Forum co-hosted by NewYork-Presbyterian Hospital/Weill Cornell Medical Center
Today the American College of Surgeons (ACS) held the ACS Surgical Health Care Quality Forum New York, the 10th program in a series of events to drive national discussions on effective quality improvement methods that surgeons, physicians and hospitals are using to improve patient safety and reduce costs.
The forum was hosted by ACS in partnership with NewYork-Presbyterian Hospital/Weill Cornell Medical Center and drew more than 160 attendees from nearly 40 hospitals, medical schools and other health care organizations in the state – a record attendance since the ACS Inspiring Quality Community Tour began in 2011.
During the more than three-hour forum, presenters focused on the critical roles that quality data, measurement, and reporting have in the future of health care, using the ACS National Surgical Quality Improvement Program (ACS NSQIP®) as a leading and successful model, giving surgeons reliable data to help pinpoint areas for improvement. ACS NSQIP is set apart from other quality programs because it uses risk- and procedure mix-adjusted data extracted from the patient's medical chart, not insurance claims, and is based on 30-day surgical patient outcomes.
"The New York medical community has pioneered public reporting and the use of meaningful data to improve outcomes," said Fabrizio Michelassi, MD, FACS, Lewis Atterbury Stimson Professor and Chairman, Department of Surgery, Surgeon-in-Chief, NewYork-Presbyterian Hospital/Weill Cornell Medical Center, and event host. "We, perhaps better than anyone, know the benefits and challenges of public reporting and this forum is an important vehicle to continue those discussions and demonstrate how outcomes-based programs like ACS NSQIP are driving effective quality improvement here in New York and across the country."
Panelists shared the ways ACS NSQIP has led to better patient outcomes and reduced costs in their hospitals. Their findings are in line with a 2009 study published in the Annals of Surgery that determined ACS NSQIP-participating hospitals each prevented 200-500 complications annually and in doing so, saved an average of 12-36 lives per year. With the average cost of medical complications equaling $11,000 per occurrence, the combined potential savings of 4,500 hospitals could add up to $13-26 billion each year, amounting to an estimated total savings of $260 billion over a period of 10 years.[i]
"We are at a critical time when it comes to advocating for the right kind of quality improvement, especially as CMS moves toward public reporting based on clinical data and outcome measures in the coming years and ties these measures to value-based purchasing programs," said David Hoyt, MD, FACS, executive director of ACS. "The challenge now is taking action on what we know already works. Hospitals now have good reputational and financial reasons to participate in programs like ACS NSQIP and help communicate that quality improvement is not just quality improvement for compliance sake – it is quality improvement to help hospitals achieve better outcomes that ultimately lowers costs."
Additional comments made by participants during the forum included:
Steven J. Corwin, MD, CEO, NewYork-Presbyterian Hospital
"In the wake of the Affordable Care Act, regulators now more than ever are looking at outcomes and their relation to the overall cost of health care. Hospital administrators and clinicians need to measure meaningful outcomes and use real-time data to ensure we deliver the type of improvement valued most by regulators."
Foster C. Gesten, MD, FACP, Medical Director, Office of Quality and Patient Safety, New York State Department of Health
"Public reporting of health outcomes by providers is here to stay, with increasing expectations by payers and the public of transparency and accountability. This is taking place during a time in which ever rising health care expenditures, public and private, are being scrutinized for value. Clinicians, including the surgical community by virtue of its history and its expertise, can lead and contribute to this movement by helping to create a system of performance measurement that first helps providers improve care quality and safety for their patients, but is also responsive to these wider set of expectations by the public."
Laurie H. Glimcher, MD, Stephen & Suzanne Weiss Dean, Weill Cornell Medical College; Provost for Medical Affairs, Cornell University
"Integrating the system-based approaches used in successful quality improvement programs into medical school curriculum is critical to equip our future generation physicians with an understanding of how the right process can improve outcomes."
Clifford Y. Ko, MD, MS, MSHS, FACS, Director, ACS Division of Research and Optimal Patient Care
"Regulators are realizing that we need a more robust quality measurement system in this country based on clinical, not administrative data, and focused on measuring outcomes. ACS NSQIP is working closely with CMS to evolve our hospital quality measurement in this direction, which is good for our patients, for surgeons and hospitals, and for our nation's health care system."
H. Leon Pachter, MD, FACS, George D. Stewart Professor and Chair, Department of Surgery, NYU School of Medicine
"Our hospital uses a unique management dashboard, which provides quality data on mortality, 30-day readmissions, surgical site infections, and length-of-stay rates. This has been a useful tool to objectively determine trends, verify data and provide feedback to surgeons including how they fare among their colleagues."
Jeffrey H. Peters, MD, FACS, Professor of Surgery, Chair, Department of Surgery, University of Rochester Medical Center
"Quality improvement is not self-sustaining and therefore hospitals need continuous feedback in order to move the needle. I've managed the implementation of ACS NSQIP in two hospitals and have seen significantly better improvement trends for the hospital that generates and receives more feedback. It is critical for hospitals to remain proactive in order to get results."
Alfons Pomp, MD, FACS, FRCSC, Leon C. Hirsch Professor, Vice Chairman, Department of Surgery, Chief, Section of Laparoscopic and Bariatric Surgery, NewYork-Presbyterian Hospital/Weill Cornell Medical Center
"It's imperative that hospitals have the right infrastructure in place before they can act on performance improvement based on results they receive from measurement tools like ACS NSQIP. Having adequate staffing levels, technology, checklists, etc., continuously validated through the accreditation process, are key to implementing quality improvement successfully."
Pierre F. Saldinger, MD, FACS, Chairman, Department of Surgery, Surgeon-in-Chief, New York Hospital Queens
"I've practiced in three other cities before coming to New York and it is my experience that regardless of geography, hospitals have the most success with programs like ACS NSQIP when they involve experienced clinicians who proactively seek out performance results in advance of issues, rather than reactively make changes if the data is disappointing."
Steven C. Stain, MD, FACS, Henry and Sally Schaffer Chair, Department of Surgery, Albany Medical Center; Professor and Chair, Department of Surgery, Albany Medical College
"The data we have collected through ACS NSQIP has been a catalyst for change at our multi-specialty hospital. As a result of seeing the risk-adjusted data, we have implemented new hospital processes and protocols to address the areas we've identified as needing improvement."
To further encourage community-level health care leaders to share best practices on quality improvement, the ACS will continue to host a series of community forums across the nation, including Atlanta on December 12, 2012, and Orlando on January 23, 2013.
American College of Surgeons