Q. What is the American College of Surgeons (ACS)?
A. The American College of Surgeons is a scientific and educational association of surgeons that was founded in 1913 to improve the quality of care for the surgical patient by setting high standards for surgical education and practice. The College is dedicated to improving the care of the surgical patient and 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 currently has approximately 79,000 members, including more than 4,000 Fellows in other countries, making it the largest organization of surgeons in the world. Presently, there are more than 2,600 Associate Fellows.
Q. What is the ACS Inspiring Quality initiative?
A. Launched in 2011, the Inspiring Quality initiative aims to raise awareness of proven models of care that measure and improve quality and increase the value of health care services. Ultimately, the goal is to create greater awareness of proven ongoing quality improvement programs that are achieving tangible results.
Q. What does the ACS currently do to inspire quality in health care?
A. For more than 100 years, the College has led national and international initiatives to improve care in hospitals, as well as in the fields of trauma, cancer, and surgical quality. These initiatives have been shown to measurably improve the quality of care, prevent complications, reduce costs, and save lives. They are built on four key principles: setting the standards, building the right infrastructure, using the right data, and verifying with outside experts. Together, these four principles form a continuous loop of quality improvement through which organizations and providers learn how to improve and keep improving.
Q. What is ACS NSQIP?
A. The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP®) is a nationally validated, risk-adjusted, outcomes-based approach to measuring and improving the quality of surgical care. ACS NSQIP employs a prospective, peer-controlled, validated database to quantify 30-day, risk-adjusted surgical outcomes, which provides a valid comparison of outcomes among all hospitals in the program. Currently, there are more than 400 participating hospitals whose surgical staffs use ACS NSQIP tools, analyses, reports, and support in making informed decisions about improving quality of care. Peer-reviewed studies have shown ACS NSQIP is effective in improving the quality of surgical care and reducing complications, which leads to lower costs.
Q. How does ACS NSQIP differ from other quality improvement programs?
A. Most quality improvement efforts are based on administrative data from insurance claims. Among many shortcomings, administrative or claims data does not enable researchers to adjust for risk (for example, to accurately assess the quality of an outcome, researchers need to know if the patient was a healthy 21-year-old or a sick 75-year-old), or to determine if a patient had a related complication after leaving the hospital (when half of all such complications typically occur). In contrast, ACS NSQIP uses risk-adjusted data that is gathered from medical charts by clinically trained personnel and includes an assessment of the patient’s condition a month after the surgical procedure. This information enables each hospital to make a valid comparison of its outcomes with those of other hospitals. As a result, a determination can be made regarding what improvements should be made. When clinicians have confidence in the measures being used to asses their performance and outcomes, they are more likely to actively participate in a quality improvement program.
Q. How is the ACS working to implement its successful program throughout the country?
A. Over the past several years, the ACS has been in discussions with the Centers for Medicare and Medicaid Services (CMS) to implement outcomes-based quality measures across the country. Research shows current quality programs based on processes of care do not necessarily result in improved patient outcomes. As a result, CMS and other organizations are increasingly interested in using outcomes-based programs to measure quality of care.
ACS NSQIP is the nation’s only risk-adjusted, nationally validated program to measure 30-day patient outcomes for all surgical specialties based on clinical, not administrative, data. Because of the success of the program, CMS has asked the College to develop five outcomes measures that could be used by all hospitals in the United States. Three of those measures have been endorsed by the National Quality Forum (NQF). The measures could be implemented nationally as performance measures as early as 2012.
Q. Some prominent quality programs haven’t demonstrated the significant impact needed to reform our health care system. Why does the ACS believe that its approach will work?
A. Studies have shown that ACS NSQIP is effective. A 2009 study published in the Annals of Surgery found that participating hospitals are preventing 250 to 500 complications and saving 12 to 36 lives per hospital, per year. A 2006 study in the New England Journal of Medicine found the risk of death at a Level I trauma center is 25 percent lower than at a non-trauma center. Additional outcomes-based studies are in process, and the ACS will continue to study and learn how best to use these programs to measurably improve care.
Q. What would national implementation of ACS NSQIP mean for surgical patients?
A. Putting these tools in place means everyone concerned would benefit, and no one more so than our patients. By using this approach to quality improvement, every hospital has the opportunity to prevent 250 to 500 complications and save 12 to 36 lives per year. Added up across the country, the end result would be millions of patients returning home without complications, and tens of thousands of lives saved every year. At the end of the day, it means better care at a lower cost.
Q. Does the ACS also help hospitals improve safety?
A. Safety is an important focus of our quality improvement programs. The College provides educational programs for surgeons and surgical residents focused on patient safety and preventing adverse events, such as wrong-site surgeries.
Q. Does the ACS work with other organizations and regulators?
The College works closely with other professional societies and surgical specialty societies, not-for-profit organizations focused on quality, and regulators. All of our programs are developed in partnership with leading experts in the field, and they fit closely with national quality goals. For example, the Commission on Cancer is supported by 48 national professional associations, including the American Cancer Society. During the past few years, new ACS NSQIP measures have been developed in partnership with the Centers for Medicare and Medicaid Services (CMS), and CMS is currently considering five measures for national implementation.
Q. Does participation in ACS quality programs help hospitals and surgeons comply with regulations?
A. ACS programs help hospitals and surgeons meet many current regulatory requirements. Participation in ACS NSQIP helps surgeons meet Maintenance of Certification (MOC) Part IV and satisfies the Joint Commission OPPE requirements. In addition, ACS NSQIP participants have reported that participation in the program has helped them succeed under local pay-for-performance initiatives established by payers.
Q. Will ACS programs integrate with electronic medical records?
A. Over the past several years, the College has worked to expand data automation from any type of electronic medical record (EMR) a hospital may implement. For example, hospitals participating in ACS NSQIP are able to automatically upload a number of variables into the ACS NSQIP database from their EMR. However, a trained data abstractor must still review a number of variables before they are entered in the database.