On April 24, the Des Moines Register published an article that raised questions regarding the oversight and potential licensure of ambulatory surgery centers and other healthcare providers in the state. Since the Des Moines Register is part of the Gannett media network, the article also appeared in a number of other Gannett newspapers across the country. The comments that follow provide insights from the Iowa Association of Ambulatory Surgery Centers (IAASC) on that article and the issues it raised.
Q: What is the IAASC's response to the Des Moines Register report?
IAASC: First, patients can rest assured that their health and safety is the highest priority in Iowa's ASC community. Through the state's certificate of need process, Medicare certification and the work of multiple accrediting bodies in the state, all of Iowa's ASCs are subject to rigorous independent oversight. The healthcare professionals who work in Iowa's ASCs are also licensed professionals, many of whom have sought advanced training and board certification in their specialties.
The standards that the various independent oversight organizations have adopted represent years of careful study and debate among a diverse group of healthcare professionals with years of experience and expertise. The accrediting process is also a mechanism for sharing best practices, examining the quality of care a health facility provides and introducing improvements, often in areas where outcomes data reports already indicate high quality care.
However, even the best can improve over time, especially when the rapid advances in technology that occur in the healthcare community each day are taken into consideration. Accordingly, each of the facilities identified in the report has already provided additional detailed information that might change the conclusions, as well as a number of remedial steps that are already being taken.
Q: What is the IAASC's position on licensing of surgery centers?
IAASC: To the extent that additional licensure could actually improve quality and patient outcomes in Iowa's ASCs, both IAASC and the national Ambulatory Surgery Center Association (ASCA) would support those efforts.
It is important to note, however, this is not the first time that the issue of licensing ASCs in Iowa has been raised. In the past, the individuals involved in those discussions agreed that the superior outcomes data reported by Iowa's ASC, coupled with the substantial amount of oversight already in place (certificate of need, Medicare certification, accreditation, professional licensure and more) were already effectively addressing the issue of independent oversight.
Q: What can you tell me about the quality of care provided at your members' ASCs?
IAASC: Commitment to quality care has been a hallmark of the ASC industry nationally and here in Iowa since the industry's earliest days.
Regardless of where care is given, it is impossible to entirely eliminate the risk of patient infection. Similarly — and this is especially true when infection rates are extremely low — it is not possible to conclude that either a facility or its personnel contributed to the patient's infection.
Fortunately, ASCs nationally, and in our state, have an excellent track record of providing safe patient care. For example, national data reports indicate that, on average, ASCs experience only one surgical site infection per 1,000 patients in the 30-day period immediately following surgery. In at least one of the ASCs referenced in the recent article about ASC oversight in Iowa that statistic is comparably low — 0.3 percent or less than one infection for every 330 procedures.
One of the best ways to evaluate the care a healthcare facility provides is to ask the patients who have received care in those facilities. Patient surveys Iowa's ASCs conduct consistently show high levels of patient satisfaction with the ASC experience.
Q: What does the IAASC and its members do to ensure patient safety and quality care at Iowa surgery centers?
IAASC: One of the reasons IAASC came into being was to give ASCs in Iowa an opportunity to come together to share best practices and work collaboratively to ensure that Iowa's ASCs are providing the highest quality care. And just like ASCs across the country, ASCs in Iowa have an excellent track record of providing safe patient care.
In setting standards and policies, Iowa's ASCs look to international and national organizations like the World Health Organization, the Centers for Disease Control and Prevention, the Association for Professionals in Infection Control and Epidemiology, the Association of periOperative Registered Nurses and more. ASCs in Iowa also voluntarily participate in a number of national quality reporting and benchmarking projects, such as ASCA's Outcomes Monitoring Project. The management team and staff also look to their own professional societies for practice updates related to new techniques and standard-setting advice. Many have also pursued additional specialized training in areas like infection prevention.
IAASC and many of its member ASCs have also long been involved with and helped support the work in which ASCA is involved. In fact, the majority of Medicare-certified ASCs in Iowa are ASCA members. ASCA has a long history of supporting quality care in ASCs, and in recent years has focused increasing attention on ensuring that its members have access to state-of-the-art infection prevention resources. During this time, ASCA has offered workshops, webinars, print and online resources and more to its members.
Concurrently, ASCA has joined with other national and international organizations concerned with infection prevention in all settings. In fact, this month, ASCA convened a stakeholders meeting that included participants from a broad cross-section of the industry and the federal regulatory bodies involved with this issue.
In addition to supporting new standards aimed at monitoring infection prevention in Medicare's certification surveys, ASCA is also working to improve that process and ensure that any future inspections provide meaningful data and lead to recognizable improvements in the quality of care ASCs provide.
ASCA also supported establishment of the ASC Quality Collaboration, an independent initiative that promotes quality and safety in ASCs. The ASC Quality Collaboration is committed to developing meaningful quality measures for the ASC setting, and six of those measures have already been endorsed by the National Quality Form (NQF). Many ASCs are already voluntarily reporting the results of the ASC measures NQF has endorsed. The ASC Quality Collaboration also provides infection control toolkits to ASCs. The kits cover an extensive range of topics, including hand hygiene, safe injection practices, point-of-care devices, environmental infection prevention, single-use device reprocessing, endoscope reprocessing, sterilization and high-level disinfection.
For the past five years, as the national organization representing the ASC industry, ASCA has also been urging CMS to establish a uniform quality reporting system to allow all ASCs to publicly demonstrate their performance on quality measures.
Q: How can patients who are concerned about their care learn more about the ASC they are going to and feel assured about receiving top-notch care for which ASCs are nationally known?
IAASC: As noted in our response to the first question, patients truly can rest assured that their health and safety is the highest priority in Iowa's ASC community. In addition to the accreditation discussed above, the healthcare professionals who work in Iowa's ASCs are not only licensed professionals, they are also extremely caring individuals who have taken an oath to put patient well-being above all else.
Second, patients and their healthcare providers should keep in mind that the patient/provider relationship is highly personal, and that each and every medical procedure should be approached thoughtfully and with due diligence. Patients about to undergo surgery and their friends and family members should ask their providers as many questions as necessary — about the procedure, about the healthcare professionals who will be providing their care and about the facility where they will receive that care — to provide important peace of mind preceding a procedure. Iowa's ASCs are also available to take questions directly from patients with concerns about the care they will receive at those ASCs. If asked, many ASCs will also provide tours of their facilities for patients who are considering having a procedure there, and for the patients' friends and family members with a special interest in those patients.
Learn more about the Iowa Association of Ambulatory Surgery Centers.
Related Articles on ASC Quality Care:
OSHA Inspections of Outpatient Care Centers Start in Four States
U.S. Representative Discusses Benefit of ASCs in Tour of Tri-Cities Surgery Center
7 Statistics on Surgery Center Outcomes From the ASC Association