The CMS is seeking to ramp up oversight of ambulatory surgical centers with development of a new quality measure that will track how many people have an adverse health reaction after getting care at the facilities.
The agency teamed with a research unit of Yale New Haven Health Services Corp. to develop the measure, which was posted for public comment Tuesday. The CMS will take feedback through Aug. 7.
Specifically, the measure would track hospitalizations that occur after a Medicare beneficiary receives care at an ambulatory surgical center. The CMS plans to use this measure to report on the quality of ASCs and prompt improvements in care for Medicare beneficiaries.
Ambulatory surgery is increasingly common in the U.S. since nearly 70% of all surgeries are performed in an outpatient setting, with an expanding number and variety of procedures being performed at stand-alone ASCs, according to the CMS notice.
The Ambulatory Surgery Center Association, an industry trade group, backed the quality measure. "It can both assist surgery centers in their efforts to continuously improve and help patients choose the right site of service for the care they need," said ASCA CEO William Prentice.
Annually, more than 3 million Medicare beneficiaries go to the facilities. ASCs received $4 billion in reimbursement in 2015, the most recent year of federal data available. Still, there's no single quality measure by which all ASCs are assessed, according to a March report by the Medicare Payment Advisory Commission.
Procedures performed at the centers are usually considered to be a low risk, but preventable adverse events have been noted, including uncontrolled pain, urinary retention, infection, bleeding, and venous thromboembolism.
National estimates of hospital visit rates following outpatient surgery vary from 0.5% to 9.0%, based on the type of surgery and time frame for measurement after surgery. In the notice posted Tuesday, Yale estimated the rate of hospital visits following general surgery ASC procedures averaged 2.2%. Of these hospital visits, 1.6% were emergency department or observation stays, and 0.6% were unplanned inpatient admissions.
Providers at ASCs are often unaware of patients' subsequent acute care visits given that patients tend to go to the ER or to hospitals unaffiliated with the ASC.
"For these reasons, a quality measure of hospital visits following ASC surgery will serve to improve transparency, inform patients and providers, and foster quality improvement," the Yale notice said.
