According to the National Center for Health Statistics, 35 million procedures are performed in outpatient settings annually. When most people think of “outpatient,” the procedures that typically come to mind are sports related injuries like knee meniscus or shoulder rotator-cuff repair. However, the reality is that even advanced surgeries have moved out of inpatient settings. In fact, Blue Cross Blue Shield recently reported that 82% of spine surgeries are now performed in an outpatient setting. Unfortunately for patients wondering about the quality of outcomes from outpatient surgeons or facilities, there is nowhere to turn because the data simply does not exist.
Quality Transparency: An Industry Movement
Earlier this month, when the Centers for Medicare and Medicaid Services (CMS) announced they will release quality metrics for Ambulatory Surgical Centers (ASCs), we were delighted. We believe this effort is another beacon shedding light on a darkened corner of healthcare quality.
While CMS took an important first step, their set of metrics require consumers to interpret the results and make complex trade offs. They fell short of giving people an integrated score from which to make decisions. In parallel with the CMS, MPIRICA has been working with our exclusive healthcare analytics partner, MPA Healthcare Solutions, to provide consumers with a single, easy to comprehend score for making educated healthcare decisions around outpatient surgery.
The Wild West of Outpatient Care?
After the high profile death of comedian Joan Rivers from what CNN calls a “minor elective surgery,” the perceived safety of outpatient procedures, as a whole, came into question. Some might say that the space of outpatient surgery is still untamed: costs, quality information, and patient-safety history are not always available and can be highly variable. Additionally, there are variations in regulations between different types of facilities, and best practices are not always implemented. Given the large volume of outpatient procedures, the Hospital & Health Network concluded that lapses in best practices “means that in aggregate, a substantial number of incidents [still] occur.” It’s how Joan Rivers, and patients like you and me, die from routine procedures.
For consumers, outpatient care is more convenient and saves time. To payers, outpatient care is more cost effective. So it should come as no surprise that the trend points to more surgeries moving to outpatient facilities. This has generally been seen as a positive development in health care; according to Sandra R. Hernández, President & Chief Executive Officer of the California Healthcare Foundation, it’s a trend “that reflects advances in science, technology, and consumer preferences.”
Yet we can’t ignore the reality that consumers still don’t have a clear grasp of the risks and complexities of their outpatient treatment. This goes double for advanced procedures like hip replacement and spine surgery. These surgeries are not trivial and can have serious consequences. The lack of unified regulation or central governing body, and the lack of outcomes data are just some of a myriad of hurdles facing consumers wanting access to quality metrics when choosing outpatient surgical centers.
Wild wild west, indeed.
The New (Deputy) Sheriff in Town
If the outpatient surgery landscape is the wild west, then MPIRICA is the new sheriff’s deputy in town. As always, we pose a very simple question: “how can patients and families research the quality of these centers before scheduling a procedure?”
Dr. Kevin Bozic, MD of the Dell Medical School in Austin, Texas recently lamented in a session at South by Southwest Interactive that without objective quality measures, the next best thing is to ask your grandmother! But while your grandma may have the wisdom of decades, her recommendations are likely based one (or a handful, at most) experience(s), which is a miniscule percentage of the total cases a provider might have performed. When it comes to an accurate measure of provider quality, there is simply no substitute for analysing hundreds (or even thousands) of cases over multiple years. That’s what we’ve done with each provider of the outpatient procedures we cover.
As you can see from the news release, we expect to release our outpatient scores for physicians and hospitals this quarter, which cover more than 1,000 additional procedures in the following categories: Anorectal, Arthroscopic Knee Procedure, Back and Neck, Breast Biopsy, Foot and Toe, Hand and Fingers, Hernia, Eye Surgery, Gall Bladder Surgery, Kidney Stones Removal, Pacemaker, Percutaneous Cardiac Intervention (PCI), Prostate Surgery, Upper Extremity Orthopedics, and Ventral Hernia Repair.
Patients can use these scores to select the best outpatient provider, and rest assured that the wild west will become a little less wild and a lot less deadly.