Vascular Surgery Outcomes to Be Tracked by Michigan BCBS

The American College of Surgeons

Fifteen of the largest hospitals in the state of Michigan will soon be participating in a ground-breaking program to evaluate the results of the general and vascular surgery procedures performed in their institutions.

Participating hospitals will submit surgical patients' outcomes data to the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) and make use of its data collection and analysis instruments, which have a proven track record in the Veteran's Affairs (VA) surgical care system.

This joint collaboration between the ACS and Blue Cross Blue Shield of Michigan (BCBSM) and its HMO affiliate Blue Care Network represents a pioneering effort between a national medical organization and a health plan to evaluate and improve the quality of surgical care, while ultimately reducing health care delivery costs.

ACS NSQIP is a national validated program that was created to measure and enhance the care of surgical patients. The program is outcomes-based and risk-adjusted. Now referred to as the ACS NSQIP, it has been used successfully in the Veterans Affairs health care system for over a decade.

In 2001, a grant from the Agency for Healthcare Research and Quality was awarded to the ACS and the VA for collaborative implementation of the NSQIP in private sector hospitals.

During the 3-year study that followed, data from nearly 100,000 surgical cases were collected from 18 private sector hospitals.

The introduction of ACS NSQIP in Michigan represents a new approach to using this pre-existing quality measurement program. Participating hospitals are all in one state and are working with each other and a health plan, BCBSM, to identify and act on opportunities for quality improvement.

Moreover, all institutions will be enrolled in the program on a "pay for participation" basis rather than the common "pay for performance" basis.

This arrangement means that they will receive financial support from BCBSM for a substantial proportion of the data collection costs if they are actively contributing data to the ACS NSQIP registry and participating in the collaborative quality improvement effort.

Michigan hospitals will begin reporting their data to ACS NSQIP this fall. Aggregate data on the impact of the project will be made available to BCBSM and provided in public reports about the project.

However, individual hospital data will be available only to the participating hospital and its surgeons for quality assessment and improvement purposes.

ACS NSQIP is one of three health care quality improvement initiatives currently underway through BCBSM.

In addition to the ACS NSQIP study of outcomes of general and vascular surgical procedures, BCBSM has also funded statewide surgical outcome registries and quality improvement programs for cardiac surgery (in collaboration with the Michigan Society of Thoracic and Cardiovascular Surgeons), and bariatric surgery (inviting all hospitals that perform the procedure in the state to participate).

HOSPITALS WILL SEND OUTCOMES DATA TO THE AMERICAN COLLEGE OF SURGEONS NATIONAL SURGICAL QUALITY IMPROVEMENT PROGRAM.