SCIP and NSQIP the Alphabet Soup of Surgical Quality NSQIP National Conference Christopher C Johnson M.D. Caryn Foster RN, SCR Nicholas Hellenthal M.D., F.A.C.S. 7/26/15
Disclosure None
Introduction The Surgical Care Improvement Project (SCIP) Campaign launched in 2005 by CMS and CDC Goal of reducing surgical complications by measuring adherence to perioperative process measures. In 2013, Medicare reimbursement was tied to SCIP measures under value-based purchasing Hundreds of thousands of dollars at risk per institution. Although the evidence behind the SCIP measures is strong, the literature varies on whether they correlate to outcomes. We sought to correlate SCIP measures to NSQIP outcomes at our institution.
Did SCIP work? Adherence to Surgical Care Improvement Project Measures and the Association with Postoperative Infections Study: Discharge data from 398 SCIP participating hospitals from 7/2006-3/2008 collected (405,720 patients). Study addressed ability of reported adherence to SCIP metrics to predict postoperative infections. Conclusion: Adherence reported to individual SCIP measures, which is the only publicly reported form of performance, was not associated with a significantly lower probability of infection Stulberg et al. JAMA 6/2010
Did SCIP work? Surgical Care Improvement Project in the Value-Based Purchasing Era: More Harm than Good? Invited article supported by NIH grant Conclusion: The institution of SCIP has markedly increased the compliance to its measures but little evidence shows that it provides any substantial benefit to patients, whereas this improved compliance comes at the cost of significant time, money, and staff resources. Despite this, several SCIP measures, which are currently incorporated into quality contracts, will be tied to Medicare reimbursement in 2013 under valuebased purchasing, with 3 rd party payers likely following suit. Weston et al. Quality Improvement 2/2013
Methods Over a year and a quarter (2013, 1 st quarter 2014) at our institution (Bassett Medical Center) Retrospectively compared SCIP metrics and their correlative NSQIP outcomes for surgical patients 1437 patients were included in our NSQIP analysis.
8 6 99% 99.9% 99% 96% 98% Nat'l CMS Top Benchmark Hosp. (n=100) SCIP Infection control vs SCIP-Inf-1a: Prophylactic Antibiotic Initiated Within One Hour Prior to Surgical Incision (n=112) (n=124) 91% (n=105) NSQIP SSI (n=126) 8 6 SCIP-Inf-3a: Prophylactic Antibiotics Discontinued Within 24 Hours After Surgery End Time 98% 99.9% 99% 99% 94% 98% 98% Nat'l CMS Top Benchmark Hosp (n=100) (n=111) (n=122) (n=104) (n=119) 8 6 SCIP-Inf-2a: Prophylactic Antibiotic Selection for Surgical Patients 99% 99% 99% 99% 99% 98% Nat'l Benchmark CMS Top Hosp. (n=100) (n=112) (n=124) (n=105) (n=125) 8 6 SCIP-Inf-6: Surgery Patients With Appropriate Hair Removal 99.9% 98% 99% National Benchmark CMS Top Hosp. (n=129) (n=163) (n=176) (n=144) (n=173) NSQIP Data Wound occurrence 2014q1 Comparables 2013 Comparables Superficial SSI 1 (1.4%) 1.8% 12 (0.9%) 1.8% Deep incisional SSI 0 0.4% 1 (0.1%) 0.5% Organ/space SSI 0 0.7% 10 (0.7%) 0.7% Wound disruption 0 0.3% 1 (0.1%) 0.4% Total cases 70 5891 1367 23932
SCIP Beta Blocker vs NSQIP Cardiac events 8 6 SCIP-Card-2: Patients on Beta Blocker Therapy Preadmission Who Received Beta Blocker During the Perioperative Period 98% 99.9% 96% 97% Nat'l Benchmark CMS Top Hosp. (n=52) (n=71) (n=75) (n=55) (n=74) NSQIP Data Cardiac occurrence 2014q1 Comparables 2013 Comparables Arrest with CPR 0 0.2% 3 (0.2%) 0.3% MI 0 0.4% 0 0.3% Total cases 70 5891 1367 23932
SCIP VTE vs NSQIP DVT/PE SCIP-VTE-2: Patients Who Received Appropriate VTE Prophylaxis Within 24 Hours Prior to Surgery to 24 Hours After Surgery 8 98.3% 99.9% 96% 98% 96% 99% 6 National Benchmark CMS Top Hosp. (n=83) (n=107) (n=114) (n=85) (n=100) NSQIP Data Respiratory occurrence 2014q1 Comparables 2013 Comparables P.E. 0 0.4% 1 (0.1%) 0.3% DVT 0 0.4% 2 (0.1%) 0.5% Total cases 70 5891 1367 23932
SCIP Urinary Catheter vs NSQIP UTI SCIP-Inf-9: Patients with Urinary Catheter Removed on POD1 or POD2 8 97.9% 99.9% 98% 98% 97% 98% 6 National Benchmark CMS Top Hosp. (n=85) (n=119) (n=111) (n=99) (n=118) NSQIP Data Urinary Tract occurrence 2014q1 Comparables 2013 Comparables Renal insufficiency 0 0.2% 1 (0.1%) 0.2% Renal failure 0 0.2% 2 (0.1%) 0.3% *UTI* 0 1.2% 2 (0.1%) 1.1% Total cases 70 5891 1367 23932
Conclusion SCIP measures may relate to postoperative outcomes, yet failure does not correlate with worse outcomes. Paradoxically, exemplary outcomes may be seen in the face of SCIP failures. These data further the argument for outcome-based (rather than processbased) reimbursement.