As the Centers for Medicare and Medicaid Services (CMS) continue to hash out the details of the new MACRA Quality Payment Program (QPP), one thing is becoming clearer and clearer: in order for anesthesiologists, or any physicians for that matter, to survive in this new age of value-based care, they must begin to take their clinical and practice data much more seriously.
The most obvious need for anesthesiologists to compile clinical and practice data is to meet the reporting requirements for the quality and Clinical Practice Improvement Activities (CPIA) categories of the QPP. The quality category replaces PQRS, and physicians will be required to report six measures, including at least one outcomes measure. The CPIA are activities to improve one’s practice and the patient experience. Physicians must report on three high-weighted activities or six medium-weighted activities for a 100% score. Having efficient access to data, whether through claims reporting or downloaded to a registry or through an EHR vendor, will be imperative for successfully participating in the QPP.
But other value-based payment programs, including bundled payments, the Medicare Shared Savings program, and especially the Perioperative Surgical Home (PSH) model touted by the American Society of Anesthesiologists (ASA), will elevate the role of data in providing a lower-cost, higher value clinical experience for patients and practices alike.
In a recent article by Anesthesiology News, Carolyn Crist writes about how SCOR (the Society for Ambulatory Anesthesia, or SAMBA’s, Clinical Outcomes Registry) may be a useful tool to help anesthesiologists improve the quality of their practices.
SCOR extrapolates data from a hand-written form used by nursing staff that details a patient’s activities throughout the procedure, including details on the patient, surgeon, anesthesiologist, and procedure, as well as start/end time, anesthetic technique, antibiotics, and analgesics. The form also asks for information about the patient’s recovery room stay, including adverse events, pain score, unplanned catheters, opioid medications, nausea and vomiting. Finally, the form prompts nurses to follow up with patients after discharges to collect data about pain control, patient satisfaction, and post-discharge nausea and vomiting.
According to Karen Carlson, MD, MBA, assistant professor of anesthesiology at the Emory University School of Medicine, the form takes staff about 60 to 90 extra seconds to complete and enter into the electronic health record, and then her practice mines the data to find ways to improve clinical workflows and patient experience.
Apart from reporting QPP measures or participating in SCOR, what other data could anesthesiologists begin collecting and analyzing to preparing for more value-based initiatives? Douglas G. Merrill, MD, MBA, professor of anesthesiology at the University of California, Irvine Medical Center recently spoke about about the perioperative surgical home and safety at “Driving Change in Ambulatory Anesthesia,” a joint meeting held by the Society for Ambulatory Anesthesia and the American Society of Anesthesiologists. According to another Anesthesiology News article about that event, Merrill advised anesthesiologists “to monitor outcomes, including those of various providers, such as physicians, nurses and home health aides.” Specifically, he recommended collecting and analyzing the following data for possible improvements:
- post-discharge data
- pain control
- postoperative nausea and vomiting
- PACU time
- returns to the operating room
- patient satisfaction
- infection rates
- cost of on-site care
- time to return to work
- opioid use on site
For Dr. Merrill, the bottom line when thinking about the role data plays in value-based care is to plan ahead and start now. “My suggestion is to be proactive,” Dr. Merrill said. “As these strategies increase in number and scope, you’ll be not only prepared, you will have already acted.”
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