How important are metrics in the ASC community? You need to only review the Oct. 11, 2010, letter to the Department of Health and Human Services from the ASC Association, ASC Advocacy Committee and ASC Quality Collaboration[1] to see the potential impact on the industry's future based on the trend of measuring and reporting quality data for standardized measures in patient care. Highlights include the following:
- More than 22 million procedures are performed in some 5,300 ASCs in the United States.
- Every procedure performed in an ASC saves the Medicare program more than 40 percent, and usually saves the Medicare beneficiaries between 50-60 percent on their co-payments.
- Current voluntary collecting and reporting of quality data metrics shows that "ASCs have low rates of medical error and few complications related to common procedures performed in outpatient settings."
This letter goes on to outline the importance of how ASCs will meet the needs of expanded preventative care service objectives, while leading the efforts in collecting and reporting patient data on delivering high quality care. These efforts will help refine the continued development of best practices for patient safety and care, and the move towards pay-for-performance reimbursement. Further, these measures will continue to guide the focus of the ASC industry on access to quality care and promoting efficiency in the services.
There are a number of surveying and benchmarking firms and resources that can support or complement your current quality data programs. The GI Quality Improvement Consortium (www.giquic.org) has launched its project to collect quality indicators for colonoscopies, and will launch modules for EGD, ERCP and EUS procedures. Data can be submitted using an electronic report writer or an electronic data collection form and is based on real-time clinical data. Measures include:
- historical and physical documentation;
- informed consent documentation including potential complications;
- adequacy of bowel prep;
- written discharge instructions;
- ASA category documentation;
- indications documentation;
- cecal intubation rate with photo documentation;
- adenoma detection rate;
- polyp morphology description;
- polyp size description;
- withdraw times; and
- adverse events.
Customized reports and benchmarks comparing performance against other groups regionally and nationally will provide peer-based evaluations and opportunities to support quality improvement programs. These documented performance and quality improvement measures could support the various ASC society's quality and value incentive recommendations.
Center performance metrics
There's an endless number of metrics to help identify areas that can improve center efficiency and increase profitability from both an operations and financial review. Although we rely on balance-sheet reporting to understand the bottom-line of our efforts, the key indicator in center performance is the patient. Breaking this notion down further, patient volume data provides the baseline for current performance reporting, while measuring and responding to patient satisfaction metrics provides an outlook to future center performance.
Patient volume and utilization metrics establish the baseline for many other key measurements:
- Staffing and center resources
- Accessories, supplies and drug costs per case
- Equipment repair and replacement costs
- Room time per case
- Rooms in operation per day
The common denominator in all of these performance indicators is patient volume. Some of these metrics are easy to gather and review in order to determine the efficiency and performance of your ASC:
- Number of patients per month, per doctor
- Schedule and block time utilization statistics
- Referring physician trends
- Recall program effectiveness
While there is constant discussion on ways to improve efficiency and cost controls, addressing center procedure volume performance tends to be a more sensitive topic. Although there are no easy solutions for improving capacity, sharing performance results each month and evaluating historic patient and procedure volume trends can highlight opportunities for change and improvement.
Patient satisfaction performance metrics
The patient experience, generally measured on a scale of "strongly agree" to "strongly disagree," at the conclusion of the procedure, really does have a more expanded process start and end time. Just as important as knowing why the patient selected the facility is will they recommend the doctor and facility. Again, patient satisfaction metrics provide an outlook to future center performance. Besides communicating results internally to the physicians, clinical and administrative staff, the results should also be shared with the referral sources, your practice staff and in community outreach and marketing programs. And if it is not on your radar already, gaining insight from the person accompanying the patient is just as valuable, plus adds another referral source, or a potential patient for your center. Consider questions that encompass the entire patient experience:
- Why/how did the patient select your ASC?
- Were the pre-procedure instructions clear?
- What was the wait time based on your instructed arrival time?
- What was the appearance of the facility — ASC, waiting room, clinical area, etc?
- How competent and courteous was the staff — reception, nursing, anesthesia, physician?
- Were the discharge instructions clear?
- Did you receive a follow-up call?
As most centers report participation in some form of patient satisfaction survey, they also report minimal patient participation and response levels. If scripted properly, the follow-up call can also be an opportune time to ask several key questions that gather patient feedback — and increase the patient response results.
How do you use the data?
Beyond capturing data, what are your plans to use the findings to effect change in the operation and delivery of services, and/or validate changes you have made toward best-practice solutions? Comparing the metrics and benchmarks to your own facility over regular intervals examines and reinforces your commitment to process improvement. Additionally, using national benchmarking data for comparisons to other like ASCs identifies areas for improvement and highlights areas where your center excels. Sharing the results with everyone in your center promotes your ongoing commitment to process improvement, staff fulfillment and patient satisfaction.
Frank D. Principati is chief operating officer for Physicians Endoscopy. Mr. Principati joined Physicians Endoscopy in June 2010, and has a background in various operations roles in the healthcare and information solutions industries. Prior to PE, he was a division president at AmSurg. Over a five-year period, he led the growth and expansion in developing a regional office in the northeast. Prior to AmSurg, Mr. Principati was the senior vice president of operations at Thomson Scientific & Healthcare in Philadelphia for 10 years. He was primarily responsible for coordinating worldwide strategies for various operations, support and service groups. He also served in an interim role as the general manager for Derwent North America during this time. He can be reached at fprincipati@endocenters.com.
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