Ann Shimek, MSN, BSN, RN, CASC
Executive Director, ASC Quality Collaboration
Can you tell us a little about your professional experience and how it has helped prepare you for your new position as executive director of the ASC Quality Collaboration?
I’ve spent my entire professional career of more than 30 years working in and around operating rooms. And for the past 20 years, I’ve worked exclusively for ASCs, including at the management company and facility levels. I’ve been an administrator, a clinical director and a materials manager. Over the course of my career I’ve also had frontline responsibility for the fulfillment of various regulatory and compliance requirements.
What are your primary goals for the Collaboration in 2020 and beyond?
In consultation with the board of directors earlier this year, I initiated a look-back and progress report against the original goals and objectives that were put in place when the Collaboration was started in 2006. Our primary goal in the beginning was to help develop quality metrics that could help demonstrate the high quality of care in ASCs. Without question, we’ve made considerable progress on that front, but there is clearly more that needs to be done—both in terms of improving the focus of the data we collect, as well as in how we present that data to all our publics. We are also very focused on deploying new technologies for ASCs to help them improve the efficiency and the accuracy of their reporting.
In addition, the suspension of elective surgeries brought about by the COVID-19 pandemic this spring put several new demands on the Collaboration regarding our data collection efforts and how it can be used to shape future policies.
What have you learned so far regarding both the suspension and the resumption of elective surgeries?
Our primary concerns remain the same—quality outcomes for patients and safe working environments for physicians and staff.
To that end, we sent a survey in April to approximately 1,600 ASCs to learn more about what they were encountering in terms of potentially infected patients.
We asked how many essential surgeries were still occurring during the suspension of elective surgeries, whether facilities were screening or testing patients specifically for the virus, if any patients tested positive either preoperatively or postoperatively, and whether any patients were subsequently hospitalized and why. The preliminary results are very encouraging.
With 710 facilities responding and a universe of more than 84,000 procedures, there were no procedures performed on patients with a known infection and very few who tested positive postoperatively within 14 days of their procedure. There were also no reports of staff being infected through transmissions from patients. If these trends hold, and I believe they will, I think the data will make a strong case for the safe operation of ASCs, even during a pandemic.
In 2019, the Centers for Medicare & Medicaid Services (CMS) reduced the number of reportable events in the ASC Quality Reporting Program. Can you comment on that development—as well as any additional steps that you believe can be taken to provide patients with a more complete picture of the quality of care ASCs provide?
On one hand, it’s understandable why CMS would eliminate certain reporting requirements after the data demonstrated there were few, if any, incidents to report in the discontinued categories. On the other hand, we believe that patients would benefit by continuing to have access to that information and the reassurances it can provide.
We would also like to see CMS shift methodologies from the current claims-based disclosures to an online reporting structure that would also include hospital outpatient departments (HOPDs) so that patients and payers could make apples-to-apples comparisons between ASCs and hospital outpatient care.
Members of the Collaboration also believe that patient satisfaction surveys should be part of the quality evaluation of ASCs, and we are continuing to work with CMS on improving The Consumer Assessment of Healthcare Providers and Systems Outpatient and Ambulatory Surgery Survey (OAS CAHPS), a voluntary patient satisfaction survey for ASC patients. As early as this summer, we are hoping CMS will allow ASCs to begin emailing the survey to patients in order to improve on the low response rates that we have experienced with telephone calling and traditional mail.
How can we improve the accessibility of quality reporting data for patients and non-medical professionals?
Historically, the Collaboration has done a great job of presenting data in a very user-friendly way. Still, we believe a lot more needs to be done to enable patients and payers to better understand the quality of care ASCs provide.
One concern with the current quality reporting data is that it lacks context. For instance, ASCs are required to report when patients are transferred to a hospital but there is no means for reporting why the patient was transferred—which may, in fact, be unrelated to a surgical procedure.
We also believe patients should have the ability to compare the quality of ASCs to that of HOPDs.
What advice would you give a prospective outpatient surgery patient who is trying to evaluate the quality of care they can expect from their surgeon and an ASC where that care would be provided?
I would tell anyone considering or in need of surgery to gather all the information they can find online about their provider and surgical facility, including information on our website and available through the CMS Quality Reporting program. But until we make some substantial improvements in the collection and disclosure of quality data in all healthcare settings, there is no substitute for asking your surgeon a few important questions. Here are five I would encourage every patient to ask their surgeon before giving their consent for a procedure:
- What is your success rate performing this procedure compared to any national averages?
- Why are you recommending this center or hospital for my procedure?
- Do you have a financial incentive for bringing me to this location?
- Would I pay more or less for my surgery if it were performed elsewhere?
- Where can I find any safety or quality data about you and the center or hospital where I will be having my surgery?