Providing high-quality care is at the heart of everything we do as surgeons, and it has been the cornerstone of the American College of Surgeons since our founding in 1913. Today, it’s more important than ever that we accelerate conversations about surgical quality as we emerge from the pandemic and confront the strains it has put on our healthcare system, superimposed on existing burdens placed on us as physicians.
Some hospitals are encountering challenging financial conditions, and with such difficulties, some look for ways to save money by eliminating programs. It is precisely at times like these that we must be vocal advocates for our colleagues and for surgical quality. Our patients need us, our fellow surgeons need us, and our hospitals need our guidance. ACS quality programs demonstrably lead to better care and better outcomes.
We are embarking on a multiyear, national campaign to promote the important role our surgical quality programs can play in improving patient outcomes while enhancing hospital efficiencies. Through our Power of Quality campaign, which we unveiled at Clinical Congress last October, we endeavor to bring our quality programs to every community and every hospital in America.
In the coming months and years, the ACS will highlight our quality programs and will work with participating hospitals to showcase how they can be used to deliver the best possible care—even in these turbulent times. By demonstrating success and providing metrics, we are confident that more and more communities will want our programs in their local hospital systems.
A Role for Every Surgeon
Surgeons play a key role in championing our programs and promoting quality. Yours is often the most effective voice your hospital leaders can hear to make the case for quality. Our experiences, along with the evidence of our programs’ impact, make a compelling argument for hospital leaders. Our ACS program leaders can assist you by providing the materials and information you need for these important conversations. Our staff can also highlight those hospitals that recognize the difference our programs make every day to bolster your positions.
Evidenced-based Improvement
We all know that data are the keys to effective quality improvement efforts—relevant clinical data, not administrative or claims-based data that are too often being used today as a basis for decisions. The data hospitals can access through our National Surgical Quality Improvement Program (NSQIP) databases remain superior and are foundational to strong quality improvement efforts. A seminal study from 2012, published in Annals of Surgery, reviewed nearly 118,000 patient records from 200 hospitals to assess the difference between NSQIP data and claims data to capture surgical complications. The study demonstrated poor to moderate agreement in coding between NSQIP and Medicare claims data for 10 postoperative complications. The variability that results from using claims data to make clinical decisions is deeply problematic. We must be mindful of the standards set for the data we use and ask the right questions to inform our clinical decision-making.
Historically, the ACS quality programs continue to make a profound difference in treatment paradigms. In a 2006 New England Journal of Medicine article, fatality rates after treatment were lower in trauma centers versus non-trauma centers. In manuscripts on metabolic and bariatric surgery, several studies have demonstrated that ACS-verified centers have fewer complications, lower mortality, and lower costs than those not verified by the ACS. Additionally, it is well documented in the literature that breast cancer patients who receive treatment in centers accredited by our National Accreditation Program for Breast Centers have demonstrably better outcomes.
From Pediatrics to Geriatrics
The ACS has 18 quality programs that help hospitals achieve better results and improve the efficient delivery of surgical care. I am confident that patient care will improve if we can have our quality programs adopted by more institutions. In addition to condition-specific programs, we also have developed population-based programs like our Children’s Surgery Verification (CSV) Program and our Geriatric Surgery Verification (GSV) Program. The CSV Program provides the nation’s first and only multispecialty standards for children’s surgical care. We’ve verified more than 50 programs and have more than 160 participating in our children’s NSQIP database.
On the other end of the spectrum, our GSV Program caters to the unique care needs of surgical patients who are 75 years old and above. This program has enormous implications for hospitals across the country as the proportion of geriatric patients in our population continues to grow. Consider the example of Unity Hospital, a member of Rochester Regional Health in upstate New York. Matthew Schiralli, MD, FACS, medical director of the geriatric surgery program for the system, let us know that his institutions have seen a 20% decrease in elderly patients’ death and serious morbidity and a marked reduction in extended stays due to postoperative delirium.
In addition, he reported that the ACS’s quality programs have helped them prioritize what works to improve patient outcomes, reduce unnecessary hospital stays, and save money.
Paying for Quality
As part of the Power of Quality campaign, a significant goal is to raise awareness of our quality programs among stakeholders who are in the position to incentivize paying for quality, such as the Centers for Medicare & Medicaid Services (CMS) and other payers and employers. For example, we have been pleased with CMS’s recognition of our GSV Program as a way to promote age-friendly care in the Medicare population.
As part of a preliminary rulemaking process, we proposed the Geriatric Hospital Measure for use in CMS’s Hospital Inpatient Quality Reporting Program. In collaboration with the Institute for Healthcare Improvement and the American College of Emergency Physicians, we developed a new type of measure—a “programmatic measure”—based on the GSV. The measure considers the full spectrum of care needed for older adults to assure Medicare that we know how to address frailty and ensure that patients and caregivers know where to get comprehensive care that reflects the unique needs of the elderly.
The multistakeholder committees that reviewed this measure provided preliminary support, and the ACS staff will continue to work with CMS and other stakeholders toward its inclusion in the Medicare Hospital Inpatient proposed rule.
The Power of Quality campaign is integral to the priorities of the American College of Surgeons. I am committed to providing an opportunity for every member and every hospital to engage more meaningfully with our quality improvement efforts.
Together, we will improve patient outcomes, enhance efficiencies, reduce complications, and have a meaningful impact on our healthcare system for all patients.
