From HCAHPS to healthcare surveys, hospitals seem to be swimming in data.The question is, where is the comparable data for ASCs?
From HCAHPS to healthcare surveys, hospitals seem to be swimming in data.
There is data for almost every aspect of the healthcare experience imaginable, from financials to patient experience, from infection control to provider interactions. That data is both a burden and a boon: While hospitals may have been the first to experience the federal carrot of meaningful use, they have also been the first under the federal stick of readmissions penalties. Regardless, the availability of hospital data makes it easier for those institutions to size up strategies to improve, reinvent and prosper.
The question is, where is the comparable ASC data?
Evaluating measures
The National Quality Forum, a nonprofit organization of multi-stakeholders in healthcare quality, takes a broad approach in evaluating and endorsing quality measures that provide information about quality and performance in various parts of the healthcare system. Its role is to facilitate consensus among stakeholders in creating standard criteria for benchmarks. It has a particular interest in patient-reported outcome and safety measures and is building an expertise in composite cost and efficiency measures as well, according to Reva Winkler, MD, MPH, the NQF's senior director of performance measures.
The way the process works is this: Measure developers submit measures to the NQF and provide the organization with the data to which they have access — not necessarily the same as all the data that exists. The NQF evaluates the submission for importance to measure and report, including evidence, as well as reliability, validity, feasibility and usability before considering endorsement.
For ASCs, the most prominent source of NQF-endorsed measures is the ASC Quality Collaborative. They have six measures endorsed by the NQF:
Challenges abound
According to Dr. Winkler, there are several reasons why ASC data collection has trailed so far behind. "The long view, over the last 15 to 20 years, is that there were a lot of things to be learned about the process of data collection," she says. "It started out with hospitals because all the stars were aligned. We learned a lot from it — data systems in hospitals tend to be relatively uniform, much more than in the outpatient setting."
Indeed, the best measures have data that can be easily pulled from electronic systems. This is a relatively new concept in the ASC setting. According to Dr. Winkler, there has been a move away from chart abstraction to electronic data, but chart abstraction is still used widely, though it is far more costly than its electronic data reconnaissance counterpart.
This difference has widespread implications for data collection in the ASC setting. ASCs tend to have data collection systems that can vary widely. As an industry, data management is not yet mature in the ASC setting. Dr. Winkler says from what the NQF sees, many ASCs are still collecting data from chart abstraction, despite the growing prevalence of EHR technology.
Success?
Recently, however, EHR adoption has been increasing, in part due to CMS' FY 2015 incentives to get there on a timeline. ASCs attached to hospitals, when compared to standalone ASCs, are especially prepared for data collection, though local healthcare market forces are more predictive than anything for whether an ASC is capable of joining the data revolution.
And, quality is one of the best-supported areas for measure development. "Having to develop systems to support quality measurement has been one of the biggest drivers for reporting quality measures and data collection," says Dr. Winkler of federal policies.
In addition, CMS is continuing to grow its quality reporting program with specific, procedure-based measures. While some ASCs have voiced frustrations that they can't be responsible for following up with patients who have completed care, Dr. Winkler says the situation isn't unique to ASCs and is mirrored in hospital readmissions. "I think a lot of it is a sense that your interest in the patient doesn't abruptly stop the minute they walk out the door. While that is relatively new, and somewhat difficult, we're seeing incentives for development of follow-up and the growing sense that is an appropriate role for any healthcare provider to play. It's up to the healthcare facility and provider to figure out the best mechanism for carrying that out," she says.
Indeed, in addition to CMS and ASCQC's reporting programs, a number of other ASC organizations have taken interest in collecting data and compiling practical benchmarks from ASCs across the country. ASCA and companies like Voyance, SOIX, VMG Health and HealthCare Appraisers have made strides in collecting large volumes of ASC data and putting out financial, clinical and operational measures, often segmented by size, composition of stakeholders or geographical market, to assist ASCs in most situations in understanding how they fit into the national healthcare puzzle. And, of course, management and development companies collect internal benchmarking data to provide their members with essential guidance in business and development.
So, while ASC data collection has been behind, it's catching up, and quickly. Dr. Winkler thinks progress is being made and suspects it's only a matter of time before CMS starts releasing ASC data. "I think we can look forward to a time when CMS will publically report data. I don't know the timeframe, but I think it's likely," she says.
More articles on turnarounds:
Which benchmark can turn my ASC around? A diagnostic test
Surgery center false claims lawsuit on share pricing settles: 9 key points
4 recent ASC industry leadership moves
From HCAHPS to healthcare surveys, hospitals seem to be swimming in data.
There is data for almost every aspect of the healthcare experience imaginable, from financials to patient experience, from infection control to provider interactions. That data is both a burden and a boon: While hospitals may have been the first to experience the federal carrot of meaningful use, they have also been the first under the federal stick of readmissions penalties. Regardless, the availability of hospital data makes it easier for those institutions to size up strategies to improve, reinvent and prosper.
The question is, where is the comparable ASC data?
Evaluating measures
The National Quality Forum, a nonprofit organization of multi-stakeholders in healthcare quality, takes a broad approach in evaluating and endorsing quality measures that provide information about quality and performance in various parts of the healthcare system. Its role is to facilitate consensus among stakeholders in creating standard criteria for benchmarks. It has a particular interest in patient-reported outcome and safety measures and is building an expertise in composite cost and efficiency measures as well, according to Reva Winkler, MD, MPH, the NQF's senior director of performance measures.
The way the process works is this: Measure developers submit measures to the NQF and provide the organization with the data to which they have access — not necessarily the same as all the data that exists. The NQF evaluates the submission for importance to measure and report, including evidence, as well as reliability, validity, feasibility and usability before considering endorsement.
For ASCs, the most prominent source of NQF-endorsed measures is the ASC Quality Collaborative. They have six measures endorsed by the NQF:
- patient falls
- patient burns
- hospital transfer/admission
- wrong site/side/patient/procedure/implant
- prophylactic IV antibiotic timing
- appropriate surgical site hair removal.
Challenges abound
According to Dr. Winkler, there are several reasons why ASC data collection has trailed so far behind. "The long view, over the last 15 to 20 years, is that there were a lot of things to be learned about the process of data collection," she says. "It started out with hospitals because all the stars were aligned. We learned a lot from it — data systems in hospitals tend to be relatively uniform, much more than in the outpatient setting."
Indeed, the best measures have data that can be easily pulled from electronic systems. This is a relatively new concept in the ASC setting. According to Dr. Winkler, there has been a move away from chart abstraction to electronic data, but chart abstraction is still used widely, though it is far more costly than its electronic data reconnaissance counterpart.
This difference has widespread implications for data collection in the ASC setting. ASCs tend to have data collection systems that can vary widely. As an industry, data management is not yet mature in the ASC setting. Dr. Winkler says from what the NQF sees, many ASCs are still collecting data from chart abstraction, despite the growing prevalence of EHR technology.
Success?
Recently, however, EHR adoption has been increasing, in part due to CMS' FY 2015 incentives to get there on a timeline. ASCs attached to hospitals, when compared to standalone ASCs, are especially prepared for data collection, though local healthcare market forces are more predictive than anything for whether an ASC is capable of joining the data revolution.
And, quality is one of the best-supported areas for measure development. "Having to develop systems to support quality measurement has been one of the biggest drivers for reporting quality measures and data collection," says Dr. Winkler of federal policies.
In addition, CMS is continuing to grow its quality reporting program with specific, procedure-based measures. While some ASCs have voiced frustrations that they can't be responsible for following up with patients who have completed care, Dr. Winkler says the situation isn't unique to ASCs and is mirrored in hospital readmissions. "I think a lot of it is a sense that your interest in the patient doesn't abruptly stop the minute they walk out the door. While that is relatively new, and somewhat difficult, we're seeing incentives for development of follow-up and the growing sense that is an appropriate role for any healthcare provider to play. It's up to the healthcare facility and provider to figure out the best mechanism for carrying that out," she says.
Indeed, in addition to CMS and ASCQC's reporting programs, a number of other ASC organizations have taken interest in collecting data and compiling practical benchmarks from ASCs across the country. ASCA and companies like Voyance, SOIX, VMG Health and HealthCare Appraisers have made strides in collecting large volumes of ASC data and putting out financial, clinical and operational measures, often segmented by size, composition of stakeholders or geographical market, to assist ASCs in most situations in understanding how they fit into the national healthcare puzzle. And, of course, management and development companies collect internal benchmarking data to provide their members with essential guidance in business and development.
So, while ASC data collection has been behind, it's catching up, and quickly. Dr. Winkler thinks progress is being made and suspects it's only a matter of time before CMS starts releasing ASC data. "I think we can look forward to a time when CMS will publically report data. I don't know the timeframe, but I think it's likely," she says.
More articles on turnarounds:
Which benchmark can turn my ASC around? A diagnostic test
Surgery center false claims lawsuit on share pricing settles: 9 key points
4 recent ASC industry leadership moves