Ambulatory surgery centers (ASCs) continue to be affected by a barrage of legislative and regulatory changes. Consider, for example, the Ambulatory Surgical Center Quality Reporting (ASCQR) Program which requires ASCs to report quality data G-codes on five measures (four adverse events including burns, falls, wrong site/side/patient/procedure/implant or direct hospital transfer/admission and the timing of prophylactic IV antibiotic administration). Facilities failing to implement G-code quality reporting measures on these events will face future Medicare payment reductions. ASCs will be considered successful reporters if at least 50 percent of their Medicare claims, where Medicare is the primary payor, contain quality data G-codes.
In terms of quality reporting, this is just the beginning. It is expected that the ASC industry standard will eventually move towards a pay-for-performance model. Therefore it is important that facilities get a handle on new reporting requirements as they are introduced to avoid future financial penalties associated with non-compliance. For instance, non-compliance with reporting quality codes in 2012 will affect payments in 2014. While meeting new quality reporting requirements can be a daunting task for facility management and staff alike, deploying best practices can help lessen the impact and promote success.
To help ease the process for adhering to future quality reporting requirements, or for those struggling to meet the current G-code requirements, consider the following best practices deployed by Trinity Surgery Center. It is with these processes we were able to meet the ASCQR’s G-code requirements with relative ease and minimal disruption.
1. Do your due diligence up front. The key to success is education. Facility leaders must have an in-depth understanding of the G-code quality reporting measures and how it will impact their center prior to educating staff. At Trinity
we began tracking quality reporting two and a half years ago, as soon as we heard about the requirements. Doing your homework to stay current on updates and changes is essential. The ASC Quality Collaboration (www.ascquality.org) and your local ASC Association are great resources as they continually monitor standards and provide updates as they become available. It is with this information that facility leaders will be able to effectively communicate the importance of new quality reporting measures to staff. This information will help you put the proper processes in place to ensure a successful rollout.
2. Set up a trial. To ensure processes run smoothly and your facility is ready on the go-live date, trials are critical. Trials should begin approximately six months prior to the go-live date to allow time for any necessary process adjustments. When implementing a trial it is important to do so in a manner that places the least amount of stress on your clinical and business staff.
Understanding your vendor's upgrade plans will help get you started. Because software updates may not be ready during your trial period, you will need to initially deploy some manual methods. For us this included the development of a blue paper form which was used as a tacking mechanism by the insurance verifier who identified Medicare primary patients to flag the medical records for the clinical staff. We also manually tracked claims to make sure they were accepted by Medicare.
3. Make it easy for your staff. Look for opportunities to make things easier for your staff, for us that meant leveraging software to automate time-consuming, error prone processes. For example, by using SourceMedical's Vision software we have an option to set reportable questions to default to "no" which indicates that a patient did not have any of the events. If an event were to occur staff would simply change the response to "yes" and the G-code automatically populates on the backend of the system for coding and posting. In addition to saving significant staff time, it is much easier and more accurate than manual entry as staff do not have to think about which G-code corresponds with which patient event for every patient.
4. Require facility-wide training. The G-code quality reporting measures will directly affect most, if not all, clinical staff members. Therefore, it is very important that every staff member, both business and clinical, know about the G-code reporting measures and what it means if your center is not compliant. Facility-wide training will help you accomplish this knowledge transfer.
We opted for a combination of video and hard copy educational materials. Only information that affects staff and what they are physically doing each day was included in the training materials. Every staff member was required to watch the video and/or read the handout and then sign-off when they were done. The training was set-up on a laptop and passed around so staff could watch it when they had time. If they had any questions, we went over it as a team. This facility-wide training was a key factor in the success of our roll-out.
As an industry, ASC providers profess they provide high quality, safe care to patients. The quality indicators used throughout surgery centers and hospitals should serve as reminders that the major events should not occur. If reporting shows recurrence of these issues, it can highlight concerns that a facility must address. While individual issues might not raise red flags, a report of all adverse events makes it easier to see problem areas and correct them before they lead to more serious consequences.
Furthermore, because ASC quality reporting information will be available to the public, anyone with Internet access will be able to easily look up how facilities are performing and quickly see where they stand in terms of the competition. Therefore, these quality indicators also serve as a benchmark and a competitive differentiator. To provide the best possible care for patients and ensure financial success for facilities, accurate quality reporting is essential. Commercial software systems will help address regulatory requirements and should provide the forum for reporting within the process flow of documentation.
About the authors:
Nancy Burden is the administrator at Trinity Surgery Center. Linda Pavlak, RN, CAPA, CASC, LHRM is the nurse manager at Trinity Surgery Center. Natalie Ritenour is the PAS Coordinator at Trinity Surgery Center.
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