Phillip Clendenin Wishes AMSURG Partners a Happy Doctors’ Day

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March 30 is National Doctors’ Day, and I want to take this opportunity to thank you for the important work you do to deliver high quality, patient-centered care in your community. Last year, you and your fellow physicians performed more than 1.7 million procedures at AMSURG centers. Whether you are preventing colon cancer, restoring vision or repairing injuries, you are improving the health and lives of those around you.

At AMSURG, we are working every day to ensure you have complete confidence in the operations, quality and overall health of your center, allowing you to focus on caring for your patients.

Happy Doctors’ Day. We’re proud to partner with you.

Safety is our Priority

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As one of the leaders in providing ambulatory surgery options for patients, we are deeply concerned by the recent stories that called out patient tragedies and undermined a proven healthcare service option to gain viewership and readers. In addition, we believe all outpatient surgery centers should follow strict licensing, accreditation and patient safety processes to ensure the highest quality care and safety.

For decades, ambulatory and outpatient surgery have been valid options for surgical care. These settings enable shorter recoveries and offer more affordable options for identified procedures.

At AMSURG, we partner with our physicians and employees to deliver the highest standards of care and quality. AMSURG centers are Medicare approved and undergo voluntary accreditation by the Accreditation Association for Ambulatory Health Care (AAAHC) or The Joint Commission. In addition, our centers voluntarily comply with the OAS CAHPS (Outpatient and Ambulatory Surgery Consumer Assessment of Healthcare Providers and Systems) survey process. Each center’s Governing Board and medical staff review quality information every quarter to ensure a culture focused on safety, quality, and the patient experience. We pride ourselves in providing every patient with personalized care.

All patients undergo a complete health assessment and medical history review to ensure they are an appropriate candidate for care in an ambulatory surgery center. Based on the medical condition of the patient, medical history, and the planned surgery, the physician may determine that the patient should receive care in a hospital.

Our clinical quality team is focused on ensuring our teams continuously review quality and patient safety data in each center. Operational and clinical staff members review quality metrics monthly with a goal of continually meeting and exceeding patient expectations. However, like all surgical procedures, even those in the hospital, there are risks. Patients should review those risks with their physician before making a final decision on their care.

We want to assure our current and future patients that our ambulatory surgery centers are committed to offering a safe, high quality patient experience. The ambulatory surgery environment is a safe and affordable option for those patients who meet health and medical review requirements.

Additional Information:

Ambulatory Surgery Center Association Website

ASCA News Release

Patient Praises Total Hip Replacement Experience at Florida Surgery Center

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Total hip replacements have dramatically increased in frequency in recent years, with more than 300,000 procedures performed annually. General wear and tear, rheumatoid arthritis and injury are just a few of the reasons why people decide to pursue hip replacement surgery. Like many people who experience severe, prolonged hip pain, John Adicks, a pharmacist from Gainesville, Fla., decided to explore his options for hip replacement.

Adicks wanted to have the procedure performed as soon as possible, so he scheduled it for November 2017 at Orthopaedic Surgery Center of Ocala, Fla., as opposed to a hospital outpatient department. The ease of scheduling the replacement was one of the selling points of having the procedure at a center; the hospital would have not been able to fit him into the schedule until March 2018. Adicks also stated, “I felt I would be exposed to far fewer germs in a surgery center setting than in a hospital.”

Upon arrival at the surgery center, Adicks and his wife Jeanette were pleasantly surprised by their experience. “Jeanette is a critical care nurse and she was very impressed by the facility,” Adicks said. Both noted how exceptionally clean the facility was and how quickly the process moved. After the procedure, Adicks left the facility on crutches and a physical therapist stopped by for a home visit shortly thereafter. Just two weeks later, he no longer needed the crutches.

For those contemplating a total hip replacement, Adicks said he could not stress enough how much the procedure reduced his pain: “I was in significantly more pain prior to the replacement and only experienced minor soreness after the procedure.” He previously had a knee replaced as a hospital outpatient and said the hip replacement surgery was a far superior experience, with regard to both pain and the care he received. Adicks recalled, “The staff took really great care of me. I would unequivocally recommend having a procedure at a surgery center after my experience exceeded expectations.”

AMSURG and a Partnering ASC Shared Total Joint Replacement Advice in OR Manager

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In OR Manager’s February 2018 issue, Troy Sparks, BSN, RN, CNOR, Regional Vice President and Total Joint Program Coordinator, AMSURG, shared advice on developing a high-quality total joint replacement program in ambulatory surgery centers (ASC). In the article titled, “Total joints present increasingly attractive option for ASCs,” he stressed the importance of physician leaders, strict patient eligibility criteria and patient education.

Sparks worked closely with Surgery Center of Long Beach, an AMSURG partner, to develop the program. In 2017, the center became the first ASC in the U.S. to receive a Center of Excellence Award in Orthopaedic Certification by the Accreditation Association for Ambulatory Health Care.

View the full article here.

Kaizen Event Reduces Room Turnover Delays by 33 Percent

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Team PictureAMSURG’s process improvement team recently led a Kaizen event aimed at improving turnover times at a Maryland center. Ninety days after the collaborative event, the sustained improvement was a 33 percent reduction in room turnover time, from 15 to 10 minutes between patients.

Certified Kaizen facilitator, David Mayer, led the two-day Kaizen event and the team consisted of AMSURG corporate staff as well as the center’s clinical and operational staff. Collaboratively, they identified opportunities for improvement in all areas of center operation, including pre-op, anesthesia, patient consent, procedure specimen/report input, GI Tech tasks and PACU. During the event, the team implemented 12 key changes through best practice standardization, creative problem solving and visual management tools.

AMSURG’s process improvement team specializes in eliminating duplication and reducing non-value added elements of key operational processes, allowing ASCs to run more safely and efficiently. To learn more about a partnership with AMSURG, contact us.

Dr. Adam Blomberg Featured in Becker’s ASC Review Interview

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Adam Blomberg, MD, FASA, was featured in a December interview with Becker’s ASC Review, where he discussed the ASC-based anesthesiologist’s role in enacting ERAS protocols and mitigating opioid usage.

Dr. Blomberg spoke on the need for coordinated collaboration among ASC staff to enact patient-centered ERAS protocols. He also discussed anesthesia’s unique role in mitigating opioid usage through multimodal pain management techniques, including regional anesthesia and preoperative pharmacogenetics testing.

Dr. Blomberg is a board-certified anesthesiologist serving as Chief of Anesthesiology at Memorial Healthcare System. He also serves as the National Education Director for Envision Physician Services Anesthesiology.

View the article here.

AMSURG Research to Focus on Colonoscopy Screening Rates and Community Costs

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As an early advocate of GIQuIC, AMSURG has anticipated the many benefits that better data about GI procedures and screening can bring to physicians, payors and patients. At a March GI Research Summit, leaders from AMSURG, Evolution Health and other industry-leading organizations collaborated on how best to study and leverage GIQuIC data in pursuit of the Healthcare Quadruple Aim.

Dr. Gerald Maccioli, chief quality officer of Envision Healthcare, said, "I believe we have a moral obligation to investigate our exceptional database and convert it to useful hypotheses and, ultimately, meaningful action." AMSURG's contributions to the GIQuIC database surpassed one million procedures earlier this year.

The group of industry leaders, which gathered at Envision Healthcare's Nashville headquarters on March 2, also included AMSURG President Phillip Clendenin, Evolution Health Chief Quality Officer Daniel Castillo, and Dr. Ashish Atreja, chief innovation and engagement officer at The Mount Sinai Hospital. A full day of collaboration yielded several hypotheses that could be pursued with AMSURG's current GIQuIC data and supplemental demographic information.

The three potential hypotheses focus on socioeconomic factors related to colon cancer screening rates and risk, social determinants that contribute to community screening rates and average screening ages, and the community cost impact of colon cancer screening.

"For physicians, this analysis would be difficult or impossible at the individual or group level, but at the AMSURG level we can provide real insight into what is happening and how to make improvements in colon cancer screenings," said Eric Thrailkill, chief information officer for AMSURG and Evolution Health.

"In response to some of the literature that has recently appeared on this topic, we kept coming back to the topic of age-appropriate screening recommendations," said Kathy Wilson, vice president of quality for AMSURG. "We believe this is a meaningful opportunity to support our physician partners and positively impact patients and communities."

AMSURG Drives Better Patient Engagement through Patient Connect

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When patients are actively engaged in their healthcare, they contribute to better outcomes and have overall better health. This is why AMSURG’s Patient Connect platform relies on a patient’s own clinical data to drive participation and compliance with medical recommendations.

A recent pilot of the program asked whether providing expanded clinical information at the time of recall, such as findings from a previous screening colonoscopy, along with an enhanced patient experience produces a substantially improved patient recall success rate. The answer, overwhelmingly, was yes.

The participating pilot centers and practices were running the full spectrum of patient recall programs with existing recall levels ranging from zero to 25 percent. After implementing Patient Connect, AMSURG was able to increase the recall rate at all participating centers to approximately 40 percent.

“Patients are more engaged in their own healthcare decisions than ever before,” said Kathy Wilson, Vice President, Clinical Quality. “Given the massive amount of healthcare cost attributed to behavioral choices, this is an area where we can make a big impact.”

The initial stage of this program interfaces with GIQuIC data and focuses on GI patient recall, but the long-term benefit of this program lies in its flexibility. In the future, AMSURG can expand the program to work in any specialty and provide communication options and journeys customized to each patient.

“We are bringing together all of the disparate solutions that focus on one element of the patient communication market and providing our partners with a flexible platform that will not be available, or easily replicated, by competing groups. That, combined with our vast knowledge and understanding of how today’s patients want to manage and communicate about their health, will not only give our partners a competitive advantage, but it will help us in our ongoing aims to better serve our patients and drive down colon cancer mortality rates,” said Sara Sweitzer, Senior Director, Patient Contact Solutions.

For more information about partnering with AMSURG, contact us.

HOPD/Site Neutrality

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Effective as of January 2017, medical services administered at off-campus hospital departments that had not been billed as a hospital outpatient department (HOPD) prior to Nov. 2, 2015 will not receive increased Medicare payments. This "site neutrality" provision of the 2017 CMS Physician Fee Schedule aims to offset hospitals' incentive to acquire ambulatory surgery centers for conversion to HOPDs in order to secure boosted Medicare payouts.

AMSURG General Counsel Clint Cromwell explained that the legislation effectively minimizes the advantages of billing as an off-site HOPD. "The Government now has narrowed the rules on who is allowed to bill as an HOPD," Cromwell said. "Under the old requirements, if the facility was 100 percent owned by a hospital and was 30 miles away, it could be billed as an HOPD. Now it has to be no more than 250 yards away from the hospital."

As the Final Rule on the 1314 Bipartisan Budget Act of 2015, this provision prevents new and "non-grandfathered" HOPDs from reimbursement under the Medicare Outpatient Prospective Payment System (OPPS) and off-site facilities will receive an estimated less than 50 percent of the previous OPPS rate, effectively shrinking the financial advantage of holding provider-based status at off-site facilities.

By eliminating the financial advantage of holding provider-based status at off-site facilities, this legislation places a hefty burden on health systems to recoup financial costs for their off-site facilities while keeping those off-site facilities well-maintained.

Exemptions to the site neutrality rules include HOPDs that are located within 250 yards of a hospital campus or remote location. Also exempt are off-campus facilities that change ownership, as long as new owners agree to existing Medicare provider agreements.

Cromwell anticipates that while it might not have a big impact on hospitals, this provision emphasizes a broader shift to efficient healthcare practices. "The playing field is becoming level," Cromwell said. "The healthcare landscape is pivoting to emphasize the type of efficiency that makes up the AMSURG business model. Hospitals' reliance on our services will continue to grow in the coming years."

2017 Changes to Billing Codes and Stark Laws Physicians Should Know

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The Centers for Medicare & Medicaid Services (CMS) released its Physician Fee Schedule Final Rule in October detailing the new Quality Payment Program established under the Medicare Access and Chip Reauthorization Act (MACRA). A primary stipulation of the Final Rule increased the physician fee by 0.24 percent as opposed to the 0.5 percent increase originally expected.

Sheridan Chief Quality Officer Gerald A. Maccioli, MD, noted that although the 0.24 percent physician fee increase is seemingly positive, it is not enough to cover the inflationary costs of physician care. "In reality, this increase is a net loss economically," he said. While disappointing to physicians, this lackluster "increase" belies equally important takeaways from the 2017 Physician Fee Schedule.

The Final Rule includes billing code revisions for primary care and care management, which will more accurately pay primary care practices that utilize multi-specialized care resources in the treatment of patients that have behavioral health conditions.

One condition of the Final Rule particularly pertinent for AMSURG physician partners is the changes to the Stark Laws. "These Stark Laws are in place to prohibit referrals for certain Medicare-paid health services to an entity with which a physician has a financial relationship. Dr. Maccioli said. "The CMS Final Rule expands the number of covered codes and it is imperative for physicians to carefully review them."

These changes to the Physician Fee Schedule reflect healthcare's larger transition toward value-based accountable care, as laid out in MACRA, and will go into effect Jan. 1, 2017. "If physicians are asked to co-lead in the volume-to-value revolution, it will succeed; if not, it will fail," Dr. Maccioli said, underlining the importance of the AMSURG physician partnership model in this shifting healthcare landscape.