The Leapfrog Group is branching out beyond hospital ratings with plans to launch a survey of 250 ASCs in 2019 before opening it up to the nation's 5,000-plus centers in 2020.
The Leapfrog Group President and CEO Leah Binder spoke with Becker's ASC Review about the decision to expand its ratings to hospital outpatient departments and ASCs, and outlined what ASCs can expect as the survey rolls out.
Note: Responses have been lightly edited for style and length.
Question: Why did you extend the survey to the outpatient setting?
Leah Binder: Estimates are that 60 percent of surgeries are now performed either in the outpatient setting or in ASCs. There's been an enormous growth over the past decade or so. Our constituency of employers and other purchasers are very interested in this phenomenon since they pay for these surgeries. We feel we don't have enough information on the quality and safety of the [centers], so Leapfrog has decided to go out and get the information we need.
Q: How will the outpatient and ASC surveys be formatted?
LB: The outpatient survey is actually going to be part of the overall Leapfrog Hospital Survey. It will be a new section of the survey. … We collect information on infections and the use of [computerized physician order entry] and barcoding. A lot of that will likely apply to outpatient surgical settings as well within the same hospital. But we will also be asking specific questions about the outpatient surgical units — the safety and quality of care delivered — that we don't ask currently. We will have a completely separate survey for ASCs because the quality monitoring is done in very separate silos right now, so we've had to separate out the two instruments for collecting data. Our intention is to collect similar data [to what] we'll get from the Leapfrog Hospital Survey so we can offer consumers information to compare the same procedure offered either at a hospital outpatient department or an ASC.
Q: What are the benefits of gathering this kind of safety data for outpatient facilities?
LB: It's important to us that healthcare providers compete on the basis of their quality and safety — that they try to improve on their quality and safety in order to attract patients. ... That's been Leapfrog's goal from the day we were founded in 2000. By publicly reporting on the quality and safety of outpatient and ambulatory surgery, we hope consumers and purchasers will pay attention to that information before they make a decision on where to seek their care, and that will drive a market for the highest performing providers.
Q: How can participating in the survey benefit ASCs?
LB: Many purchasers and plans use Leapfrog [Hospital Survey] data for value-based purchasing and reporting to their own employees or enrollees. Leapfrog is very much a part of what purchasers are doing to improve care for the people they purchase healthcare for. This will extend that same model to the outpatient and ambulatory setting. The purchasers themselves have really driven this. They are the ones that came to Leapfrog and asked us to please extend our survey reporting to these settings because so many of their employees are going to ambulatory and outpatient services, and they want to be sure they're getting safe care. [ASCs will] be making themselves visible to hundreds of purchasers and health plans across the country and they'll be either publicly reported as options for networks selected by purchasers, or otherwise used in benefits design or contracting. Leapfrog has a very strong role in purchaser decision-making, and this is a way for hospitals and ASCs to get in front of that market.
Q: What has the response been like so far in terms of volunteers for the pilot surveys (which will be launched in January 2019)? Are ASCs and HOPDs embracing the news of the expansion?
LB: We've been very pleasantly surprised by the number of volunteers for our pilot. In fact, we may have to close our pilot soon because I think we're almost at the maximum. We're also pleased with the response from the ambulatory surgery community. They've been open to transparency and open to independent evaluation of their quality. It tells us they want to play ball in a truly competitive marketplace, and they're willing to be transparent to make that happen. It's really encouraging to see that.
Q: What challenges do you anticipate in rolling out the survey?
LB: The first thing is the federal government has not advanced very far in developing good measures and reporting on safety and quality for ASCs or even outpatient surgery. … The second issue is it's very important to us that we understand where commercially insured populations are going, where working Americans are seeking care. There's relatively little data on where they're seeking care from ASCs and even outpatient surgery. We're going to rely on centers to come forward themselves to be sure they're accounted for among options for the commercially insured population.
Q: What else do you want practice leaders to know about the survey and how it will implemented when it's officially launched in April 2019?
LB: I want to encourage them — even if they're not able to submit the first year's survey, which is capped at 250 — to look at the survey, give us feedback and think about how they will respond the following year when we will open it up for more responses. One area where we want to encourage all ASCs to be prepared is to participate with the CDC's National Healthcare Safety Network. We will be asking them to sign up to participate with NHSN, and we'll be asking for their data from NHSN. … That's something ASCs can start thinking about now.
Q: How can ASCs provide feedback about the survey?
LB: In April [2019], they can give us feedback on our help desk line. Prior to that, we will likely be putting out proposed parts of the survey. There'll be opportunities that we'll be reaching out to the community to look for feedback at different moments prior to putting out the final survey.
Every year, we update our survey [so it's] reflecting the latest science. ... We have a contract with [Baltimore-based] Johns Hopkins Medicine. They do a lot of the research on all the latest literature, peer reviewed studies that come up during the year, and they propose to us if there are new measures or issues we ought to look at for the survey. They've done that for the hospital survey, and they will also be doing that for the new section on the hospital survey, as well as the ASC survey. Leapfrog has a reputation for crossing t's and dotting i's on our science. We feel very strongly about the scientific integrity of our survey and our transparency. So, we will always explain exactly what we're measuring, why we're measuring it and how we're measuring it — how we rate, what our standards are. We are very transparent about our entire process, fair to providers and independent.