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Hospital Visits after Orthopedic Ambulatory Surgical Center Procedures

CBE ID
3470
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 orthopedic procedures in an ambulatory surgical center (ASC). To assess quality, the measure calculates the risk-standardized rate of acute, unplanned hospital visits within seven days of qualified orthopedic surgeries or procedures performed 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 rationale for public reporting of the ASC Orthopedic Surgery remains imperative, given the significant growth in ASC utilization; in 2018, there were more than 23 million ambulatory surgeries performed at ASCs in the United States (Young et al., 2021). As ASCs increasingly become the preferred choice for lower-risk surgeries, including orthopedic procedures, evaluating postoperative outcomes, such as unplanned hospital visits, becomes pivotal for ensuring quality care and patient safety. This rising trend in orthopedic procedures at ASCs underscores the importance of incentivizing ASCs to address preventable complications and acute care needs, thus fostering continuous quality improvement in outpatient surgical care (Lopez et. al., 2021).

 

The ASC Orthopedic Surgery measure captures unplanned hospital visits 7 days after an outpatient orthopedic procedure. The measure focuses on the outcome of unplanned hospital visits because this is a broad, patient-centered outcome that captures the full range of hospital visits resulting from adverse events or poor care coordination following outpatient surgery. By providing ASCs with detailed information about patients who have an unplanned hospital visit, this measure supports quality improvement at ASCs, and through public reporting the measure provides through assessment and illumination of the variation in risk-adjusted hospital visits following outpatient orthopedic procedures.

As described in Section 2.2, efforts to reduce post-discharge hospital visits by addressing surgical site infections and medication reconciliation are pivotal in enhancing patient outcomes, exemplified by initiatives like the AHRQ's quality improvement collaborative for ambulatory surgery (Davis et al., 2019). Improved data availability is crucial for accurately assessing outcomes and facilitating post-discharge patient follow-up. Better measurement and understanding of hospital visits post-surgery are essential for driving quality improvement initiatives and ensuring patient-centered care in outpatient settings. Hence, interventions aimed at enhancing care quality, including optimized patient selection, advanced surgical techniques, pain management protocols, patient education, and medication reconciliation, have the potential to mitigate unplanned hospital visits and improve overall surgical outcomes (Erhun et. al., 2016). Please see Section 6.2.1 for more information on how ASCs can improve performance.

Improving the quality of care provided at ASCs is a key priority in the context of growth in the number of ASCs and procedures performed in this setting. Orthopedic procedures conducted in ambulatory settings have historically been minor in nature. However, advancements in surgical and anesthetic techniques, cost-effectiveness, and lower complication rates now enable the performance of more complex procedures on an outpatient basis; CMS now allows both total knee and total hip arthroplasty to be performed in the ASC setting. 

 

References

Davis KK, Mahishi V, Singal R, Urman RD, Miller MA, Cooke M, Berry WR. Quality Improvement in Ambulatory Surgery Centers: A Major National Effort Aimed at Reducing Infections and Other Surgical Complications. J Clin Med Res. 2019 Jan;11(1):7-14. doi: 10.14740/jocmr3603w. Epub 2018 Dec 3. PMID: 30627272; PMCID: PMC6306128. 

Erhun F, Malcolm E, Kalani M, Brayton K, Nguyen C, Asch SM, Platchek T, Milstein A. Opportunities to improve the value of outpatient surgical care. Am J Manag Care. 2016 Sep 1;22(9):e329-35. PMID: 27662397.

Lopez, C. D., Boddapati, V., Schweppe, E. A., Levine, W. N., Lehman, R. A., & Lenke, L. G. (2021). Recent Trends in Medicare Utilization and Reimbursement for Orthopaedic Procedures Performed at Ambulatory Surgery Centers. The Journal of bone and joint surgery. American volume, 103(15), 1383–1391. https://doi.org/10.2106/JBJS.20.01105

Young S, Pollard RJ, Shapiro FE. Pushing the Envelope: New Patients, Procedures, and Personal Protective Equipment in the Ambulatory Surgical Center for the COVID-19 Era. Adv Anesth. 2021 Dec;39:97-112. doi: 10.1016/j.aan.2021.07.006. Epub 2021 Jul 27. PMID: 34715983; PMCID: PMC8313519.

1.20 Types of Data Sources
1.25 Data Source Details

Medicare Fee-For-Service (FFS) claims and administrative data.  Please see section 4.2.2 for details.