Becker's ASC Review

18 Thought Leadership Leapfrog's inaugural ASC survey 'disheartening,' has 'little value,' administrators say By Angie Stewart W ith more than 60 percent of surgeries taking place in ASCs and outpatient units, e Leapfrog Group decided earlier this year to begin collecting quality and safety data on the increas- ingly popular facilities. Initially, the effort was met with enthusiasm. Leapfrog received "endless phone calls" from ASCs wanting to participate in Leapfrog's voluntary survey, indicating they were "anxious to show their value in the open marketplace," Leapfrog President and CEO Leah Binder told Becker's ASC Review at the time. William Prentice, president and CEO of the Ambulatory Sur- gery Center Association, said the survey could be another oppor- tunity to support price and quality transparency, although he had "some misgivings" about whether Leapfrog would render judgment without sufficient data. Leapfrog launched the ASC survey April 1, along with a section for hospital outpatient departments on its hospital survey, which has been as- sessing inpatient care for nearly 20 years. By the Aug. 31 deadline, Leapfrog received submissions from 321 ASCs. In October, Leapfrog compiled the data and presented it alongside data from 1,141 HOPD respondents. In an executive summary of the findings, Leapfrog highlighted what it called "gaps" in board certification among ASCs and HOPDs; low adoption of antimicrobial stewardship among ASCs; and low imple- mentation of electronic hand monitoring in both settings. ese were just a few of the conclusions ASC administrators took issue with, despite earlier excitement about the survey. ose interviewed by Becker's ASC Review over several weeks expressed numerous concerns about the survey's methodology and value. Setting standards While Ms. Binder told Becker's ASC Review that Leapfrog was pleased with the number of ASC respondents — which exceeded the initial goal of 250 — Mr. Prentice noted that the data represents a small frac- tion of the 5,800-plus Medicare-certified ASCs in the U.S. He and others also criticized the makeup of the panel of experts who helped develop the survey. Panelists included physicians and leaders from Pittsburgh-based UPMC, Baltimore-based Johns Hopkins and national nurse organizations, but none held ASC-specific titles. According to Michael McClain, executive director of ASCs at Renton, Wash.-based Providence St. Joseph Health and former executive director at Seattle-based Proliance Orthopedic Associates, the panel's composition contributed to "incredibly acute care-centered" questions that relied on standards common in the hospital outpatient setting but not in an ASC. "I don't think it necessarily reflected the differences in how we provide care, how patients are screened, the patient type or technology type, and staffing models that sit in the ASC," he said. ere were differences between the ASC and HOPD surveys, but for the most part, Leapfrog kept questions the same, according to Ms. Binder. As a standards-setting body, she said, Leapfrog included questions that went beyond minimum requirements to be accepted in the field. "We tried to keep them as uniform as possible because we want con- sumers to be able to compare places where they might seek same-day surgery," Ms. Binder said. "So, whether it's an ASC or a hospital, they should, for example, expect to have someone with advanced life sup- port on site." Leapfrog also chose to highlight board certification across both set- tings, citing a correlation between board certification and infection control. However, Mr. Prentice questioned whether there's evidence that board certification and other measures Leapfrog highlighted actu- ally translate to better outcomes. "I'm sure there is a surgery center or a hospital out there that doesn't have board-certified surgeons providing care, and they've had excel- lent outcomes. And there's another where there are board-certified surgeons, and they have had bad outcomes," he said. Patient safety indicators Leapfrog's goal was to gather data useful to employers, as well as to patients shopping for care, according to Ms. Binder. "We're asking about the factors that we consider critical to a high- quality surgical experience, whether you're at an ASC or a hospital," she said. "What Leapfrog is saying on behalf of employers is we'd like ASCs and hospitals to be putting all efforts [into what] we see as the gold standard." Because of this approach, some questions dealt with rules and regula- tions that haven't been required in ASCs — or, in some cases, HOPDs. For instance, Leapfrog reported that adoption of safe practices en- dorsed by the National Quality Forum was higher among HOPDs, but that it's "likely because hospitals have been asked to comply with these practices for many years," the report states. Compared to hospitals, ASCs also reported lower compliance with Leapfrog's nine-item Never Events Policy, which Leapfrog has been asking hospitals to adopt since 2007. Other survey questions related to patient safety revealed that only 18 percent of ASC respondents had an antimicro- bial stewardship program in place, compared to 93 percent of hospitals. It was "disheartening" to see these kinds of questions that catered more to resource-heavy hospital settings, said Suzi Walton, administrator of Columbus-based Ohio Surgery Center. "Some things they were asking to be done were far past regulation, like antimicrobial program requirements," she said. "ere's not a single evidence-based [antimicrobial] program needed in the ASC. It's le out of [e Joint Commission's] sentinel alert." Ms. Walton was referring to e Joint Commission's antimicrobial stewardship requirements set to take effect in 2020; the accrediting body explicitly stated that the requirements are not applicable to ASCs. Information on antimicrobial stewardship wasn't available for HOPDs due to a lack of reporting tools, so ASCs were compared to hospitals. Ninety-three percent of hospitals, which use far more antibiotics than ASCs, had adopted a program to promote appropriate antimicrobial use. Patient experience measures ASCs were also compared to HOPDs on patient satisfaction, but Leapfrog's report focused on the questionnaire used rather than the actual scores. e group found that fewer ASCs than HOPDs reported administering e

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