Investment in outcomes

Hamilton Medical Center in Dalton, Ga., is investing heavily in a national program to improve surgical quality.

The program provides hospital leaders "powerful" insights about surgical outcomes compared with other hospitals across the nation, said Dr. Ian Hamilton, a vascular surgeon at Hamilton who's leading the linkage to the National Surgical Quality Improvement Program.

"It's difficult for us to know exactly what our outcomes are unless it's followed closely with a program like this," Dr. Hamilton said. For a hospital to do it alone, "it's time-intensive and, in fact, it's very expensive," he said.

The national program, supported by the American College of Surgeons, analyzes data compiled by the hospital on surgical outcomes. That ranges from the percentage of patients who returned to surgery within 30 days to infection rates for individual surgeons. Hospital leaders can compare their results to those of 243 other participating hospitals.

The annual cost to participate is more than $100,000. It includes a $35,000 fee to the American College of Surgeons and the salary of a full-time nurse trained in the NSQIP program to compile data.

Hamilton Medical Center will be one of four hospitals in Georgia participating. In Tennessee, 10 hospitals are in the program, including Erlanger hospital in Chattanooga, according to the Tennessee Hospital Association.

The cost can be a problem, said Dr. John Sweeney, director of surgery and chief quality officer at Emory University Hospital in Atlanta. Emory was among the NSQIP pilot hospitals in 2001 and just rejoined it this year, he said.

But the investment in quality and the avoidance of complications tend to pay off quickly, Dr. Sweeney said.

"When you sit down and calculate the cost of complications, if you were to decrease wound infections and pneumonias by 1 percent, you'd be making money hand over fist. You'd recoup your investment and then some," he said.

GETTING RESULTS

Studies show NSQIP hospitals get results.

A study published last year in the Annals of Surgery evaluated 118 hospitals participating in NSQIP between 2006 and 2007. It found that 66 percent improved risk-adjusted mortality and 82 percent improved risk-adjusted complication rates.

The model for NSQIP was a program the U.S. Department of Veterans Affairs launched in 1991 in response to a congressional mandate to improve care. The American College of Surgeons adopted the program after it was shown to bring results.

In VA hospitals, the program resulted in a 27 percent drop in post-operative mortality and a 45 percent decline in post-operative morbidity, according to the American College of Surgeons.

Dr. Hamilton noted that changes in payments from the Centers for Medicare and Medicaid Services also have been an incentive to help reduce surgical complications.

In 2008, the Centers for Medicare and Medicaid Services said it no longer would pay hospitals for conditions caused by certain mistakes, such as operating on the wrong limb, bedsores or infections related to improper catheter use.

Some of those problems overlap with criteria monitored in the NSQIP program, so improvement could help hospitals avoid losing payments from CMS, Dr. Hamilton said.