Growing Trend Patients at Risk December 2016 Introduction to the NJ Health Care Quality Institute Mission to undertake projects that will ensure that quality safety accountability and cost containment are all closely linked to the delivery of health care in New Jersey ID: 726669
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Slide1
Ambulatory Surgery Centers
Growing Trend – Patients at Risk?
December
2016Slide2
Introduction to the NJ Health Care
Quality Institute
Mission
: to undertake projects that will ensure that quality, safety, accountability and cost containment are all closely linked to the delivery of health care in New Jersey.
New Jersey’s Regional Health Improvement Collaborative & member of NRHI
Regional Leader for The Leapfrog Group
National Quality Forum (CSAC Committee and the End of Life/Palliative Care Committee) Slide3
What is an Ambulatory Surgery Center?
It is a health care facility focused on providing same-day
surgical
care, including diagnostic and preventive procedures.Slide4
What types
of surgeries do ASCs do
?
Cataract, Endoscopy,
Colonoscopy, Orthopedics,
Dermatology, Knee surgery,
and many other surgical procedures Slide5
Growing in Usage
Nationally, the rate of visits to ASCs increased three-fold from 1996 to 2006, whereas the rate of visits to hospital-based surgery centers has remained essentially unchanged during that time period.Slide6
Who Owns Ambulatory Surgery Centers?
Physicians own at least part of 90% of all ASCs.
Trend toward more hospital ownership:
Hospitals have ownership interest in 23% of all ASCs
2% of ASCs are wholly owned by hospitals.
Slide7
Why should we care?
50%
Patient Assumptions
Plan Incentives
More proceduresSlide8
Who oversees non-hospital based surgery centers?
0%
50%
About 43 states require ASCs to be licensed
CMS requires “Certification” for reimbursing Medicare and/or Medicaid patient procedures Slide9
New Jersey’s Campaign
To ensure consumers are receiving safe care in ASCs through:
improved oversight by regulators
increased transparency of quality & safety
Slide10
Our First Campaign
2011 – NJHCQI conducted an open records request
Reviewed 91 DOH inspections of licensed and unlicensed surgery centers.
49 of the 91 Licensed Ambulatory Surgery Centers did not meet standards to participate in Medicare
Of the 51 Licensed ASCs, eight were in "Immediate Jeopardy,” which resulted in two centers being closed temporarily.
Of the 40 Unlicensed Surgical Practices, 17 were in “Immediate Jeopardy,” which resulted in seven closed temporarily.
* Immediate Jeopardy = “has caused, or is likely to
cause, serious injury, harm, impairment or death to a
patient.”Slide11
What NJHCQI found
Regulatory structure is inconsistent:
ASC – licensed by the State ($4,000 licensing fee), regulated by the DOH (133 ASCs)
One Room Surgery – no license required, unknown number
116 have CMS certification (Medicaid/Medicare patients)Slide12
Inspections
Inconsistent
DOH inspects licensed centers
BME investigates complaints for unlicensed centers
Infrequent
Licensed ASCs and CMS-certified one room surgeries are inspected every four years
One room, non-certified centers inspected only if complaint is filed
Not Transparent
DOH Inspections: Open Records BME Investigations: Confidential CMS certification by accrediting agencies such as The Joint Commission, Accreditation Association for Ambulatory Health Care, American Association for Accreditation of Ambulatory Surgery Facilities: not subject to Open Records
*accrediting agencies conducted inspections for 307 NJ facilities
Slide13
Adverse Events:
Enacted 2008
Licensed ASCs (> one room) must report to the DOH serious preventable adverse events
conduct a Root Cause Analysis (RCA). 2015 report with 2012 aggregate dataAlmost half of 163 licensed ASCs reported an adverse event.199 reportable events were submitted:
67% were Intraoperative or postoperative coma, death or other serious preventable adverse events (133 events)
82% of events resulted in hospital admission
Caused the death of 6 patients.
Public Reporting of Adverse EventsSlide14
Public Reporting of Health Care
Acquired Infections
Enacted 2010
Licensed ASCs to report HAI rates for “major site categories”
Data to be made publicly available “in a way that the public can compare facilities.”
Data collected for 2012-2014: Three surgical site infections:
Breast
Laminectomy (decompression surgery)
Knee Arthroplasty
No Public Report has been released to date. 60 infections were reported for 2012-15 in a little-known meeting.Slide15
Public Reporting for Unlicensed ASCs
Board of Medical Examiners regulations require reporting in cases where an incident related to surgery or anesthesia which results in
a patient death,
transport of the patient to the hospital for observation or treatment for a period in excess of 24 hours,
or a complication or untoward event.”
These reports “shall” be investigated by the Board but are “deemed confidential.”Slide16
Our next steps
Second request of inspection reports
Better transparency
Better oversightSlide17
Do you know what’s happening in your state?
Does your state license ASCs?
Scope of the definition of an ASC
Requirements for licensure
Conditions of licensure renewals
Which department has oversight and what remedies are available?
Who inspects ASCs and how often?
(Cont’d)Slide18
Do you know what’s happening in your state?
(Cont’d)
Are inspection reports publicly available?
Are ASCs required to report adverse events and/or HAIs? Are these reports public?
Available to the public?
Up to date?
Verified?
What is that Regulatory Body doing with the inspection and reporting information?
Are license fees and/or taxes paid? Are the funds earmarked for oversight?Slide19
For more information:
Patricia Kelmar, JD
Senior Policy Advisor
NJHCQI
pkelmar@njhcqi.org
** THANK YOU **