American College Of Surgeons - Inspiring Quality: Highest Standards, Better Outcomes

Business Case for ACS NSQIP

Complication costsBetter Quality + Lower Costs = Significant Returns

By preventing complications, the American College of Surgeons National Surgical Quality Improvement Program® (ACS NSQIP®) will not only help you improve care and save lives, but also will save money and help reduce lengths of stay and preventable readmissions.

Hospitals using ACS NSQIP benefit from:

  • Average savings of about $3 million per year
  • Reduced readmissions and reduced lengths of stay
  • Higher patient satisfaction and better patient outcomes
  • Better performance on publicly reported measures
  • Better performance under pay-for-performance programs

ACS NSQIP is so effective, that, in many cases, it pays for itself.

The ACS NSQIP Advantage

Proven to help hospitals reduce complications.

Increasingly, hospitals are penalized for preventable complications. Since 2007, the Centers for Medicare and Medicaid Services (CMS) will no longer reimburse a hospital for certain hospital-acquired conditions (HACs). Other insurers have followed suit and implemented similar policies.

A study in the Annals of Surgery found ACS NSQIP hospitals each prevent 250 to 500 complications annually.1 This means better care, lower costs and better results in the increasing number of pay-for-performance initiatives.

Reduced complications mean lower costs.

High cost of complicationsComplications can raise the median cost of hospitalization for major surgical procedures by up to five-fold.2 On average, a major surgical complication generates $11,626 in extra costs, according to a study by the University of Michigan.3 But the cost can be even higher – as this chart shows. As payers implement pay-for-performance programs and deny reimbursement for preventable complications and readmissions, these costs often fall on the hospital.

Preventing just 15 complications a year covers the full cost of participation in ACS NSQIP. For most hospitals, this can be achieved in just one month.

Significant economic benefits for hospitals around the country.

We have known for years that the poster child for preventable complications is the hospital-acquired infection, and yet it remains a significant challenge. ACS NSQIP has helped meet that challenge. For instance:

  • Surrey Memorial Hospital in Vancouver, British Columbia, (370 beds) reduced its general and vascular surgery surgical site infection (SSI) rate by 5.7 percent and its breast surgery SSI rate by 13.3 percent over two years, saving more than $2.7 million.
  • Baptist Hospital of Miami, Fla., used ACS NSQIP to reduce SSIs for general and vascular procedures, cutting its mortality index for those surgeries in half and saving at least $4 million a year since 2007.

A hidden cost for many hospitals is the complications that occur once the patient has left the hospital that result in readmission. Because ACS NSQIP tracks surgical outcomes for 30 days after the operation, it catches many complications that other quality programs miss. For example, in the case of colon resections, one in four patients is readmitted within 90 days, costing approximately $9,000 per patient, or $300 million a year nationally.4 Reducing even a fraction of these readmissions can lead to significant cost savings.

Hospitals that use ACS NSQIP empower their surgical teams to work effectively together to improve the quality of care. The structured data-sharing can raise awareness about issues that might otherwise go unnoticed.

  • Henry Ford Hospital in Detroit, Mich., saved $2 million a year by reducing its average length of stay by 1.54 days while increasing general surgery billings by $2.25 million a year through more accurate coding.
  • When Saint Francis Hospital and Medical Center in Hartford, Conn., implemented ACS NSQIP, it became clear that the rate of post-surgical urinary tract infection (UTI) was too high. A retrospective study of 74 instances of UTI over four years showed that preventable UTI had cost the hospital $2.17 million. Through targeted quality improvement efforts, the hospital was able to reduce its rate of UTI by 62 percent over three years.

In many cases, ACS NSQIP helps hospitals identify glitches and system inadequacies before problems arise. At Danbury Hospital in Danbury, Conn., the Surgical Clinical Reviewer (SCR) responsible for collecting ACS NSQIP data noticed certain classification inconsistencies were not meeting internal and external regulatory standards. Hospital leadership was alerted to these and other previously unrecognized issues, which were quickly resolved. As a result of the experience, they also developed a system to channel unsolicited patient feedback to improve service quality. This had had not been captured systematically before.

1 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.
2 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.
3 Dimick, J.B., et al. “Who pays for Poor Surgical Quality? Building a Business Case for Quality Improvement.”Journal of the American College of Surgeons.202(6): 933-7; June 2006.
4 Wick, Elizabeth C, et al. “Readmission Rates and Cost Following Colorectal Surgery.”Diseases of the Colon & Rectum. 54(12):1475-1479;Dec. 2011.