What will you say when payers ask for outcomes?

Measure satisfaction, functional health to stand out

You’re sitting down with the managed care company to negotiate a contract. You know your costs. You know your demographics. And you think you have the contract in the bag.

Then the payer asks you for your outcomes data.

Uh-oh.

Across the country, same-day surgery programs are being asked to demonstrate the success of their procedures by measuring patient satisfaction and the postoperative functional health of patients. To assist readers, we’ve talked to managers at a surgery center on the cutting edge of this trend.

The Surgery Center of Columbia in Middleburg, OH, used postoperative telephone calls to conduct a QA study on the hottest area of outcomes: patients’ functional health. (See QA Study Patient Information form, inserted in this issue.)

"We’ve basically started very simply: how they do outside once they leave the surgery center" says Nandlal Varyani, MD, medical director and director of anesthesiology.

The center studied four procedures:

• arthroscopy of the knee, ankle, and shoulder;

• laparoscopic cholecystectomy;

• hernia (inguinal or umbilical);

• operative pelviscopy and laparoscopy.

Patients were called the first day and after one week or later, depending on how soon they resumed their normal activities.

"We find out [from patients] on the day of surgery what their expected time off will be," says Nancy King, RN, CAPA, TQM coordinator at the center, who recently spoke at the annual Same-Day Surgery Conference, sponsored by Same-Day Surgery newsletter, in Washington, DC. "At the end of our study, we obtain information regarding actual time off work. Our medical director wrote a report with these findings that was given to third-party payers."

One problem uncovered in the outcomes study: Patients said they were returning to the activity later than they actually were because they already had arranged time off from work, Varyani says. For example, patients might have arranged for two weeks off from work, and many were reluctant to confess that they had resumed normal activities after a matter of days.

"I know for a fact that they’ve resumed normal activity before their planned time off," Varyani says.

As a result, the center is going to modify the questions to ask patients when they returned to specific activities. (For more on measuring functional health, see Same-Day Surgery, June 1996, p. 61.)

Despite the new interest in how patients are doing functionally, don’t drop the emphasis on keeping patients happy, King advises.

"Regardless of all the measurements out there, the No. 1 concern is patient satisfaction," says King.

The surgery center gives each patient a patient evaluation form when they leave the center. The survey is self-addressed with no postage necessary. Each survey is reviewed by administration, and complaints are addressed.

"Statistics are kept on all surveys and are the basis for a large part of our quality measurements," King says.

The center also fills out a patient satisfaction sheet when staff make postoperative telephone calls. (See sheet, inserted in this issue.) Each patient is asked, "Considering all aspects of your experience at the surgery center, would you say you were completely satisfied?" If the patient has a negative response, the person filling out the form writes a brief description of the complaint.

"These complaints are returned to the administrator daily, and this information is shared with third-party payers on a quarterly basis," King says. "Third-party payers have become an important customer. They are requesting data pertinent to patient care and satisfaction." (For more on postoperative telephone calls, see story, p. 10.)

Looking at patients’ top 10 concerns

The center also has performed a study to determine how its patient satisfaction lines up with the top 10 list of patient concerns, as measured by Press, Ganey Associates in South Bend, IN. (See results, inserted in this issue.)

When the statistics were studied, the most common complaints were that patients felt they were being discharged too soon or rushed out. Although only 13 complaints had been received in this area, the center performed a focus study and examined the following factors: gender, procedure, day of the week, time of the day, nurses and anesthesiologists involved, actual post-op time, and post-op medications given.

The study did not reveal any trends or similarities. As a result, "PACU nurses were advised to document patients’ readiness to be discharged," King says.

To obtain more detailed information, the center may revise the form to identify individual areas of satisfaction, King says.

When collecting outcomes information, don’t neglect either patient satisfaction or functional health, Varyani and King say. By combining the functional health and patient satisfaction statistics at The Surgery Center of Columbia, "we’ll know how satisfied they are and how expensive we are," Varyani says.

"It will be a great selling tool: ‘My patients get better quicker, cost less, and don’t have too many problems,’" he says. "With quality and cost, we have it made."