American College of Surgeons and Boston Health Care Leaders Examine How Quality Improvement Helps Curb Escalating Health Care Costs

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Jun 12, 2012, 05:00 ET

Surgeons call on quality improvement programs to drive better outcomes and care at a lower cost

CHICAGO, June 12, 2012 /PRNewswire-USNewswire/ -- The American College of Surgeons (ACS) hosted a Surgical Health Care Quality Forum in Boston on June 4, with health care policy and clinical experts to discuss how quality surgical care not only delivers better patient outcomes, but also better financial outcomes – a critical yet often overlooked component of surgical quality programs.

"If we can get to a place where improving quality reduces preventable complications, we will have found part of the solution to the vexing problem of controlling costs in an equitable, humane and efficient way," said keynote speaker Stuart Altman, Ph.D., MA, BBA, Economist and Health Policy Expert, Brandeis University, and co-author of "Power, Politics, and Universal Health Care: The Inside Story of a Century-Long Battle." "In the past we didn't include physicians and surgeons in discussions on how to fix the American health care system because we thought they were part of the problem – a big mistake. We need them as part of the solution because they are American health care. Everyone needs to play, and physicians and surgeons are really on the right track focusing on quality improvement as one viable means to address the cost issue."

The ACS Surgical Health Care Quality Forum Boston is part of the College's Inspiring Quality initiative to promote critical elements required in successful quality improvement programs that can measurably improve outcomes and reduce health care costs. For example, preventing a medical complication – which can raise the median cost of hospitalization for major surgical procedures up to five-fold[i] – avoids additional expenditures including longer hospital stays and readmissions.

"If physicians, surgeons and hospitals are engaged in the important dialogue around improving surgical quality programs that advance patient outcomes, we will be in a better position to deliver better value because we believe that appropriate care delivered the first time lowers cost," said co-host Michael J. Zinner, MD, FACS, Moseley Professor of Surgery, Harvard Medical School; Clinical Director, Dana Farber/Brigham and Women's Cancer Center; Surgeon-in-Chief, Brigham and Women's Hospital (BWH); Member, American College of Surgeons Board of Regents.

Surgical care takes up half of the annual commercial health care expenditures nationwide[ii]. Over the years, national debates on health care reform have largely focused on access, leaving cost and quality all but missing from the discussion – until recently. ACS views improving quality as instrumental to adding value to health care systems because it reduces costs and improves care, but stresses that these solutions need to be brought to a larger national audience and expanded across all hospitals in the U.S.

"Surgical quality matters everywhere in the country, but we've taken special pride here in Boston because this is where Ernest A. Codman, MD, FACS – the founder of the quality movement – made his stand on quality improvement as a critical component of the profession," said co-host Andrew L. Warshaw, MD, FACS, W. Gerald Austen Distinguished Professor of Surgery, Harvard Medical School; Surgeon-in-Chief, Emeritus, Massachusetts General Hospital (MGH); Chair, American College of Surgeons Health Policy and Advocacy Group. "The 'end-results' idea Dr. Codman laid out 100 years ago, has served as the foundation for the American College of Surgeons four guiding principles in the continuous quality improvement cycle, which are: set the standards; build the right infrastructure; use robust data; and verify. While we need to do a better job at getting widespread adoption, there is no need to recreate the wheel on quality improvement processes that are proven to deliver better patient outcomes and reduce costs."

"In surgery, we know what needs to be done to improve results and reduce costs," said panelist Atul Gawande, MD, MPH, FACS; BWH; Harvard Medical School and Harvard School of Public Health; Lead Advisor, Surgery, World Health Organization Patient Safety; Author. "The problem is doing it. But we are starting to see answers."

Known as a model for outcomes-based quality improvement, the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP®) collects clinical, risk-adjusted, 30-day outcomes data in a nationally benchmarked database. The program has been credited as "Best in the Nation" for surgical quality by the Institute of Medicine, and is currently utilized by approximately 400 hospitals across the U.S. A study published in the Annals of Surgery in 2009 determined that hospitals participating in ACS NSQIP prevented 250-500 complications, resulting in an average of 13-26 lives saved per hospital, per year[iii]. At $11,000 for an average cost of a complication, the combined potential savings of 4,500 hospitals could add up to $13-26 billion each year, amounting to an estimated total savings of $260 billion over a period of 10 years.

"Truly focusing on quality improvement requires good data – data that surgeons trust – and we have that with ACS NSQIP," said panelist Matthew Hutter, MD, MPH, FACS; Director of the Codman Center for Clinical Effectiveness in Surgery, MGH; Harvard Medical School. "Administrative data isn't good enough to drill down and help identify the cause of complications in order to prevent them from happening again. Clinically rich data – from a patient's medical chart – benchmarked with other hospitals across the nation is what physicians, surgeons and hospitals need to drive change."

"When economic realities dictate that we can't spend more, and our population demands that we do a better job of maintaining their health, the only solution is to increase the value of what we do," said panelist Samuel Finlayson, MD, MPH, FACS; Kessler Director, Center for Surgery and Public Health, BWH. "To ensure that surgery is appropriately used, our current systems of care delivery have relied on hurdles and blocks in the form of insurance pre-approvals, paperwork, and extra clinic visits. This 'make it hard to do the wrong thing' approach is not only frustrating to surgeons who just want to do the right thing, but is also expensive for payers and tiresome for patients. In contrast, we need to redesign surgical care in a way that reflects a 'make it easy to do the right thing' approach. We need to develop ways to deliver better information, streamline and coordinate care flow, and structure surgical decision-making so that providing the most efficient, most appropriate surgical care is actually the easiest thing for a surgeon to do."

Increasingly, hospitals are financially penalized for preventable complications, but institution-level quality data derived from programs like ACS NSQIP have been proven to make the difference. By helping hospitals identify areas where they may be underperforming, leadership can create action plans to re-engineer workflows, foster and improve internal education, and develop clinical performance improvement initiatives.

"We've found at MGH that there are three key institutional fundamentals for continuous quality improvement to thrive: leadership; infrastructure; and incentives," said panelist Peter Slavin, MD, President, MGH. "The institution can drive quality by implementing programs and protocol, but it's up to the collaboration among all team members – from hospital administrators to clinicians – and their willingness to strive for culture change and progress that makes quality improvement 'real.'"

About the American College of Surgeons
The American College of Surgeons is a scientific and educational organization of surgeons that was founded in 1913 to raise the standards of surgical practice and improve the care of the surgical patient. The College is dedicated to the ethical and competent practice of surgery. Its achievements have significantly influenced the course of scientific surgery in America and have established it as an important advocate for all surgical patients. The College has more than 78,000 members and is the largest organization of surgeons in the world. For more information, visit www.facs.org.

[i] Rowell, KS, et al. "Use of National Surgical Quality Improvement Program Data as a Catalyst for Quality Improvement." Journal of the American College of Surgeons. 204 (6): 1293-1300; June 2007.

[ii] Health Care Cost Institute Annual Expenditure Summary: 2007 to 2010; http://www.healthcostinstitute.org/files/HCCI_HCCUR2010_Appendices.pdf

[iii] Hall, BL et al. "Does Surgical Quality Improve in the American College of Surgeons National Surgical Quality Improvement Program?" Annals of Surgery. 250 (3): 363-376; Sept. 2009.

SOURCE American College of Surgeons