News From the College

Philadelphia Forum: Physician-Led Quality Improvement


The American College of Surgeons (ACS) in October held the ACS Surgical Health Care Quality Forum Philadelphia, the ninth stop in a national tour to drive discussions on effective quality improvement methods used by surgeons, physicians, and hospitals to improve patient safety and reduce costs.

The Philadelphia forum focused on the importance of physician-led quality improvement initiatives in sustaining better outcomes, using the ACS National Surgical Quality Improvement Program (ACS NSQIP) as a leading model that provides surgeons with reliable data to help pinpoint areas for improvement.

ACS Surgical Health Care Quality Forum Philadelphia (from left to right): Dr. Pauly, Dr. Steele, Dr. Kaiser, U.S. Rep. Jim Gerlach (R-PA6), Dr. Schwartz, Dr. Snyder and Dr. Kukora

"We’re all faced with the challenges of navigating a complex and ever-changing health care system," said Marshall Z. Schwartz, MD, FACS, professor of surgery and pediatrics at Drexel University, pediatric surgeon-in-chief at St. Christopher’s Hospital for Children, Philadelphia, a member of the ACS Board of Regents, and event co-host. "The good news is we don’t have to re-invent the wheel to achieve the level of quality improvement and cost savings we need for health reform to be successful."

"Using proven quality improvement methods like ACS NSQIP is a perfect example of what we, as physicians, can do together to support health reform," added Howard M. Snyder III, MD, FACS, attending urologist at Children’s Hospital of Philadelphia, professor of urology in surgery at the University of Pennsylvania School of Medicine, Philadelphia, a member of the ACS Board of Regents, and event co-host.

Keynote speaker U.S. Rep. Jim Gerlach (R-PA), a member of the influential House Ways and Means Committee, cited parallels between the government’s health care reform efforts and quality improvement programs such as ACS NSQIP, which collects clinical, risk-adjusted, 30-day outcomes data in a nationally benchmarked database. He also addressed the need to link higher quality care to reimbursement.

"The mission of the Ways and Means Committee right now is to prevent the 27 percent cuts in Medicare reimbursement and extend it until we can come up with a proper formula for reimbursing physicians," said Representative Gerlach. "You [surgeons] bring a credibility and knowledge that legislators don’t have, and I would encourage you to advocate for these changes we need to have and the programs you want to save because they work."

A 2009 study published in the Annals of Surgery determined that hospitals participating in ACS NSQIP each prevented 200-500 complications annually and saved an average of 12-36 lives per year by reducing complications. With the average cost of medical complications equaling $11,000 per occurrence, 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 (Ann. Surg. 2009; 250:363-76).

The forum emphasized the reduction of complications with a focus on surgical outcomes – an objective that is not new in Pennsylvania.

"Pennsylvania was the first state to publicly report hospital-acquired infections and that transparency has improved the appetite for quality improvement programs in our state and around the country," said Larry R. Kaiser, MD, FACS, senior executive vice president for health services, dean, Temple University School of Medicine; and president and chief executive officer, Temple University Health System.

"Surgeons trust and embrace clinical data which is why the Society of Thoracic Surgeons National Database and ACS NSQIP have been successful tools to reduce complications and improve patient care," he added.

"For ten years, Geisinger has focused on an intervention framework to identify variation in care and re-engineer best practices, resulting in decreased costs and improved quality," said Glenn D. Steele Jr., MD, PhD, FACS, president and chief executive officer, Geisinger Health System, Danville, PA. "Surgery departments present a clear opportunity to define complications and implement and assess solutions, as there is a distinct starting and end point to support accurate measurement."

Beyond improving patient care and reducing costs, ACS NSQIP is a valuable source of information that is leveraged by surgeons to compare themselves with their colleagues and that can be used by individuals to differentiate hospitals in their community.

"Using a program like ACS NSQIP allows us to benchmark ourselves against our colleagues as well as other hospitals across the country and create a national standard," said John S. Kukora, MD, FACS, FACE, chairman, department of surgery, program director, general surgery residency program, Abington Memorial Hospital (PA). "This [type of] reporting isn’t just for surgeons and hospital administrators. It can also inform consumers’ choices as they are armed with knowledge and can choose a hospital based on its performance record."

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