ASCRS Quality Assessment and Safety Committee

The Quality Assessment and Safety Committee is dedicated to optimizing care for patients with colorectal disease by setting goals and standards for the treatment of diseases affecting the colon, rectum and anus.

National Quality Forum

The NQF is a membership organization composed of patient advocacy groups, payers, health care professionals, provider organizations, health plans, and organizations involved in health care or health care research.  Its mission is to standardize healthcare quality measurement and reporting. NQF does not develop measures of healthcare quality, but does endorse measures based on review of methodology by technical advisory panels, review by a steering committee of representative stakeholders, and a member and public review followed by a vote of member groups.  The measures are evaluated according to pre-set criteria that include importance, scientific acceptability, usability, and feasibility.  When consensus standards are endorsed, they are generally adopted by the Center for Medicare and Medicaid Services (CMS).  This means that providers will be required to report their compliance with the consensus standard and compliance will likely be linked to reimbursement. We have been members of the NQF since. This is a “top down” organization, and individual members have little power or influence. The NQF is largely controlled by payers and few individuals in leadership positions in this organization actually care for patients.  Our participation in the NQF serves 3 functions:

1.     Through membership we are kept abreast of any quality measures in the approval process, allowing us to intercede as soon as possible so that inappropriate measures affecting our membership are not approved.

2.     We participate in the Health Professionals Council. The leadership of the Health Professionals Council on the executive of the NQF so we have some limited input in this fashion to executive decisions.

3.     We receive notification when advisory panels are being convened for the NQF. We are then able to submit nominations for ASCRS members to participate and represent our membership in discussions and deliberations. This is really the only role in NQF where we can have substantive input.

Dr. Rocco Ricciardi is a representative on the TAP evaluating patient outcome measures for benign GI diseases and Dr. Larissa Temple is a representative on the TAP evaluating patient outcome measures for cancer.

Physician Consortium for Performance Improvement

The PCPI, through the AMA is a major developer of quality measures for use by organizations such as the NQF (80% of measures used in the Pay for Quality Reporting Initiative were developed by the PCPI). The ASCRS is a member of PCPI and participates in development of relevant measures. Once measures have been developed by the PCPI they are put forward by approval through the AQA and or the NQF. Amy Halverson is serving as the ASCRS representative to the PCPI and goes to the semi-annual meetings when the agenda has topics of relevance to the ASCRS. Dr Halverson has recently participated as the ASCRS representative on the IBD working group.  The measures for Infammatory Bowel Disease are undergoing review following  public comments.

The Surgical Quality Alliance

In March 2006, ASCRS began to participate in the Surgical Quality Alliance.   The SQA has grown this year from 16 to 24 surgical societies and the American College of Surgeons coordinates the efforts

The SQA has dealt with several issues since its inception.  In 2006, it dealt with its identity and purpose, reporting principles (i.e. physician vs. patient) and reporting procedures.  In 2007, the SQA focused on the peri-operative reporting measures (delivery of antibiotics) that are now part of PQRI.  In 2008, the SQA has become more proactive and has been in discussions with health providers and purchasers about how surgery could become part of both the ‘Medical Home’ and ‘Episode of Care’ constructs that are being proposed as alternative methods of health care delivery.   The SQA continues to develop a reputation as being the voice of surgery and is currently discussing direct involvement with the NQF and PCPI (rather than via AQA) as well as making recommendations to CMS re the 2010 PQRI. 

Surgical Consumer Assessment of Health Policy (S-CAHPS) – Patient Satisfaction Survey Development

Evaluation of patient satisfaction will be incorporated into future pay for performance programs.  Although there have been surveys developed to assess patient satisfaction, the surgical community felt that there was no instrument that effectively measured satisfaction with surgical care.  Thus the surgical societies felt that it was very important to develop a specific survey to asses the needs of the surgical patient.  Over the last 2.5 years, the ASCRS Quality and Safety Committee has been involved with other surgical specialties to develop a survey to assess patient satisfaction after surgery.  The ASCRS contributed $5000 to the S-CAHPS project in 2008 and Larissa Temple actively participated in the Technical Advisory Panel which developed the measure. ASCRS members participated in field testing - in fact, amongst surgeons who participated in piloting the survey, 12 were colorectal surgeons from 5 different practices.  In total, 5,627 pilot surveys were mailed and 2750 were returned. Of these,  333 patients were from colorectal surgeon practices (12%).  When comparing to the other participating societies, we contributed the second highest number of patients for survey development.  The final survey consists of 45 questions (12 items about pre-op care, 11 items during surgery, 9 items about post-op care, 2 office staff, 1 global surgery item, 10 demographic questions), takes 6-10 minutes to complete and is available in English and Spanish.

The instrument can be viewed at: www.cahps.ahrq.gov/content/products/sc/PROD_SC_Surgical_Care.asp?p=1021&s=213

The survey results are expected to be useful to everyone with a need for information on the quality of surgeons and surgical care, including patients, practice groups, health plans, insurers, and specialty boards. Practices, health plans, and insurers can use the survey results for quality improvement initiatives and incentives. Specialty boards may use the survey for maintenance of certification. The survey has been endorsed by the Consumer Assessment of Health Policy (CAHPS).  In the future, this survey may be used by agencies such as CMS to evaluate the surgical care of patients and may possibly fulfill one of the requirements for MOC. The development of this instrument is a significant accomplishment for the ASCRS.  We are pleased that our membership actively participated and hope to develop easy methods to implement this survey into practices.   The survey results are expected to be useful to everyone with a need for information on the quality of surgeons and surgical care, including patients, practice groups, health plans, insurers, and specialty boards. Practices, health plans, and insurers can use the survey results for quality improvement initiatives and incentives. Specialty boards may use the survey for maintenance of certification.

Data Registry and Reporting

The SQA continues to envision a data registry for surgeons where the surgical practice would input a core data set.  The goals of the database continue to be discussed and it is now proposed that the data registry be developed in phases.  In the first phase, an outside vendor would develop the platform for surgical practices to input data for PQRI.  This would be advantageous to members in that the vendor reports a 95% success rate with submission and reimbursement from CMS.  The second and third phases would be more focused on tracking other important outcomes of our patients. 

Risk Adjusted Quality of Colorectal Surgery Outcome Measure

The SQA was very helpful during the recent TAPs sponsored by the NQF on Risk Adjusted Quality of Colorectal Surgery Outcome Measure. The SQA, as a committee designed to facilitate measure development within the surgical community, was informed of this measure and they subsequently have spoken to the appropriate individuals at ACS.  The SQA was also heavily involved in lobbying the NQF for conference calls to occur during times when surgical input was possible. 

ASCRS Participation

The ASCRS representation to the SQA in 2009-10 has been Drs. Temple, Alavi and Baxter.  We have participated on the conference calls (2-4/month), attended the SQA meetings.  By having 2-3 representatives, we have been able to have 2 individuals attend each meeting.  Dr. Temple has been an active member of the S-CAHPS Technical Advisory Panel.   Drs. Temple, Alavi and Baxter have been involved in the preliminary plans for the database development. 

Up to date articles on topics related to quality and safety.  View References.

2010 National Patient Safety Goals