First, why is Leapfrog doing this and what does ASCA think about it?

Leapfrog reached out to ASCA a few months ago to talk about their interest in creating an outpatient reporting program—apparently, the large employers that support Leapfrog have been asking for this product for a while. My personal thought, initially, was that more transparent data about ASC and hospital outpatient department quality and outcomes is a good thing, but I had some misgivings about whether Leapfrog would move too quickly and start rendering judgment on ASCs/HOPDs before there was sufficient data to do so. Fortunately, our conversations with the Leapfrog leadership—they recently presented at an ASCA board meeting—have addressed those concerns for now.

That said, ASCA intends to remain fully engaged with Leapfrog as it makes these evaluations and will keep members fully abreast of the progress and confidence in the direction of the program.

When, exactly, does Leapfrog plan to introduce these surveys?

According to Leapfrog, their current plan is that the final surveys will be available nationally to ASCs and HOPDs on April 1, 2019.

In January 2019, Leapfrog will pilot test the ASC survey with just 25 ASCs and work with those ASCs to review and refine it. We view this as a good opportunity to ensure that this project is developed with a true understanding of the ASC model and how it provides great care to patients. Accordingly, if your ASC would like to participate in the pilot test, we recommend that you contact Leapfrog’s Help Desk.

In April 2019, Leapfrog currently plans to open the ASC survey nationally but limit participation to just 250 ASCs. Results from the 2019 survey will not be published at a facility level but will be included in an aggregated public report. Based on the feedback those ASCs provide, Leapfrog will further refine the questions and measure specifications and launch their 2020 ASC Survey. Results from that survey be reported publicly by facility.

What kinds of questions will the ASC survey include?

The survey will gather information about your facility, your ASC’s medical and nursing staff, your ASC’s patient safety practices and the patient experience inside your ASC. By collecting data on operational elements that research has linked to high outcomes—proper hand hygiene, for example—Leapfrog hopes to present a profile of your facility that conveys the quality of care available there.

Will ASCs and HOPDs get the same survey?

According to Leapfrog, since ASCs and HOPDs operate differently in some ways, the surveys will not be identical. Leapfrog has indicated that the two surveys will be similar and allow for apples-to-apples comparisons across the two settings as possible.

How is Leapfrog developing the questions for the ASC survey? Is ASCA involved?

Leapfrog has assembled an expert panel that includes six health care professionals who are familiar with research in various specialties associated with care in the outpatient setting, such as anesthesia and perioperative nursing. You can find the names of these individuals on Leapfrog’s website.

ASCA has been talking with Leapfrog about this new survey for some time, and although Leapfrog is developing this survey independently, it has indicated that it has already made some changes in the program based on comments we provided. We look forward to continuing this dialogue and hope to assist with future decision-making.

Will ASCs be given letter grades like those that Leapfrog currently assigns to hospitals?

Leapfrog has indicated that it does not intend to assign letter grades at the outset of this program, and ASCA has expressed concern about how those grades would be determined if Leapfrog decides to add them later. Looking at our CMS quality reporting data, we do not believe there is a wide variance of quality in the marketplace amongst most ASCs, so the margin of difference between an “A” facility and a “B” facility could be clinically indistinguishable. Forcing the use of a letter grade could have an undue impact on a facility’s reputation and perception. Leapfrog has told us that the imposition of letter grading in this program is not contemplated for the next few years but remains on the table.

This is one area where ASCA hopes to be able to have input into the decisions that Leapfrog makes to improve the usefulness of this program.

Should my ASC sign up to participate in the ASC survey in 2019?

Whether to participate in the 2019 survey is a decision each ASC’s management team will need to make on its own. As mentioned above, participation in the 2019 survey is voluntary, and those who do not participate will not be identified in public reports. If you plan to participate in the final survey and want to begin early to see how your ASC performs, signing up to be involved in the 2019 surveys makes sense. Also, ASCs that participate in 2019 will have an opportunity to provide important feedback that could shape the future of these surveys. ASCA is encouraging member ASCs that have the resources and operational capacity to participate in this phase of the program to do so.

The fact of the matter is that we know ASCs deliver exceptional quality and value, but the burden continues to fall on our industry to prove these points. It’s why ASCA partnered with the Agency for Healthcare Research and Quality (AHRQ) to develop a culture of safety survey Safety Program and why we continue to work with CMS to refine the Medicare ASC Quality Reporting program.

If your ASC is simply interested in learning more about the reporting process, Leapfrog is hosting an in-person training and orientation for ASC leaders and administrators on November 6, 2018, in Chicago, Illinois. Participants can register online.

Any final thoughts?

ASCs have long supported price and quality transparency, and this program could be another opportunity to pursue those goals. Involvement from the ASC community in the earliest stages of this reporting program will be critical in determining the usefulness of the data Leapfrog collects and shares in the future. ASCA will continue to provide input on this survey program wherever possible and extends its thanks to every ASC that decides to be involved.