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Ambulatory surgery center (ASC) officials are clamoring for a more balanced view after a recent USA Today article highlighted tales of patient deaths following outpatient surgery. Reeling over the potential loss of goodwill, ASC executives point to quality and safety statistics that paint a more complete picture of overall surgery success rates.
ASC leaders are working to share the many positive outcomes from surgery in their centers to balance what they say is a misleading impression left by these tragic stories in the March 2 article (). They want prospective patients in their communities to know how safe outpatient surgery actually is and to compare the risks with those from surgery in hospitals.
“My first impression when I saw the USA Today article was they did a disservice to ambulatory surgery centers,” says Trista Sandoval, vice president of business development and physician relations at Pinnacle III LLC in Lakewood, CO. “While the deaths they cited were a tragedy, many of the allegations are under review or were never proven.”
It’s difficult to compare safety results between surgical settings because no organization collects all the data needed for an exact comparison. But data from two major sources suggest that surgical adverse events are uncommon in ASC settings, and deaths are very rare.
A Medicare Payment Advisory Commission (MEDPAC) report to Congress in March 2017 says that 5,500 ASCs treated 3.4 million Medicare beneficiaries in 2015. Noting that hospital outpatient departments tend to treat more medically complex patients than ASCs, the MEDPAC report found the average risk score for ASC patients to be 1.13 compared with 1.57 for patients of hospital outpatient departments.
Medicare patients make up about one-third of all ASC patients, so the overall number of ASC patients is more than 10 million per year. Of the Medicare cases, 1.1% resulted in a hospitalization within three days of discharge from surgery ().
Based on research conducted by the USA Today Network and Kaiser Health News, the recent news article highlighted 260-plus deaths since 2013 associated with ASCs. It did not compare deaths post-ASC surgery with deaths after surgery in a hospital. Researchers in one hospital found the postoperative mortality rate 30 days after inpatient surgery was 2.1% in a 2008 study ().
Expressing the viewpoint that measurement scores provide needed context for the tragic anecdotes in the news, Ambulatory Surgery Center Association (ASCA) CEO Bill Prentice advocates looking at the data to find specific areas for improvement at individual sites of service.
“There are a handful of bad actors in every site of service, and there are unfortunate errors that occur in every site of service that we all need to know about,” he says. “We need a system that makes that more transparent because current reporting does provide actionable information.”
ASCA made accurate information and facts about ASC safety and quality available to its members before the article was published.
“We did a lot of work in preparation, knowing this story was coming and knowing in all likelihood that it would be reckless,” Prentice notes.
“We do not have the reporting framework we need in healthcare, in general,” Prentice explains. “We need to ensure patients have all the information they deserve to determine where to get care.”
He supports asking regulators to help fix the problem of reporting gaps across all types of healthcare providers.
Although looking only at patient deaths does ASCs a disservice, there is continued need for surgery centers to take safety issues very seriously, says John Goehle, MBA, CPA, CASC, chief operating officer of Ambulatory Healthcare Strategies, a surgery center consulting firm in Rochester, NY.
Surgery centers also need to communicate their safety and quality activities to their patients.
If news stories prompt questions, staff can provide more information to emphasize provider expertise, safety measures, and continual training.
“When a patient comes in with concerns, staff should express understanding,” Goehle suggests.
Explain that there’s a lot more information about the ASC’s care and patients will get quality treatment at the surgery center, he adds.
The ASCA published its response to the USA Today article on its website March 2. Noting that the newspaper and Kaiser Health News focused on 260 adverse events alleged to have occurred as a result of ASC care over the past five years, the association asserted in its response that the article should have noted that ASCs safely performed many millions of procedures over that time period ().
“The implication that ASCs somehow pose a higher level of risk to the patients they serve is false and unsupported by both data and the medical literature,” the statement says.
Financial Disclosure: Editor Jonathan Springston, Editor Jill Drachenberg, Editorial Group Manager Terrey L. Hatcher, Author Melinda Young, Physician Editor Steven A. Gunderson, DO, FACA, DABA, CASC, Consulting Editor Mark Mayo, MS, and Nurse Planner Kay Ball, RN, PhD, CNOR, FAAN, report no consultant, stockholder, speaker’s bureau, research, or other financial relationships with companies having ties to this field of study. Stephen W. Earnhart discloses that he is a stockholder and on the board for One Medical Passport.