, fair measure. We can't ask about everything we want to ask about, infections being a very good example," Ms. Binder said. "Even though outcomes are a high priority, there are just not enough of those types of valid tested measures available for the survey yet." In the future, Leapfrog does plan to report on outpatient infections, Ms. Binder said. To make that happen, the group is asking ASCs to join the CDC National Healthcare Safety Network's Outpatient Procedure Component module. Ms. Binder also encouraged ASCs to help develop the type of vetted, tested measures that Leapfrog wants to incorporate. The next steps Since publishing its initial report, Leapfrog has collected late submissions from 19 ASCs and shared proposed changes to the 2020 ASC Hospital Survey, which it's asking stakeholders to comment on by Dec. 20. e proposed changes include new questions regarding participating in national clinical quality registries, new questions regarding safe opioid prescribing, and proposed scoring algorithms that will be used for pub- lic reporting on the individual facility level starting in July 2020. "Results will be published in a way that allows consumers, purchasers and payers to compare ASC and HOPD performance side by side," the organization's website states. With reservations about the survey's current value to patients and payers, Mr. Prentice said his organization will continue providing feedback. "We were hopeful upon hearing about e Leapfrog Group entering into this space that if they did it judiciously that this is something that the ASC community might be able to embrace if it actually resulted in good data that would be valuable to patients and payers about where to seek care," he said. "My concern is this survey doesn't yet do that." As is, the survey isn't necessarily damaging for ASCs, according to Mr. McClain. But if it remains an "apples-to-oranges" comparison, he said, "the survey has little value beyond outlining what we know is true: that hospital outpatient departments are different from ASCs." In the meantime, Jeffrey Flynn, the administrator of Gramercy Surgery Center in New York City, said members of the New York State Associa- tion of Ambulatory Surgery Centers, where he serves as vice president, were encouraged to sit out the survey or proceed with caution. Ms. Wal- ton, a member of the Ohio Association of Ambulatory Surgery Centers board of trustees, said centers should talk to their legal departments and boards about participation, while considering potential ramifications. "As an ASC community, any time we do anything that represents the community as a whole, take a strong look at it to see if this is benefit- ing the community or detracting from the community," she said. "It's not that we have something to hide, but [that] lack of participation will motivate change." n Regent CEO predicts 2020 ASC trends By Rachel Popa A fter a year of growth for ASCs in 2019, Regent Surgical Health's CEO Chris Bishop shared the trends he predicts will accelerate more industry growth this year. Three things to know: 1. Hospital outpatient department conversions to ASCs. Mr. Bishop predicts more of these departments will convert to ASCs, or partner with them in 2020, de- spite few conversions last year. 2. More partnerships with hospitals, new types of ASC cases. Mr. Bishop said the two fastest growing areas of growth heading into 2020 are hospital and ASC joint ventures and high acuity ASCs beginning to accommo- date cardiac, spine and joint replacement procedures. 3. Key trends affecting industry growth. The shift of cases to the ASC setting, CMS payment for knee replace- ments in ASCs in 2020, the addition of 12 cardiac codes for ASC reimbursement and CMS removing hip replace- ments from the inpatient-only list are key trends Mr. Bishop thinks will contribute to ASC growth in 2020. n

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