American College of Surgeons National Surgical Quality Improvement Program 1st National Conference

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American College of Surgeons National Surgical
Quality Improvement Program1st National
Conference

• Future Plans for ACS NSQIP
• R. Scott Jones, MD, FACS
• Chicago, Illinois
• Monday, June 26, 2006

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The Message

• The Sovereign, Autonomous Medical Profession
  failed to adapt to a capitalistic, market driven,
  health care industry
• The Government and the Capitalists control the
  health care industry
• Surgeons must adapt new strategies
• Quality and safety are paramount

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The Sovereign Medical Profession Controlled

• Itself
• Hospitals
• Allied Health Sciences
• Medical Education
• Residency Training
• The Pharmaceutical Industry
• The Health Insurance Industry
• The Federal Government

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By the End of the 20th Century the Medical
Profession Did Not Control

• Itself
• Hospitals
• Allied Health Sciences
• Medical Education
• Residency Training
• The Pharmaceutical Industry
• The Health Insurance Industry
• The Federal Government

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A Summary of Healthcare in the USA in 2003

• Patients are suing doctors
• Patients are suing insurance companies
• Doctors are suing insurance companies
• Doctors are suing the government
• States are suing drug companies
• Drug companies are suing states
• Doctors are going on strike
• Union workers are going on strike

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US Healthcare Industry An Adversarial Enterprise
Driven by Money

• Hospital vs. Hospital, Doctor vs. Hospital,
  Doctor vs. Doctor, Hospital vs. Insurer, Insurer
  vs. Hospital, Insurer vs. Insurer, Insurer vs.
  Drug maker, Drug maker vs. Drug Maker

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Some Financial Data from the Healthcare Industry
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Some Financial Data

• GDP C I GS NE
• US GDP 2005
• 12,438,873,000,000
• US Healthcare Spending (16 of GDP)
• 1,990,220,680,000
• Physicians and Other Services (22 of Health
  Spending)
• 437,048,540,600
• 582,731.39/physician

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Health Insurance Income 2005
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Health Insurance Profit Margins

• UNH- 7.3
• WLP- 5.5
• AET- 7.1
• CI- 7.8
• Hum- 2.2

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Health Insurance CEO Pay 2005
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Pharmaceutical Income 2005
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Pharmaceutical Profit Margins

• PFE- 15.8
• JNJ- 20.6
• MRK- 20.9
• BMY- 18.8
• ABT- 15.2

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Pharmaceutical CEO Pay 2005
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Corporate Hospital Income 2005
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Hospital Profit Margins

• HCA- 6.6
• THC- NA
• TRI- 4.9
• UHS- 6.2
• KND- 3.3

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Hospital Corp. CEO Pay 2005
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Medical Products and Equipment 2005
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Medical Equipment and Products Profit Margin

• BAX- 9.9
• MDT- 18.0
• BSX- 10.0
• BDX- 13.3
• SYK- 13.9

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Medical Products Equipment CEO Pay
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Corporate Power

• AHIP
• PhMRA
• AHA
• AdvaMed

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So What Can We Do?

• Remember our Mission
• Remember our Profession
• Reinvent our Profession
• Strengthen our Profession
• Focus our Energy on Improving Quality and Safety
  of Care
• Promote the Interests of the Sick and of the
  Public
• Deserve the Public Trust

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Quality Surgical Care

• Correct Diagnosis
• Proper Staging
• Proper Risk Assessment
• Disease
• Treatment
• Proper Treatment
• Best Evidence
• Best Technology
• Best Technique

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Quality Surgical Care

• Proper Outcome
• Survival
• No Complications
• Disease Cured
• Symptoms Relieved
• Function Restored
• Death with Dignity in Mortal Diseases

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ACS NSQIP Future Directions

• Begin generic quality improvement for all
  specialties
• Collaborate with SCIP/SIPP
• Introduce process measures
• Seek collaboration with additional health
  insurance plans
• Enhance feedback to hospitals
• Introduce Bariatric Surgery
• Introduce Pediatric Surgery
• Introduce Gynecologic Oncology
• Enhance feedforward to hospitals
• Introduce preoperative risk assessment
• Expand outcome measures
• Promote patient safety

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ACS NSQIP Future Directions

• Begin generic quality improvement for all
  specialties
• Current sampling methods will work but the
  numbers will change
• 1,600 sample represents 8,000 cases
• 1 SCNR collects 1,600 cases
• Hospital cost structure will change
• The transition will require careful management

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ACS NSQIP Future Directions

• Collaborate with SCIP/SIPP
• Data collection
• SSI
• VTE-PE
• Cardiac
• Pulmonary
• Process-outcomes
• Data reporting

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ACS NSQIP Future Directions

• Introduce Process Measures
• Guidelines
• Clinical pathways
• Best practices
• Set standards

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ACS NSQIP Future Directions

• Seek collaboration with additional health
  insurance plans
• Excellus
• BC/BS of Massachusetts
• BC/BS of Maryland
• United
• Aetna
• The Alabama Project
• The Oregon Project

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ACS NSQIP Future Directions

• Enhance feedback to hospitals
• Consultation
• Targeted references
• Annual meeting

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ACS NSQIP Future Directions

• Introduce Bariatric Surgery
• The business plan
• What about non ACS NSQIP hospitals?
• The Longitudinal Assessment of Bariatric Surgery
  (LABS) issue

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ACS NSQIP Future Directions

• Introduce Pediatric Surgery
• APSA Committee
• Protocols developed
• Neo natal
• Infants and children
• Trauma
• Ready for testing

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ACS NSQIP Future Directions

• Introduce Gynecologic Oncology
• Ready for protocol development
• Need multiple stakeholder input
• Need to address broader gynecology participation

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ACS NSQIP Future Directions

• Enhance feedforward to hospitals
• Data based recommendations for hospitals quality
  improvement

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ACS NSQIP Future Directions

• Introduce preoperative risk assessment
• Program specific
• Surgeon specific
• Global
• Web
• Laptop
• PDA

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ACS NSQIP Future Directions

• Expand outcome measures
• Follow up duration
• Quality of life measures
• Patient satisfation assesment
• comorbidities

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ACS NSQIP Future Directions

• Promote patient safety
• Patient Safety Organizations (PSO)
• Collect and analyze adverse event reports
• Promote safe practices

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ACS NSQIP Future-Future Directions

• Shape public policy
• Engage in public reporting
• Align healthcare professionals of all surgical
  specialties
• Align healthcare professionals of all surgical
  specialties with the healthcare professionals of
  all non surgical specialties
• Reinvent a medical profession to serve every
  patient and to serve the public

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Assessment of the Quality of Surgical Care The
Surgeons Imperative

• Protect the Interests of the Sick
• Self Interest
• Corporate Interests
• Profit
• Government Interests
• Politics
• Bureauocracy
• Live by the Scientific Method
• Evidence-based Medicine
• Reliable Data
• Recognize the Importance of Systems

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Thank You