Partnering to Improve Surgical Care
Vermont Statewide Surgical Services Collaborative
Surgical site infections, pneumonia, and urinary tract infection are examples of a wide range of complications that may occur during and after surgery.These complications often necessitate a longer hospital stay or readmission, are costly, and have a negative impact on patient’s health. Impacts from complications are contrary to the aims of health care reform to improve patient outcomes and satisfaction and reduce costs. Much progress has been made since the initial efforts:
- 2013 – Surgeon leaders reached out to the Green Mountain Care Board and VPQHC to establish a statewide collaborative to acquire funding to support adoption of the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) throughout Vermont hospitals.
- 2014 – VPQHC applied for and secured funding for the VSSSC through the Vermont Health Care Innovation Project (VHCIP) Provider Sub-grant program. Start- up funds were awarded to facilitate hospital enrollment, training, and certification of Surgical Care Reviewers (SCRs).
- 2015 – Five Vermont hospitals are currently enrolled with four actively submitting surgical clinical data; SCRs have been trained in the rigors of ACS-NSQIP data collection; Surgeon Champions and SCRs meet regularly to share lessons learned and improvement strategies.
- 2016 and beyond – Hospitals will continue to be recruited and educated in the benefits of ACS-NSQIP program enrollment to identify areas of opportunity for improvement in the delivery of surgical care; collaborative data will become available to provide performance information across the state and comparatively with regional and national participants.
ACS-NSQIP provides a risk adjusted clinical data collection method that hospitals can use to identify high quality, actionable data with which to design improvement initiatives. ACS-NSQIP has shown to improve the quality of care and reduce costs in every setting (large and small, urban and rural, teaching and non-teaching) in which it has been applied. Nationally, hospitals participating in ACS-NSQIP have seen average savings of about $3 million per year, reductions in readmissions and length of stay, better performance on publicly reported measures, and better performance under pay-for-performance programs. Here in Vermont, the system cost of surgical site complications is valued at approximately $836,000 which represents three quarters of the cost of the VSSSC effort.
Recommendations and Next Steps
The VSSSC has strategized to expand partnerships and identify additional sources of funding.VPQHC has recently partnered with MVP in this vein, a partnership which is representative of collaborative models that currently operate around the country. OneCare Vermont has expressed its appreciation of the value and cost savings reducing complications brings to the delivery system. Efforts to share achievements with other captive payers, and potentially the insurance industry, will continue with the aim of eliciting other sustained mechanisms of financial support.