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Hospital Visits After Urology Ambulatory Surgical Center Procedures

CBE ID
3366
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 urology procedures in an ambulatory surgical center (ASC). The measure estimates a facility-level rate of risk-standardized, all-cause, unplanned hospital visits within seven days of a urology surgery at an 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 Hospital Visits after Urology Procedures Performed at Ambulatory Surgical Centers (hereafter “ASC Urology Surgery”) measure captures complications arising from elective urology procedures performed at ASCs by measuring unplanned hospital visits within 7 days (ED visits, observation stays, inpatient admissions). The goal of this measure is to reduce adverse patient outcomes associated with ASC urology surgeries and improve follow-up care by capturing and making more visible to providers and patients unplanned hospital visits following orthopedic procedures. The measure score, publicly reported since 2018, holds ASCs accountable for their performance, and informs facility-based quality improvement.

There is a national trend toward increased use of ambulatory settings for several common outpatient urological procedures (Suskind et al., 2014). In general, 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, innovations in minimally invasive surgical techniques, and lower costs associated with care (Munnich et. al., 2014). For example, a study by Gul et al. found large variation in the cost for urological procedures based on both hospitals and insurance. ASC settings for such procedures appeal to patients when compared to HOPDs because of associated lower costs and recovery time (MedPac, 2024).

A hospital visit after outpatient surgery is unexpected, and many of the reasons for such hospital visits are preventable. 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 may not be 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 the ASC Urology 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.

Gul, Z. G., Sharbaugh, D. R., Guercio, C. J., Pelzman, D. L., Jones, C. A., Hacker, E. C., ... & Davies, B. J. (2023). Large variations in the prices of urologic procedures at academic medical centers 1 year after implementation of the Price Transparency Final Rule. JAMA Network Open, 6(1), e2249581-e2249581.

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

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. 

Suskind, A. M., Dunn, R. L., Zhang, Y., Hollingsworth, J. M., & Hollenbeck, B. K. (2014). Ambulatory surgery centers and outpatient urologic surgery among Medicare beneficiaries. Urology, 84(1), 57-61.

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 (FFS) Part A and Part B claims, and administrative data.