August 9, 2017
Ambulatory surgery centers are currently evaluated by the Centers for Medicare & Medicaid Services (CMS) on as many as 12 quality metrics. ASCs that do not meet the reporting requirements associated with these quality metrics can be penalized with up to a 2 percent reduction in their annual ASC payment update. In July 2017, CMS issued a proposal for an additional ASC quality metric to be added to the existing metrics. This new metric would measure the quality of general surgery procedures performed at ASCs using unplanned hospital visits within seven days of surgery.
WHAT IS ENVISIONED FOR THE NEW QUALITY METRIC?
Hospital visit rates following outpatient surgery are estimated to vary nationally from 0.5 to 9 percent and can differ based on the type of surgery, outcome measured, and time frame for measurement after surgery. For calendar year 2015, the median national observed hospitalization rate for patients receiving general surgery at an ASC was 2.2 percent, which included emergency department (ED) visits and unplanned inpatient admissions.  Post-surgical hospitalization rates vary among ASCs, which suggests a variation by facility in care and support provided to patients both during and after surgery and discharge from the ASC. The intention for the new quality metric would be to improve transparency, inform patients and providers, and improve quality. 
Envisioned details related to the metric include the following:
- The metric would measure ED visits, observation stays, and unplanned inpatient admissions within seven days of general surgery in an ASC.
- The model used to calculate the metric would adjust for factors that impact surgical outcomes, such as age, surgical complexity, type of surgery, and patient comorbidities. Each ASC would be evaluated on observed versus expected cases specific to that ASC. Both observed and expected hospitalization rates would be calculated with consideration of these factors on a center-specific basis.
- The measure score would be called risk-standardized hospital visit rate (RSHVR).
WHY IS THIS NEW METRIC NEEDED?
Many ASCs have no visibility into their patients’ acute care visits post-surgery, as patients very often seek treatment at hospitals that have no affiliation with the ASC where their surgery was performed. Additionally, very few of the existing ASC quality metrics measure quality across the broad spectrum of patients who are treated at ASCs. Several of the current quality metrics focus on patient safety factors that are relatively rare, such as wrong-site or wrong-side surgeries, or patient burns. These metrics are less likely to address outcomes across all ASC patients. The new metric is considered a strong quality indicator because it would capture a range of post-surgical issues that can result in hospital visits, from minor complaints such as nausea and uncontrolled pain to serious complications such as infection and septicemia. The hope is that measuring these hospital visits would provide ASCs with important information regarding their patients’ post-surgical experiences and also incentivize facilities to make every effort to put protocols in place to help reduce these unplanned hospital visits.
HOW COULD THIS IMPACT ASC VALUES?
If implemented, this metric would provide patients, providers, and the general public with additional visibility into the quality of care provided at specific ASCs. From a valuation perspective, this would be useful information for several stakeholders, as it would highlight areas for improvement for ASCs that may struggle with achieving high scores relative to this metric, as well as provide an additional performance measure to consider for any ASC valuation. ASCs have generally performed well against the existing quality metrics. If positive performance against this metric was achieved by the industry, it could be an additional driver of surgical volumes to ASCs, which would have positive implications for ASC values. If specific ASCs perform poorly against the metric, it would likely have detrimental effects on value if patients seek treatment elsewhere due to perceived poor quality.
Additional information, as well as the paper that was the basis of this article, can be found by visiting: https://tinyurl.com/y8x2mb2z
 Hospital Visits After General Surgery Procedures Performed at Ambulatory Surgical Centers; Measure Technical Report: Public Comment. Submitted by: Yale New Haven Health Services Corporation — Center for Outcomes Research and Evaluation (CORE). Prepared for CMS. July 3, 2017