Jennifer Green, RHIT, Vice President of Network Development at Surgical Outcomes Information Exchange answers the most common questions she hears about benchmarking and why the process is so essential for ambulatory surgery centers going forward. Q: Why is benchmarking required and how can I meet those requirements?
A: ASC administrators not well-versed in performance improvement and benchmarking often know they need to begin doing it for accreditation, but don’t know where to start. Companies such as SOIX can help them navigate required benchmarking and help them understand how they can benefit from gathering the required information.
Leaders more well-versed in benchmarking and quality performance improvement know the next question is about how data is collected and who they’ll benchmark against. “When they get their first series of reports [from SOIX] they may not need any help from SOIX in interpreting their results and instead just need the basic orientation to the reports such as which reports contain what data and how to avoid missing the forest for the trees,” says Ms. Green.
Q: What are the most important benchmarks for ASC leaders to track?
A: ASC leaders track clinical, operational and financial benchmarks. Ms. Green says clinical benchmarks are a first priority, just as providing quality care is the center's primary focus.
"The fact that an ASC is also a business means that the second priority is making sure your costs are not higher than your income," says Ms. Green. "Then, it becomes an issue of balance. You cannot provide good care if you cannot stay in business and you will not stay in business if you don't provide quality care."
Q: How do I deal with deviations from the benchmarks?
A: When ASC administrators identify areas where their center falls below the benchmarks, there is an opportunity for improvement. Consider whether the deviation is expected — sometimes unique circumstances mean an individual ASC will be different. Then consider whether the deviation impacts the bottom line.
“Sometimes the reason for the deviation is immediately known, and it is a matter of proving what you have suspected so you have the ammunition needed to support making a change,” says Ms. Green. “Other times the deviation is a complete surprise and a full quality improvement study is needed to determine why the deviation occurred and how to best handle it.”
There are times when the administrator looks at the big picture and assesses the deviation in conjunction with other findings. For example, if the center has a longer than average recovery time for knee arthroscopies but their complication rates, postoperative pain and patient satisfaction are all better than the benchmark, then the longer recovery could be justified.
“Sometimes, the good outweighs the bad,” says Ms. Green.
Q: How can ASCs use information about meeting or exceeding benchmarks to their advantage?
A: ASCs that surpass all benchmarks can use this information to market their centers. “We have a hospital in town that advertises their cardiology program by publicizing the time it takes them to open an artery,” says Ms. Green. “They say their time is XX minutes faster than the national average. So, benchmarking is not always about finding opportunities for improvement. It can also be about proving your excellence and identifying a best practice.”
Q: Is there a right and wrong way to present ASC benchmarking information to physician owners, operating partners and patients?
A: SOIX strongly recommends the presenter not make any judgments or draw conclusions when presenting benchmarking results. Their job is to report findings. Instead of saying “this report shows our recovery time is too long,” they can say “this report shows our average recovery time as being 10 minutes longer than the benchmark average.”
However, presenters should also prepare to answer questions about the results and in some cases be ready for someone who wants to “shoot the messenger.”
“Physicians deal in science; they want to see proof,” says Ms. Green. “Our reports include graphics and data. We make it a priority to train the center on understanding both. It is especially important if the numbers used in the calculations were small, making the percentages seem better or worse than they are.”
For example a pain relieve score of 50 percent is not very meaningful if only two patients had pain, and a 10 percent complication rate may not be significant if it reflects one out of 10 cases.
“However, looking at it cumulatively, a 10 percent complication rate reflective of 40 cases reported over four quarters may be very significant,” says Ms. Green.
Q: How will data collection today impact my ASC in the future?
A: Technology and patient involvement in healthcare decisions have evolved immensely over the past decade. Patients can look up health information on their phones and make appointments with care providers they select online. In July 2013, the USNews.com reported four in every 10 hospitals in the United States now have electronic medical records and new legislation focused on quality of care and price transparency will be enacted over the next few years.
"The fact is, we now use data to make decisions all the time, and as our lives become more and more data-driven, the reliability of that data will be essential," says Ms. Green.
A few ASCs tracking cost and quality data now publish these points online and can use their data to attract patients and referral providers locally and globally. Payers and industry partners are also interested in the center's data, and being able to understand data supporting the ASC as a quality provider will be vital for survival in the future.
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