Having the ability to compare quality measures for procedures such as a colonoscopy to a national average is an invaluable tool that can provide ambulatory surgery centers (ASCs), endoscopy centers and physicians with quantitative proof that they are the best option when it comes to patient care.

“GI is kind of unique because they have, for a long time, worked on establishing standard quality measures for GI,” said Kathy Wilson, vice president of clinical quality services, “So they are well ingrained in having common quality metrics that everybody is familiar with.”

Through AMSURG’s collaboration with GIQuIC, centers and physicians can report and compare quality measures on gastrointestinal (GI) procedures, creating a standard of excellent care provided to patients.

GIQuIC formed in 2005 as an affiliation between the American College of Gastroenterology (ACG) and the American Society of Gastrointestinal Endoscopy (ASGE) to establish a quality registry for GI. Registries are data repositories which can be analyzed to detect patterns and trends that can improve the process and outcomes for patient care.

AMSURG started collaborating with GIQuIC in 2011, and established a special relationship for AMSURG physicians by creating a standard process for centers to be added to the GIQuIC registry.

“We were kind of the first line of technology support for our centers that would go on GIQuIC," Wilson said. “We have more than 60 centers [on GIQuIC], and our records are almost 25 percent of the whole record base in GIQuIC.”

The GIQuIC registry has rapidly grown in the past few years from only 100,000 procedures in 2012 to a 1.5 million procedures today. The data in GIQuIC provides a benchmark for physicians and ASCs and sharing this data with the doctors can drive improvement in quality. Research from the American Journal of Gastroenterology suggests that distribution of report cards and establishment of standards of practice can significantly improve quality measures such as adenoma detection rates.

Adenoma detection rate (ADR) is a standard measure that is considered one of the most important for GIs. The higher a physician’s adenoma detection rate, the more likely he or she will detect and remove a precancerous polyp during a colonoscopy. A high detection rate also usually means that a physician produces higher quality colonoscopy with fewer cases of colon cancer among his or her patients. It has been reported that each one percent increase in adenoma detection rate is associated with a three percent decrease in the risk of cancer (Adenoma Detection Rate and Risk of Colorectal Cancer and Death).

“Consumers don’t know what they need to know regarding quality,” said Rich Palumbo, vice president of field marketing. “We have a rare opportunity to frame the conversation. Consumers don’t know what ADR is or what it means, but we have the ability to educate and compare ours to national averages.”

With the data available on GIQuIC AMSURG is also able to show managed care payers very concrete data to prove quality and to use that to better compete in a pay for quality environment and to drive business to AMSURG centers and physicians.

“Without [data from GIQuIC], it will be difficult to compete for preferred status in tiered or narrow networks,” said Mark Wainner, vice president of financial operations and revenue management. “We have to educate [payers] on the value of our data because we know which indicators are most important. We can utilize the data to better compete in an environment where better outcomes differentiate ourselves from the competition.”

AMSURG encourages their centers to give the physicians their own report cards, as well as post their overall GIQuIC results in the center.  AMSURG is also including some GIQuIC information in benchmarking reports that go out to all ASCs.

“They’ll know how they compare to other centers, but most of the improvement really comes from the physicians knowing what their results are and maybe establishing standards for their own practice or for their center,” Wilson said.

The Atlantic hurricane season begins each year on June 1 and goes through the end of November. The peak of the season is just now gaining steam and will last until October. Because their reach can extend many miles inland, hurricanes can wreak havoc on the facilities of many ambulatory surgery centers (ASCs). Hurricane season can be a tough time for anyone in the path of a storm, which is why AMSURG provides tools and services to help its surgery centers stay prepared for weather-related facility emergencies and to minimize the repercussions from being hit by extreme weather. The first line of defense when it comes to extreme weather conditions is preparation. AMSURG ASCs have policies in place to make sure each facility is prepared for extreme weather conditions such as hurricanes, flooding and tornadoes. The centers are required to drill or practice these emergency protocols quarterly. “Of course when a hurricane or whatever does hit, no one is sitting there reading the manual,” said Mike Whitby, director of facilities. “But they remember what to do from the drills. They’re prepared to handle it.” Preparedness policies and training not only help AMSURG centers stay survey ready but also help minimize the severity of damage possible in extreme weather events like hurricanes. Much like most medicine, the key to a quick recovery from a traumatic injury is maintaining good health prior to the injury. This is why the help AMSURG offers with day-to-day facility maintenance tasks is so crucial. Consistently keeping the center in top operating condition helps to prevent more serious issues from occurring in the future. While these policies can help facility staff know what to do in these situations, damage to the center can be inevitable. When extreme weather does make a direct hit, AMSURG steps up. If a center experiences damaging weather conditions, frozen pipes, equipment failures, HVAC outages or other building issues, AMSURG’s facilities team is one call away to provide a prompt, expert response to minimize the disruption of ASC services. “Helping our centers near the coast remain or return to full productivity and function after a hurricane is a top priority for AMSURG,” said Daniel Buehler, vice president of facilities management and construction (FM&C). “The goal is to keep our centers operational with no downtime.” AMSURG proved this policy of proactivity and security in August 2012 when it preemptively deployed a response unit to New Orleans to help its centers in the path of hurricane Isaac. With experts and resources immediately available after the storm had passed, the affected centers were back in business quickly in order to accommodate new and rescheduled procedures. “We keep an eye on the forecast situation, and after they occur, I’ll call centers in that area to make sure everything is ok,” Whitby said. “Situations involving hurricanes and such extreme weather conditions can be difficult for centers to manage. Sometimes just calling to make sure everything is all right gives us a chance to offer some direction in a chaotic time.”

While health facilities continue to wrestle with the rapidly changing health care environment and attempt to evolve and pivot to the changing legal, safety and quality requirements, patients struggle to understand and manage their costs while identifying accessible and helpful care providers invested in their well-being.

AMSURG is exploring strategies to improve patient engagement and patient experience, including making it easier to schedule appointments and procedures at AMSURG ambulatory surgery centers (ASCs).

“Patient engagement is on everyone’s minds. We know that patients who are more actively engaged in their health have better outcomes,” said Pauline Wilson, associate vice president of patient relationship solutions.

Those outcomes can be directly impacted by the patient experience while at the surgery center and even after they have returned home, which is why AMSURG is looking into providing:

• Wi-Fi in surgery center waiting areas
• Education information for companions who accompany patients to the ASC
• Immediate clinical results for patients
• Mobile applications to maintain connections to patients beyond the surgery center procedure

The rapid change in connected health care, combined with online health care information are significant drivers for the AMSURG gastroenterology (GI) patient engagement strategy, said Eric Thrailkill, vice president and chief information officer.

“We all participate in consumer capabilities, on the web or our smartphones, each and every day. Patients frequently wonder why access to information and conducting transactions online or on a connected device isn’t quite yet ready for primetime within our industry," Thrailkill said.  "Certainly, the proliferation of connected smartphones, combined with sensors and medical devices is empowering patients to better understand and share information with their health care providers. We’re poised to assist in this information sharing with the consideration of our technology platform.”

Mark Wainner, vice president of corporate services, said that data collected from GIQuIC (a registry for gastroenterology physicians to share their outcome data and compare with other physicians across the U.S.) and the success of early efforts of physicians who have been willing to change how they engage with patients is a compelling argument for a more robust patient engagement strategy.

“It is our mission to help physicians improve, adapt and grow, and so we have a charter to assist our physicians in this area and prove to them the benefits of changing the way they are for their patients,” Wainner said.

Part of the overall AMSURG GI patient engagement strategy also includes providing patients with discernible and detailed quality measures from the GIQuIC program. GIQuIC offers colonoscopy measures from physicians such as:

• Adenoma detection rates
• Intubation rates
• Withdrawal times
• Prep adequacy

Armed with this information, patients will be able to make more informed decisions when it comes to scheduling their procedures, ensuring that they are choosing the best quality for their health.

“Patients are being asked to act as consumers in a marketplace in which price—a fundamental driver of consumer behavior—is often unknown until after the service they purchase has been performed.”

-HFMA Price Transparency Task Force

Multiple factors, including health care reform and the rise of high deductible health plans, are transforming patients into consumers and pushing the development of multiple tools and platforms for them to attempt to determine the price of the health care they need to receive. However, many physicians and facilities such as ambulatory surgery centers are uncertain when and how to proceed in developing a price transparency strategy. The need for such a strategy varies by market and a clear consensus about the "best" option to choose has yet to emerge.

How is AMSURG Working to Develop a Pricing Transparency Strategy?

AMSURG has analyzed numerous providers within each of the three transparency provider models: payer price calculators, consumer websites and pricing transparency platforms, and is working on building relationships with many of the resources in this space to ensure we are poised to provide centers a market and procedure-specific strategy when the timing is right.

Need for Quality Data and AMSURG's WebAdvantage Platform

A recent study outlined the need to include data on the quality of care alongside pricing data as patients often equate “low-cost” with “low quality.”

Believing that providers themselves should also be a resource for transparency-related information, AMSURG is pursuing the development of tools that will allow our surgery centers to post pricing information, accompanied by strong, consumer-friendly quality metrics, on individual WebAdvantage sites. WebAdvantage is AMSURG's proprietary digital marketing platform that incorporates surgery center websites with an online marketing strategy.

If you are interested in learning how a partnership with AMSURG can help your surgery center respond to health care trends such as the move towards price transparency, contact us by email or call 877-741-0085.