Providing surgeons with the resources, tools, information, and training they need to provide quality care to the surgical patient has been the primary goal of the American College of Surgeons (ACS) since the organization’s founding in 1913. Given the regulatory demands on surgeons today, it is more important than ever that the ACS fulfill this commitment. To help surgeons better meet these evolving expectations, the ACS has been engaged in an effort to integrate and redesign our quality program database software.
The College’s commitment to quality improvement dates back to its founding, when Ernest Amory Codman, MD, FACS, introduced The End Result Idea. This concept centered on the notion that every hospital and every surgeon should follow every patient long enough to determine whether the treatment was successful, and if not, why not. Dr. Codman also was responsible for the creation of the College’s first registry—the Registry of Bone Sarcoma. This repository was the precursor to later ACS databases, including the National Cancer Data Base (NCDB) and the National Trauma Data Bank® (NTDB®), as well as more recent quality improvement programs, including the National Surgical Quality Improvement Program (ACS NSQIP®), Pediatric NSQIP, the Surgeon Specific Registry™ (SSR), and the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP™).
These and all other ACS quality programs are grounded in four key principles:
- Set the standards individualized to the patient and backed by research
- Build the right infrastructure, one with the right mix of appropriate staffing levels, specialists, equipment, and checklists
- Use the right data; that is, data drawn from medical records, backed by research, that track patients post-discharge, and are continuously updated
- Verify with outside experts through external peer review
Registries: Increasingly relevant
Meeting these standards and helping to ease the financial and administrative burdens that many surgeons are experiencing in today’s highly regulated health care environment are the underpinnings of our database software redesign project. More specifically, the ACS recognizes that Fellows need coordinated quality measurement systems and registries to comply with increasing demands for public reporting, performance-based payment reforms, and Maintenance of Certification (MOC) requirements.
A range of public reporting websites are now available, including the Centers for Medicare & Medicaid Services (CMS) Physician Compare program and ProPublica’s so-called Surgeon Scorecard. The College has significant concerns regarding both of these public reporting systems because they use Medicare billing data to measure performance and surgeon complication rates rather than risk-adjusted clinical data, such as the information used to generate ACS NSQIP outcomes reports. The College maintains that risk-adjusted clinical data are a better reflection of performance and other complicating factors that may affect patient outcomes.
The College has worked closely with CMS to ensure that information collected in the SSR is compatible with CMS’ Physician Quality Reporting System (PQRS). The SSR has been approved as a PQRS registry for individual eligible providers (EPs) to participate in traditional registry-based reporting, and the MBSAQIP has been approved as a Qualified Clinical Data Registry. Physicians and other EPs who fail to satisfy PQRS reporting requirements face penalties on their Medicare Part B billings.
As the Medicare program transitions to implementation of the Medicare Access and CHIP (Children’s Health Insurance Program) Reauthorization Act (MACRA), new payment systems will be put in motion. However, the Merit-based Incentive Payment System and alternative payment models that are set for implementation in 2019 will likely rely on outcome measures and registries to determine reimbursement. As a result, surgeon participation in the ACS clinical data registries will remain eminently important.
In addition, the Health Information Technology for Economic and Clinical Health (HITECH) Act authorizes the U.S. Department of Health and Human Services to provide incentives to EPs who meet meaningful use criteria for the use of electronic health records (EHRs) and to penalize those who do not meet the program’s objectives. Many surgeons, particularly those in small practices, find it difficult to meet the meaningful use criteria and can ill-afford to take any additional financial hits for noncompliance. Furthermore, PQRS has an EHR-based reporting option as well.
Moreover, the American Board of Surgery and other surgical boards have been gradually implementing MOC mandates. Part 4 of MOC focuses on assessment of practice performance. The SSR provides surgeons with information about procedure-specific outcomes in their own practices and allows them to benchmark their performance against the results of other participants in the national database. This feedback will help surgeons self-evaluate and identify areas for improvement.
A collaborative effort
The newly reimagined ACS quality database system responds to all of these concerns. It will not only allow the ACS to migrate all of our clinical registries into a common, consolidated warehouse and reporting platform, but it will allow for EHR integration. Furthermore, the new system will have Web portal data entry capabilities and will be deployable to all mobile devices.
Strategic planning for this effort began about two years ago, and a three-year implementation program is now under way. We anticipate that the new program will be completed in time to allow surgeons to effectively and smoothly comply with MACRA’s implementation.
Many members of the ACS leadership and staff have played a significant role in developing this program with our outside vendor, Quintiles. (See sidebar for a list of some of the key players in this endeavor.) We are extremely excited about the potential of this project and how it will help ACS members be better able to receive fair compensation, measure their performance, and, most importantly, improve the quality of surgical care.