Leapfrog Releases Preliminary Findings from ASC Survey

Digital Debut

Leapfrog Releases Preliminary Findings from ASC Survey

Report summarizes results in five sections

Preliminary results from The Leapfrog Group’s ASC Survey are in and include findings from data that 321 ASCs and 1,141 hospital outpatient departments (HOPD) submitted prior to August 31, 2019. The report summarizes results organized in five sections: basic facility information; medical, surgical and clinical staff; volume and safety of procedures; patient safety practices; and patient experience.

While the report is relatively even-handed in its treatment of surgery centers and HOPDs, ASCs are assessed unfairly against inpatient hospital results in a couple of areas. In addition, The Leapfrog Group President and Chief Executive Officer Leah Binder made the following comment about ASCs to USA Today that raises questions about the ability of The Leapfrog Group to fairly report on the results of the survey: "We know almost nothing about their safety or quality. We are concerned that same-day surgery providers are not following basic safety steps. We are trying to figure out what’s going on in the Wild West.”

Patients reported better experiences in ASCs than in HOPDs, according to the report. In the area of “mean OAS CAHPS [Outpatient and Ambulatory Surgery Consumer Assessment of Healthcare Providers and Systems] top box scores,” 86 percent of the patients who used an ASC for their procedure would recommend the ASC to friends or family, as opposed to 82 percent of the patients who used an HOPD. Fewer ASCs than HOPDs, however, reported administering the OAS CAHPS survey to collect this patient-reported data.

Because patient experience is one of the metrics most valued by consumers, the report recommended ASCs put a priority on administering the OAS CAHPS survey as a means of quality improvement and market differentiation. Both hospitals and ASCs, however, have objected to the length of the survey and the modes of delivery and are continuing to encourage the Centers for Medicare & Medicaid Services to make the surveys less burdensome and easier for patients to complete.

In the area of “adoption of monitoring and feedback hand hygiene practices,” more ASCs—75 percent—than HOPDs—66 percent—have a “system in place for initial and recurrent training and validation,” according to the report.

More ASCs—80.4 percent—than HOPDs—70.9 percent—provide “anesthesia consent materials to patients at least three days prior, one-to-three days prior, or on the same day,” the survey found. More ASCs—64.8 percent—than HOPDs—48.7 percent—provide “surgery consent materials to patients at least three days prior, one-to-three days prior, or on the same day,” the survey revealed.

ASCs and HOPDs were at the same level in the area of “percentage of facilities with board-certified physicians and nurse anesthetists:” 64.5 percent and 64.9 percent respectively reported all individuals performing procedures to be board-certified. This could be because some of the staff are board-eligible but not certified yet, said Lee Fleischer, chair of the Department of Anesthesiology and Critical Care at Penn Medicine in Philadelphia and chair of Leapfrog's expert panel on surgery centers, during the press briefing. “Others might have not taken the re-certification exam because they work in an ASC, not a hospital, and don’t need hospital re-certification,” he said. More questions would need to be asked to know for sure, he added.

In the “patient safety practices” area, the results found that only 18 percent of ASCs reported adopting an antimicrobial stewardship program, while 93 percent of hospitals reported adopting a similar program. This information is not available for HOPDs, the report stated. Missy Danforth, vice president of Health Care Ratings at The Leapfrog Group, clarified during the press briefing that the questions being asked of the two facilities are different and comparing the adoption of these practices in ASCs and HOPDs is not an apples-to-apples comparison. Hospitals are asked to adopt the Core Elements of Hospital Antibiotic Stewardship Programs of the Centers for Disease Control and Prevention (CDC), while ASCs would adopt the Health Services Advisory Group’s (HSAG) Antimicrobial Checklist, which is specifically designed for ASCs and modeled after the CDC’s Core Elements, she said. “ASCs and HOPDs are not asked to adopt the same programs, however, the core elements included in each are similar,” she said. “ASCs are asked about a broader range of medications—all antimicrobials—whereas HOPDs are asked only about a subset of antimicrobials, specifically, antibiotics. The Antimicrobial Checklist for ASCs was developed in 2017-2018 and unlike the Core Elements of Antibiotic Stewardship, it has yet to be adopted nationally. These are some of the reasons why we may see low adoption of these practices in ASCs.”

“ASCA supports quality transparency, and we will continue to work with any responsible organization looking to produce information and resources that help patients and payers identify safe healthcare providers and settings,” says William Prentice, chief executive officer of ASCA. “However, I am greatly disturbed by comments made by Leapfrog Group staff to the media that show a willingness to denigrate ASCs in contradiction to the results of their own survey. This suggests a bias that we will need to consider when members ask about participating in this project in the future.”