Understand how we got here — and how to move forward.


October 17, 2018

Leapfrog expands quality ratings to ASCs and HOPDs

Daily Briefing

    Read Advisory Board's take: Why this rating may not greatly impact patient ASC choice.

    The Leapfrog Group on Tuesday announced in 2019 it will begin rating ambulatory surgery centers (ASCs) and hospital outpatient departments on patient safety and treatment outcomes.

    Leapfrog currently gathers data to issue hospital safety grades through its Leapfrog Hospital Survey. According to Healthcare IT News, Leapfrog is a leading organization on quality and safety data tracking, identifying hospitals offering the highest-value care to help consumers make informed care decisions.

    Most surgeries are done outpatient—so where's the safety and quality data?

    Leapfrog's announcement to expand its public reporting to outpatient settings follows a recent Kaiser Health News/USA Today investigation that revealed  since 2013 more than 260 patients have died after receiving care in ASCs that lacked appropriate lifesaving equipment, sent patients home before they recovered, or operated on "very fragile" patients.

    According to Modern Healtthcare, ASCs perform more than 23 million surgeries each year, but CMS only requires such facilities to publicly report on four quality measures.

    Leapfrog President and CEO Leah Binder said, "The vast majority of surgeries in the U.S. are performed in outpatient or ambulatory settings, but there are almost no independent data about the safety and quality of this care."

    How Leapfrog will measure outpatient performance

    To collect the new data, Leapfrog will create a new voluntary survey for ASCs and add a hospital outpatient surgery department component to the organization's existing Leapfrog Hospital Survey. Leapfrog has collected and publicized patient safety data through the Hospital Survey for nearly two decades.

    The new ASC survey and hospital outpatient survey will evaluate medical and nursing staff, patient safety practices, surgical outcomes, and patient experience.

    Leapfrog will begin with a sample of 250 ASCs in April 2019. Leapfrog does not plan to publicly release that data but will share "detailed benchmarking reports" with participating ASCs in fall 2019. Leapfrog will then use that first-year data to refine survey questions and benchmarks for the 2020 survey, which will go to a larger sample of more than 5,000 ASCs.

    Leapfrog plans to publicly release performance data collected during the 2020 survey for individual ASCs and hospital outpatient departments.

    What the industry is saying

    Ty Tippets, administrator of St. George Surgical Center in Utah, said that the new survey will lead to even more insight into the quality of ASCs, which will benefit patients. "Anytime [data] is gathered and provided in a transparent, easily accessed forum—it helps empower patients," Tippets said.

    Bill Prentice, CEO of the Ambulatory Surgery Center Association, expressed optimism about the survey's potential but noted that "the devil [will be] in the details" of the metrics and reporting. "We're confident that, given the opportunity, hospitals and ASCs will be transparent in voluntarily reporting their performance, just like the nearly 2,000 hospitals that report on their inpatient quality today," he said (Jewett, Kaiser Health News, 10/6; Miliard, Healthcare IT News, 10/16; Castellucci, "Transformation Hub," Modern Healthcare, 10/15; The Leapfrog Group, release, 10/16).

    Advisory Board's take

    Haley Wiesman, Practice Manager and Lauren Lawton, Senior Analyst, Service Line Strategy Advisor

    It's unsurprising that ASC quality is getting attention, given recent high-profile reports by Kaiser Health News and others which have uncovered how little quality data is available on ASCs and shed light on the potential implications of this limited availability. That said, we don't yet know what impact consistent ASC quality reporting would have on ASC utilization.

    “Consumers largely value cost, travel times, and physician referrals over quality metrics when choosing surgical care.”

    If standard ASC quality data becomes widely available – through Leapfrog, AHRQ, or CMS – it will likely have less of an impact on consumer choice than one may assume. When we surveyed surgical care consumers, our found that consumers largely value cost, travel times, and physician referrals over quality metrics when choosing their surgical care.

    Instead, quality data transparency would more likely impact the behavior of payers, proceduralists, and referring providers. Quality data could easily add additional measures that ASCs must compete on for payer negotiations, surgeon choice, and PCP referrals.

    This move to ASC quality reporting may also impact how quickly surgical procedures shift to the ASC setting. In our research, we've seen that the speed of procedures shifting to the ASC is highly dependent on physician choice and comfort. Greater transparency in ASC quality could impact physician comfort with the site of care and either expedite or hinder the movement of procedures to ASCs, depending on what the data ultimately reveal about ASC safety.

    To discover the seven tactics we've uncovered for appealing to ASC stakeholders, download our research briefing on How to Build ASC Referrals.

    Download the Briefing

    Then, to learn about the services shifting—and the new services emerging—in ASCs, download our ASC Services Outlook Primer.

    Get the Primer

    Have a Question?


    Ask our experts a question on any topic in health care by visiting our member portal, AskAdvisory.