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Facility-Level 7-Day Hospital Visits after General Surgery Procedures Performed at Ambulatory Surgical Centers

CBE ID
3357
Endorsement Status
E&M Committee Rationale/Justification

When the measure returns for maintenance, the committee would like to see: 

  • Explore methods to enable the evaluation of improvement over time; and
  • Consider additional approaches for the reliability assessment that inform the reliability-validity (e.g. shrinkage) and reliability-usability (e.g. stability) tradeoffs
1.0 New or Maintenance
Previous Endorsement Cycle
Is Under Review
No
Next Maintenance Cycle
Spring 2029
1.6 Measure Description

This measure was developed to improve the quality of care delivered to patients undergoing general surgery procedures in an ambulatory surgical center (ASC). To assess quality, the measure calculates the risk-standardized rate of return to a hospital for an acute, unplanned hospital visit within seven days of qualified general surgery procedures performed at an ambulatory surgical center (ASC) among Medicare Fee-For-Service (FFS) patients aged 65 years and older. An unplanned hospital visit is defined as an emergency department (ED) visit, observation stay, or unplanned inpatient admission.

Measure Specs
General Information
1.7 Measure Type
1.7 Composite Measure
No
1.3 Electronic Clinical Quality Measure (eCQM)
1.8 Level of Analysis
1.9 Care Setting
1.10 Measure Rationale

The shift of surgical procedures from the inpatient setting to the outpatient setting has caused an exponential growth in the number of ASCs and procedures performed in this setting (Jain et al., 2020). The number of ASCs grew by 35% between 2006 to 2021. In 2022, about 6,100 ASCs treated 3.3 million fee-for-service (FFS) Medicare beneficiaries. FFS Medicare program spending and beneficiary cost sharing on ASC services was about $6.1 billion (MedPAC, 2024). The patient population served at ASCs has increased not only in volume but also in age and complexity, which can be partially attributed to improvements in anesthetic care and innovations in minimally invasive surgical techniques. In comparison to the traditional HOPD setting, ASCs can offer patients more convenient location, shorter wait times, lower cost sharing, easier scheduling, and the ability to return to work rapidly (Munnich et. al., 2014; MedPAC, 2024). Therefore, in the context of growth in volume and diversity of procedures performed at ASCs, evaluating the quality of care provided at ASCs is increasingly important. 

Hospital visits following an ambulatory surgery vary from 0.5% to 9.0%, based on the type of surgery, outcome measured, and timeframe for measurement after surgery (Bongiovanni et al., 2021). Hospital visits can occur due to a range of potentially preventable adverse events including uncontrolled pain, urinary retention, surgical site infection, bleeding, septicemia, and venous thromboembolism. Patients also frequently report minor adverse events -- for example, uncontrolled pain, nausea, and vomiting -- that may result in unplanned acute care visits following surgery (Owens et al., 2014; Bongiovanni et al., 2021). 

Several factors make unanticipated hospital visits a priority quality indicator. Because ASC providers are not aware of all post-surgical hospital visits that occur among their patients, reporting this outcome will help to illuminate problems that may not be currently visible (Zivanovic et al., 2020). In addition, the outcome of hospital visits is a broad, patient-centered outcome that reflects the full range of reasons leading to hospital use among patients undergoing same-day surgery. Public reporting of this outcome measure will provide ASCs with critical information and incentives to implement strategies to reduce unplanned hospital visits. 

 

References

Bongiovanni T, Parzynski C, Ranasinghe I, Steinman MA, Ross JS. Unplanned hospital visits after ambulatory surgical care. PloS one. 2021 Jul 20;16(7):e0254039.

Jain S, Rosenbaum PR, Reiter JG, Ramadan OI, Hill AS, Silber JH, Fleisher LA. Assessing the Ambulatory Surgery Center Volume-Outcome Association. JAMA surgery. 2024 Apr 10.

Medicare Payment Advisory Commission (MedPAC). Report to Congress: Medicare Payment Policy. March 2024; https://www.medpac.gov/wp-content/uploads/2024/03/Mar24_MedPAC_Report_To_Congress_SEC.pdf

Munnich EL, Parente ST. Procedures take less time at ambulatory surgery centers, keeping costs down and ability to meet demand up. Health Affairs. 2014 May 1;33(5):764-9.

Owens PL, Barrett ML, Raetzman S, Maggard-Gibbons M, Steiner CA. Surgical site infections following ambulatory surgery procedures. Jama. 2014 Feb 19;311(7):709-16. 

Zivanovic O, Chen LY, Vickers A, Straubhar A, Baser R, Veith M, Aiken N, Carter J, Curran K, Simon B, Mueller J, Jewell E, Chi DS, Sonoda Y, Abu-Rustum NR, Leitao MM Jr. Electronic patient-reported symptom monitoring in patients recovering from ambulatory minimally invasive gynecologic surgery: A prospective pilot study. Gynecol Oncol. 2020 Oct;159(1):187-194. doi: 10.1016/j.ygyno.2020.07.004. Epub 2020 Jul 24. PMID: 32718730; PMCID: PMC7380930. _________________________________________________________________________

1.20 Types of Data Sources
1.25 Data Source Details

Medicare Fee For Service administrative and claims data as well as CMS enrollment and demographic data.