HHS proposes new ambulatory surgery center safety database

HHS is looking to launch a patient safety database for ambulatory surgery centers as more facilities open around the nation.

HHS' Agency for Healthcare Research and Quality has asked the White House's Office of Management Budget for permission to launch the database, similar to others it has for hospitals, nursing homes and pharmacies.

"The expanding volume and scope of ASC services, the growing attention of federal regulators on patient safety within ASCs, and the resultant implications for public health has prompted AHRQ to present this application" to the OMB, the agency said in the July 9 notice.

There were 5,532 Medicare certified centers in 2016, up 3.5% from 5,344 in 2011, according to federal data. From 2011 to 2016, the number of ASCs grew at an average annual rate of 1.3%. Roughly 3.4 million Medicare enrollees get care at the centers annually. However, spending has grown about 27%, from $3.4 billion to $4.3 billion, over that five-year period as the facilities provide more services and see more patients.

AHRQ's request comes months after a joint investigation by Kaiser Health News and the USA Today raised concerns about the quality of care and safety at ASCs. The news outlets discovered that more than 260 patients have died since 2013 after outpatient procedures at surgery centers across the country.

Last year, the CMS announced it wanted to ramp up oversight of ambulatory surgery centers by developing a quality measure to track how many people have an adverse health reaction after getting care at the facilities.

The new database will pull its data from patient safety culture surveys given to ASC staffers. The questionnaire assesses staff members perceptions about patient safety and quality assurance issues, including what safety-related attitudes and behaviors are supported, rewarded and expected.

ASCs support creating the database, as the surveys will help ensure surgery centers are providing the best care possible.

"We want every surgery center to be doing that kind of internal review of the culture and communication to ensure that the patient gets the right care," said William Prentice, CEO of the Ambulatory Surgery Center Association.

But it's unclear whether the database will actually improve quality and safety at surgery centers, and some experts noted that the agency hasn't suggested whether safety concerns will spark corrective action.

"Collecting data about adverse events is one thing, but what is done with that data is perhaps the more critical step," said Michael Wong, founder and executive director of the Physician-Patient Alliance for Health & Safety. "Will this data be used to learn, or will patient adverse events just become a statistic?"

Still, some are more optimistic. Dr. Tejal Gandhi, chief clinical and safety officer at the Institute for Healthcare Improvement, said she has seen the hospital version of the database lead to better quality and safety cultures at facilities.

"If you had a realization that you weren't performing well and had an engaged leader who really wanted to improve, there are tools out there that will tell you this is what you need to do and give some really practical action that people can take," Gandhi said.