Dedicated to improving the care of the surgical patient and to safeguarding standards of care in an optimal and ethica

1. American College of Surgeons Dedicated to improving the care of the surgical patient and to safeguarding standards of care in an optimal and ethical practice environment

2. What NSQIP Is ______________________________ • Web-Based data collection software • Quality improvement tool • Risk-adjusted, outcomes-baseddata • Clinically Validated data • Benchmarking

3. Current Participants Number of Participating Sites by State and Region (273) CANADA 4 October 31,2010 3 MIDWEST 78 4 3 8 6 20 1 5 1 22 2 4 34 6 2 9 2 5 5 2 13 6 NORTHEAST 2 33 3 67 10 4 2 8 10 1 1 ABU DHABI 1 3 4 WEST 57 2 LEBANON 1 6 SOUTH 65 1 2 ______________________________ 10

4. Clinically Rich Data Web-Based Workstation Private & Secure Data Encryption Semi Annual Reports & Other Real-Time Reports Online Return of Investment (ROI) Calculator Best Practices (Expert panel rated guidelines) Case Studies Online Risk Calculator Participant Use File (PUF) Product Features _____________________________

5. Program Staffing ______________________________ • Surgeon Champion (SC) • Program Mentor/Advocate • Lead Quality Improvement Initiatives • Participate in Monthly SC Conference Calls • Surgical Clinical Reviewer (SCR) • Collect Data • Online/On-going training; CEU’s & Certification - provided by the ACS

6. Data Collection ______________________________ • Demographics • Surgical Profile • Pre-operative Data (risk factors) • Intra-operative Data • Post operative Data (outcomes)

7. Data Collection ______________________________ Case Selection • Sampling of all operations requiring • General anesthesia • Spinal anesthesia • Epidural anesthesia • Inpatient and Outpatient Surgical Procedures • excluding trauma and transplant

8. A randomized sampling system called the 8-day cycle Process ensures that cases have an equal chance of being selected from each day of the week Data Collection ______________________________ Sampling Methodology

9. Clinical vs. Administrative Data Clinical Data tends to tell us more… Data Collection ______________________________

10. O/E ratio = par on a golf course – the score that is expected An O/E ratio is a mathematical construct accurately showing the risk-adjusted outcome for a specific site ‘O’ represents the total number of observed postoperative events (deaths or complications) ‘ E’ represents the number of expected events based on the preoperative risk and other factors in a given patient population An O/E ratio < 1 means that the site is performing better than expected, while a ratio > 1 indicates an excess of adverse events Risk Adjustment ______________________________ Observed vs. Expected O/E Ratios

11. 01 01 04 04 08 08 12 12 16 16 Rank by unadjusted Mortality Observed Only Rank by risk-adjusted Mortality Observed/Expected 20 20 24 24 28 28 32 32 36 36 40 40 44 44 Risk Adjustment ______________________________ O/E ratios show that risk adjustment has a profound effect in determining the true performance of a medical center A B B A Changes in Medical Center Rank (O/E Ratio) After Risk Adjustment For 30-Day Mortality

12. Data Needs to be Believed:Validation with Audits Audits ______________________________ Shiloach JACS 2009

13. Real-Time and Semiannual Reports Real-time, continuously updated benchmarked online reports Pre-programmed library of reports Real-time data Not risk adjusted Able to benchmark with all or like sites Semiannual benchmarked report Risk Adjusted Available 1st and 3rd quarters Reporting ______________________________

14. Real-Time Reports Workflow Reports Site-Level Reports Database Statistics Data Analysis ACS Reports Reporting ______________________________

15. Reporting ______________________________

16. How are our outcomes? SSI? Pneumonia? UTI? Reporting ______________________________

17. Reporting ______________________________ How are our outcomes? SSI? Pneumonia? UTI?

18. Reporting ______________________________ How are our outcomes? SSI? Pneumonia? UTI?

19. Reporting ______________________________ Further drilling down on the data

20. Real Time Analysesi.e,Mortality in Colectomy cases with or without UTI Reporting ______________________________

21. Semiannual Report Reporting ______________________________ Risk adjusted for hospital-to-hospital patient mix differences.

22. Over 40 Risk Adjusted Outcomes 30-Day Mortality & Morbidity/ Serious Morbidity O/E Ratios in All Patients 30-Day Morbidity/Serious Morbidity O/E Ratios in patients >65 Cardiac Occurrences Pneumonia Unplanned Intubation Ventilator Dependence >48 hours DVT/PE Renal Failure Urinary Tract Infection/UTI O/E Ratios Surgical Site Infection/Deep & Organ Space O/E Ratios Colorectal 30-Day Death or Serious Morbidity O/E Ratios Reporting ______________________________

23. Reporting Interpretation of Results ______________________________ Observed to Expected (O/E) Ratio Represents the hospital’s outcomes compared to the other ACS NSQIP hospitals, adjusted for inter-hospital differences in patients’ characteristics, comorbidities, and preoperative laboratory values LOW OUTLIER: If the upper bound of the O/E confidence interval is <1.0, the hospital’s outcomes are statistically better than expected. Thus, the hospital’s outcomes are “Exemplary.” AS EXPECTED HIGH OUTLIER: If the lower bound of the O/E ratio is >1.0, the hospital’s outcomes are statistically worse than expected. Thus, the hospital’s outcomes “Need Improvement.” ACS NSQIP Hospital ID Number

24. Return on Investment ______________________________ NSQIP Improves Outcomes and Saves Money

25. Does Surgical Quality Improve using the ACS NSQIP? Return on Investment ______________________________ • 82% of NSQIP hospitals had decreased surgical complications • 66% of NSQIP hospitals had decreased mortality • Each hospital is projected to avoid between 250-500 complications per year – on average

26. Return on Investment ______________________________ • Example … • If 250 complications are avoided • And each complication costs $10,000 • The potential savings is $2,500,000

27. Beaumont Hospital saved $2.2 million and reduced average LOS by 6.5 days by reducing SSI. In 2009, the hospital estimates it prevented nearly 300 SSI’s. Surrey Memorial Hospital reduced SSI’s over 4 years for savings of $2.54 million Henry Ford Hospitalreduced LOS for annual savings of $2 million Return on Investment ______________________________

28. Henry Ford Hospital reduced their length of stay by an average of 1.54 days after reviewing data from all patients who underwent a general, vascular, or colorectal procedure translating into an annual savings of $2 million. Surrey Memorial Hospital avoided an estimated $380,000in costs over a four-monthperiod through initiatives to reduce the number of urinary tract infections. Return on Investment ______________________________

29. Return on Investment ______________________________ ROI Calculator

30. Non-Monetary Benefits … Valid National benchmarking for surgical outcomes Provides proactive, value-oriented performance measurement before it’s dictated by outside agents Improves local market position through publicly visible improvement programs Optimizes cross-departmental partnerships and collaboration through shared knowledge Helps build high performance surgical teams and employee retention, (i.e. nurses) Offers CME’s for Surgeon Champions and CEU’s for SCR’s Return on Investment ______________________________

31. Complete yet concise resource for health care providers and QI professionals Evidence-based Expert panel-rated Framework to: Prevent postsurgical complications Prioritize/direct QI efforts aimed at reducing incidence/impact of postsurgical complications Best Practice Guidelines ______________________________

32. Best Practice Case Studies Kaiser Sunnyside Medical Center used NSQIP data to optimize glucose and temperature control in the operating room Advocate Good Samaritan Hospital used NSQIP data to improve postoperative Renal Outcomes ______________________________ • Scripps Green Hospital used NSQIP data to reduce surgical site infection rates in vascular surgery • Morristown Memorial Hospital used NSQIP data to prevent surgical site infections

33. The Options _____________________________ Four Adult NSQIP options NSQIP Classic NSQIP Essentials NSQIP Small &Rural NSQIP Procedure Targeted

34. Regardless of Which Option, All Hospitals Will Receive: The Options _____________________________ • Semi Annual Reports • Real Time Online Reports (including new SPCs) • National Benchmarking • NSQIP Best Practices/Guidelines • NSQIP Improvement Case Studies • Additional Items (e.g. Risk Calculator, Public Use File)

35. For All Options, the Rigor and Validity of ACS NSQIP is Unchanged The Options _____________________________ • Risk Adjustment • 30 Day Post Surgical Outcomes • Clinical Data • SCR Training • SCR Certification

36. NSQIP Classic General/Vascular = 1,680 cases per year, 8-day sampling cycle Multispecialty = 20% total case volume by specialty, 8-day sampling cycle 1 FTE _____________________________

37. NSQIP Essentials General/Vascular = 1,680 cases per year, 8-day sampling cycle Multispecialty = 20% total case volume by specialty, 8-day sampling cycle 1 FTE _____________________________

38. NSQIP Small & Rural Small Hospital: < 1,680 cases per year OR Rural Hospital: ZIP code is defined within RUCA data codes 100% collection of cases across all specialties Collection of core variables for QI purposes 1 FTE (or less depending upon case volume) _____________________________

39. NSQIP Procedure Targeted Larger hospitals targeting high-risk/high volume procedures Hospital selects procedures Selection may be CPT code-driven Minimum of 1,680 cases per year: - 15 “Core” cases per 8-day cycle - 25 “Procedure Targeted” cases per 8-day cycle Minimum 1 FTE (or more depending on volume) _____________________________

40. NSQIP Procedure Targeted _____________________________ Nine Subspecialties • General Surgery • Vascular • Gynecologic • Urologic • Plastic & Reconstructive Surgery • Otolaryngology • Orthopedic Surgery • Neurosurgery • Thoracic Surgery

41. NSQIP Procedure Targeted _____________________________ 30+ Procedures Pancreatectomy▪ Colectomy ▪ Ventral Hernia Repair ▪ Bariatric ▪ Proctectomy ▪ Hepatectomy ▪ Tyroidectomy ▪ Esophagectomy ▪ Appendectomy ▪ Cartoid Endarterectomy ▪ Cartoid Artery Stenting ▪ Open AAA Repair ▪ EVAR ▪ Open Aortoiliac Bypass ▪ Endo Aortoiliac Repair ▪ Lower Extremity Open Bypass ▪ Lower Extremity Repair Endovascular ▪ Hysterectomy ▪ Myomectomy ▪ Reconstructive Procedures ▪ TURP ▪ Bladder Suspension ▪ Radial Prostatectomy ▪ Radical Nephrectomy ▪ Radical Cystectomy ▪ Muscle/Myocutaneous Flap ▪ Reduction Mammoplasty ▪ Breast Reconstruction ▪ Abdominoplasty ▪ Thyroidectomy ▪ Total Hip Arthroplasty ▪ Total Knee Arthroplasty ▪ Spine Surgery ▪ Hip Fracture ▪ Brain Tumor Procedure ▪Spine Procedure ▪ Lung Resection

42. Pricing _____________________________

43. Recognition _______________________________ Meets MOC Part 4-Evaluation of performance in practice through tools such as outcome measures and quality improvement programs, and the evaluation of behaviors such as communication and professionalism.

44. Recognition _______________________________ Institute of Medicine named NSQIP “the best in the nation” for measuring & reporting surgical quality and outcomes.

45. Summary Risk adjusted Data Clinically Robust Data Validated Data Best Practices Tools, Guidelines, and Case Studies Proven! (improve quality AND decrease costs) _______________________________

46. Tresha Russell Business Development Representative tresharussell@facs.org 312-202-5441 _______________________________

47. Thank you _______________________________