Commitment needed to track cataract outcomes

Data collection can be cumbersome

Determining outcomes in cataract surgery may seem simple. Did the patient's vision improve? Were there any surgical complications? Was the patient happy with the result? Getting the answers to those and more detailed questions for every patient can become a daunting task, however.

Outcomes management requires careful planning and a strong commitment on the part of physicians and staff, says ophthalmologist Robert Bailey, MD, attending surgeon at Wills Eye Hospital in Philadelphia and chairman of quality assurance/utilization review for the Greater Philadelphia Eye Care/Centers for Excellence, an independent practice associa- tion (IPA).

Marketing to managed care

By joining a national cataract database, the IPA gained valuable comparative data that could be used in marketing to managed care companies. But the surgeons also were required to collect all the information requested by the database, not just the items they found most useful.

"Most of the [outcomes] information could be gleaned from the chart," Bailey says. "The question was how to find the time to do it."

Bailey and his colleagues asked patients to complete visual functioning and satisfaction surveys preoperatively and at one-day, six-week, and six-month follow-up visits. For surgery centers to conduct a similar long-term outcomes survey, they would need to work with surgeons to collect the follow-up information, Bailey notes.

Technicians also completed a three-page operative form as part of the national database project, sponsored by the American Society of Cataract and Refractive Surgery in Alexandria, VA, and managed by Summit Medical Systems in Minne-tonka, MN. (Society membership is required for joining the database. For details, see box at right.)

Now, while the society considers streamlining its data collection forms, the Philadelphia-based physician group is devising its own outcomes project on diabetic retinopathy. Initially, the physicians simply will look at frequency of visits for diabetic patients, which is a measure used by the National Committee for Quality Assurance, a health plan accrediting body in Washington, DC.

Bailey suggests surgeons and surgery center managers consider the following before launching an outcomes program:

1. What do you hope to gain from outcomes data?

"You really have to have a goal of why you're doing this before you start," he says. Officials from his IPA began negotiating with a managed care company that required information on cataract outcomes. They sensed that other payers soon would request or demand such information and that the physicians and affiliated surgery centers could gain a competitive advantage by being among the first to measure their own outcomes, he says.

The physicians also wanted to compare their results with a national benchmark. After a year of data collection, the IPA was able to show that its intraoperative complication rate of 2.99% was lower than the national average of 3.4% and its patient satisfaction scores were above 94 out of a best possible score of 100.

The IPA also negotiated global fees to cover patients up to three months after cataract surgery. The outcomes project enabled the surgeons to know their actual complication rates, rather than relying solely on information from medical literature, Bailey says.

"The problem with risk contracts is that most providers don't have the data [about utilization and complication rates], so they're at the mercy of managed care companies," says Allen Strahl, MBA, president and chief executive officer of Eye Physicians Management Corp. in Willow Grove, PA, which manages the IPA. "The tracking of quality data and the continual improvement are vital to being able to negotiate and manage risk contracts."

Yet extensive and time-consuming data collection isn't necessary to monitor outcomes and provide quality and patient satisfaction benchmarks, Bailey asserts. He suggests targeting your outcomes program to capture the information you need without spending unnecessary resources.

Surgeons could meet to determine what data they consider most important to track, such as pre-op and post-op visual acuity and functioning, intraoperative and postoperative complications, patients' other ophthalmic conditions, and patient satisfaction with care.

2. How will the data collection impact your patient processes?

Bailey does 400 to 500 cataract procedures a year. His technicians helped patients complete their forms pre- and postoperatively and filled out the operative data either between cases or at the end of the day.

On busy days, some forms simply weren't completed, which meant those patients weren't included in the database. "When that happens, it skews your data," he says. "It's not looking at every cataract." A simpler data collection form would make it easier for staff to gather data on every patient, Bailey says.

Some practices added a part-time employee to handle the data collection, Strahl says. "In the long run, it is the best investment they can make in their practice, because [outcomes data are] what the payers and public want to know," he says.

3. How can you offset the costs of outcomes management?

There is power in numbers. Same-day surgery programs that are part of a hospital, health system, or corporate chain already have the benefit of sharing costs for outcomes managers, software, or databases.

The Greater Philadelphia IPA allowed physician groups and their physician-owned surgery centers to band together for managed care contracting and outcomes management alike. The practices sent their forms to the IPA management company, which processed them and sent the data to Summit.

Companies may fund studies

Occasionally, pharmaceutical or device companies will provide funding for outcomes information related to their products.

For example, surgery centers or hospital-based same-day surgery departments can purchase a listing in directories such as the Clinical Investi-gators Directory, which is used by pharmaceutical and device companies and others seeking facilities or physician group to participate in clinical studies. A subscription, which includes the listing, costs $275 (for individual physicians) to $375 (for facilities) a year.

[Editor's note: For additional information on outcomes management, contact the Research Investigator's Source, 715 Florida Ave. S, Suite 105, Minneapolis, MN 55426. Telephone: (800) 535-6365. Fax: (612) 544-1415. World Wide Web: http://www.clinicalinvestigators. com.]