Progress on the Surgical Care Improvement Project SCIP Special Study: The Unique Role of a Surgeon O

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Progress on the Surgical Care Improvement
Project(SCIP) Special StudyThe Unique Role of
aSurgeon Organization

• Quality Surgical Solutions

• and

Hiram C. Polk, Jr. MD, FACS John N. Lewis, MD,
MPH Jan P. Van Vlack, RN February 2005
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SCIP Special StudyFrom Surgical Infection
Prevention (SIP) to SCIP

• Centers for Medicare Medicaid Services (CMS)
  contract awarded to
• Kentucky Medicare Quality Improvement
  Organization (QIO)
• Ohio Medicare QIO

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SCIP Special Study continued

• Subcontracts
• Kentucky Medicare QIO with Quality Surgical
  Solutions
• Ohio Medicare QIO with Oklahoma Medicare QIO

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Quality Surgical Solutions (QSS)

• A surgeon organization whose mission
• is to improve quality and decrease costs of
  surgical care

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QSSAdded Value to SCIP

• Surgical quality expertise
• Surgical research and practice expertise
• Practiced, accomplished leadership
• Surgeon network
• Hospital recruitment and commitment
• Access to surgeon data on hospital case
  abstracted data

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Building Physician Consensus

• Growing awareness of quality movement
• Quality is more than the avoidance of error
• Surgeons curiously excluded and/or
  non-participants in much work to date

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Scene Setting

• To Err is Human and
• Crossing the Quality
• Chasm
• Fundamental conflict with
• extreme risks and/or anxiety about
• professional liability issues
• Relative success with SIP
• Promise of reassertion of physician
• leadership

National Academy Press, Washington D.C. 2000
National Academy Press , Washington D.C,.2001
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KentuckyA Favorable Platform for Special Study

• University of Kentucky Medical Center (UKMC)
  alpha test site for National Surgical Quality
  Improvement Program (NSQIP/VA)
• Early quality initiatives at Norton Hospital
• Quality Surgical Solutions
• Health Care Excel of Kentucky

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What is QSS?

• 66 surgical specialists
• 15 hospitals
• 12 cities
• 2 health plans
• 43 protocols/current procedural technology (CPT)
  codes
• BETTER PRACTICES

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Specialties Representedin QSS

• General surgery to include trauma, digestive,
  vascular, colorectal, oncology, endoscopy
• Orthopedic, otolaryngologic, urologic,
  gynecologic surgery

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Fundamental Hypotheses

• Better quality surgical care is associated
• with reduced direct and overall expenses
• Physicianled initiatives work
• Commitment to prove concepts and
• ethically reward its doctors
• Only effective public role is that of patient
  advocate

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Record ofAchievement Locally

• Confidentiality of data
• Prompt spread of agreed upon goals
• Surgeons more prone to emulate other surgeons

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Create an Environment of Transformational Change

• Innovate, report, refine, publish
• Quality Improvement Conference
• Value of the near miss and the praise of heroes
  and heroines
• Examine routine and/or outdated printed orders

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Personal RoleGenerally Helpful

• Accept secondary and tertiary referrals without
  pain
• Longstanding commitment to surgical excellence
• Trained (partly or fully) many of Kentuckys
  surgical specialists
• Halo effect of QSS and having discussed it with
  hundreds of surgeons and administrative leaders
• Personalized letters seeking surgeon support for
  SCIP through their hospitals

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Which Six and Why?

• A Lap GB D CABG/valve
• B Hysterectomy E CR resections
• C Major vascular F Total Knee/Hip
• ____________________________________
• Not limited to Medicare beneficiaries
• Primarily large volume hospitals
• Significant complications and death

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Recruitment for SCIP Pilot

• Group meetings for potential hospital
  participants and often their surgical specialists
• Follow-up meetings, letters, and telephone calls
• Recognition of the impact of current data
  submissions with invisible or meaningless feedback

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Conference Calls

• Interest groups for each procedure
• Lewis, Garrison, Polk, Van Vlack, and 2-5
  specialists for the procedure
• Prolonged sessions
• Physicians very knowledgeable of current
  literature
• Immediate agreement on process measures
• and feedback

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Detailed Developmentof QSS Involvement

• Laborious development of doctor report forms
• Alpha test of forms
• Surgeon-leader reports
• Begin to match hospital and surgeon reports
• Broad-based educationlaboratory for student
  success (LSS), grand rounds, collaboratives

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An Overview

• Hospital contributions
• - Multiple procedures and surgeons
• Honest sampling
• Detailed, accurate abstraction
• - Tremendous enthusiasm
• Surgeon contributions
• - Pre- and postop data
• Detailed outcomes
• Documentation of patient education

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Unique Opportunity to Match Hospital and
Physician Reporting

• More complete outcomes
• Validation of accuracy for both methods of
  reporting
• Consolidate surgeon and hospital performance into
  homogenous profile of quality

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Patient Education

• Far better done in surgical specialists
  officeshow to document and promulgate
• How can we quantitate and then assess quality?
• Discussion

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Atmosphere that Promotes Patient Safety

• Near miss and specific praise for the hero or
  heroine
• Value of the process that targets the very rare
  disaster
• The analogy between a plane crash and a pulmonary
  embolusprophylaxis of the latter carries both
  risks and costs

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We have achieved our goals in reining in the
professional liability dragon.

• Physicians must now take the lead in identifying
  and solving problems of patient safety. We are
  now more protected than ever and can be the
  patient advocate we all want to be.
• Allow doctors to clearly identify methods that
  provide improved quality.
• June, 2004 G.E. McGee, M.D., FACS

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Peer-Reviewed Publications

• Allen JW, DeSimone KJ. Valid peer review for
  surgeons working in small hospitals. Am J Surg
  200218416-18.
• Allen JW, Hahm TX, Polk HC Jr. Surgeon-led
  initiatives cut costs and enhance the quality of
  endoscopic and laparoscopic procedures. J Soc
  Laparosc Surg 20037243-247.
• Galandiuk S, Rao MK, Heine MJ, et al. Mutual
  reporting of process and outcomes enhances
  quality outcomes for colon and rectal surgery.
  Surgery 2004 136833-841. Presented at the
  Annual Meeting of the Central Surgical
  Association, March 2004.
• McCafferty MH, Polk HC Jr. Addition of
  near-miss cases enhances a quality improvement
  conference. Arch Surg 2004139216-217.
• Shively EH, Heine MJ, Schell R, et al.
  Practicing surgeons lead in quality care, safety,
  and cost control. Ann Surg 2004239752-762
  Presented at the Annual Meeting of the Southern
  Surgical Association, 2003.
• Galandiuk S, Carter MB, Abby M, eds. When to
  Refer to a Surgeon. St. Louis, MO Quality
  Medical Publishing, 2001.

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• A multifaceted endeavor with the ultimate goal of
  significantly improving surgical care in the
  United States through the prevention of
  complications associated with surgery

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With a goal to reduce surgical complications and
mortality 25 by 2010, the following estimated
complications could be prevented annually for
Medicare beneficiaries. 13,000
perioperative deaths 271,000 surgical
complications Hunt and Bratzler
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The Elements of SCIP

• The Partnership
• The Program
• The Pilot

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• The SCIP Partnership
• A coalition of organizations interested in
• the improvement of surgical care through the
  reduction of post-operative complications
• the development of performance measures and a
  data collection tool

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SCIP Partners

• Agency for Healthcare Research and Quality (AHRQ)
• American College of Surgeons (ACS)
• American Hospital Association (AHA)
• American Society of Anesthesiologists (ASA)
• Association of periOperative Registered Nurses
  (AORN)

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SCIP Partners continued

• Centers for Disease Control and Prevention (CDC)
• Centers for Medicare Medicaid Services (CMS)
• Department of Veteran Affairs (VA)
• Joint Commission on Accreditation of Healthcare
  Organizations (JCAHO)
• Institute for Healthcare Improvement (IHI)

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• The SCIP Program
• Technical elements, consisting of process
  measures (including specifications), outcome
  measures (including appropriate risk adjustment
  methods), and the SPOT database and electronic
  data collection tool

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• The SCIP Pilot
• A Medicare demonstration pilot designed to assess
  the feasibility of engaging private sector
  hospitals to reduce the incidence of
  post-operative morbidity and mortality

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Where Do We GoFrom Here?

• Completion of pilot data collection
• Final reports
• Finalization of performance measures
• for 8th SoW
• National rollout

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For more information

• Visit the National SCIP Web site
• http//www.medqic.org/scip
• Contact the Kentucky Medicare QIO
• kyscip_at_kyqio.sdps.org
• [phone]
• Contact Quality Surgical Solutions
• http//www.qualitysurgical.com
• [phone]

This material was prepared by Health Care Excel
of Kentucky, the Medicare Quality Improvement
Organization (QIO) of the Commonwealth, under
contract with the Centers for Medicare Medicaid
Services (CMS), a federal agency of the U.S.
Department of Health and Human Services. The
contents presented do not necessarily reflect CMS
policy. Pub HCEKI 01-2005