Oregon’s outpatient surgery centers are behind other healthcare organizations in reporting medical errors and infections
January 27, 2012 -- Oregon ambulatory surgery centers want to be an integral part of any newly formed Coordinated Care Organization. But some question just how transparent the 86 freestanding outpatient centers in the state are when it comes to reporting quality.
Participation by ASCs in the Oregon Patient Safety Commission has been slow, now with 58 percent of the facilities reporting severe medical errors. By comparison, all of Oregon’s hospitals are currently taking part in the hospital error-reporting program. And more than 75 percent of nursing homes have agreed to participate.
“It’s fair that we’ve had a little bit more of a challenge in reaching those smaller, more rural facilities,” said Bethany Higgins, the commission’s executive director.
But Higgins said the commission is making progress. Oregon ASCs now use a “safe surgical checklist,” pioneered by the commission. They also offer training courses on infection control, which many ASCs have taken part in, Higgins said.
“The training around infection protection seems to have caught a lot of interest,” Higgins said. “I’m really encouraged by that.”
But, when it comes to reporting rates of healthcare acquired infections, ASCs have l
argely avoided slower to publicly report as hospitals have been doing for the past several years. However, those ASCs that do partipicate have a much higher rate of reporting than, say, nursing homes. Only 8 percent of pariticpating nursing homes reported errors to the commission compared to 61 percent of participating ASCs.
While outpatient surgery centers typically involve elective procedures by relatively healthy patients, significant infections can occur especially with the use of endoscopes for colonoscopies. Based on a survey of ASCs last year, gastrointestinal endoscopy accounted for 25 percent of the procedures done by outpatient centers in Oregon.
Naomi Price, a consumer representative on the Patient Safety Commission, who looks closely at the infection rates, believes the state has been derelict in not requiring ASCs to report that information to the Legislature. The Health Care Acquired Infection Rate Committee has been in existence for the past four years.
“The Legislature, in devising the infection reporting statute, required the ASCs to start reporting the same way as hospitals,” Price said. “However, in rule making the state sidestepped the wishes of the Legislature and has stepped away from that requirement and just made baby steps.”
Oregon ASCs sincerely want to report infections, said Kecia Rardin, president of the Oregon ASC Association. It just needs to be meaningful, she said. For more than a year, committee members have been debating how best to report those rates.
“They have not been asked (to report infections by the committee) because the majority of ASCs are not performing procedures that are similar to the procedures that infections are being reported on in the hospital setting,” Rardin said. “It’s been a challenge to decide what procedures to have them report on.”
For instance, in order to determine an infection, an ASC would need to do post-discharge monitoring, something not required of hospitals, which only report infections when patients are still in the hospital. This is a sticking point that the Infection Rate Committee is trying to reconcile, said Dee Dee Vallier, a consumer representative.
Also the vast majority of infections acquired at hospitals, some 80 percent, show up after the patient returns home, according to the CDC.
“Using the CDC statistics, we’re only getting 20 percent of the surgical site infection rates at hospitals,” Vallier said. “They’re supposed to be doing follow-up surveillance but the hospitals aren’t. The hospitals aren’t doing it so it really wouldn’t be a fair playing field if we asked ASCs to do it.”
Because ASCs specialize in so many different types of procedures it makes it increasingly difficult to report meaningful quality data, but the association is committed, Rardin said. Infection rates are low at ASCs, which should be something to highlight, she said.
As for the patient safety commission, Rardin said almost all of the facilities that belong to the Oregon ASC Association are participating and that reporting rates among them were robust.
“There’s a benefit of not taking healthy patients into an environment where you have a lot of sick people,” Rardin said. “That doesn’t mean there isn’t a lot of things surgery centers should be reporting. Our responsibility is to find out what we can report that’s going to do the most good for the most people and be a benefit.”
Value and transparency become increasingly important as ASCs and other specialized areas of medicine are eager to participate in the Coordinated Care Organizations that will manage the state’s Medicaid program.
“Surgery centers have already shown our ability to perform high quality care at a fraction of the price,” Rardin said. “We’re saving Medicare billions of dollars per year at the national level. We’re a prefect model for an accountable care organization.”
Price urged ASCs to become more transparent when it comes to quality reporting if they want a greater share of the healthcare dollar.
“If ASCs want to be part of CCOs, that could be a great thing to integrate care and have it happen in the most appropriate setting,” Price said. “At the same time, the accountability aspect has to be integrated into this and right now I don’t see that’s happened yet.”
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