The inaugural edition of Best Ambulatory Surgery Centers will be published on usnews.com on May 14, 2024. As announced last fall, U.S. News is developing these consumer-centered ratings to help patients, in consultation with their referring healthcare providers, identify high-quality sites of care for some of the most common same-day therapeutic and diagnostic procedures.
The following details may help organizations prepare for the forthcoming publication:
- An embargoed preview of each ASC’s ratings will be available to its leaders on April 16, 2024, via the U.S. News Healthcare Dashboard. Registered users of the dashboard can now log in and add their organization’s ASCs to their Dashboard profile, which will ensure they receive upcoming information from U.S. News, including the embargoed results. ASC leaders who are not currently Healthcare Dashboard users can now register to ensure they, too, receive timely information about their ASC’s ratings; there is no fee to register.
- An overview of the methodology behind the ratings appears below. A detailed methodology report will be available to Dashboard users on April 16.
- ASC and health system leaders, physicians and staff who wish to learn more about the data and methodology are invited to attend a U.S. News-hosted webinar on April 10. There is no fee to attend.
How ASCs Will Be Rated
The inaugural edition will include ratings in four separate specialty areas: Colonoscopy & Endoscopy; Ophthalmology; Orthopedics & Spine; and Urology. Single-specialty ASCs will receive a single rating in the relevant specialty. Multi-specialty ASCs will receive up to four separate ratings. About 700 ASCs will be rated in Urology, and approximately 2,000 will be rated in each of the other three specialties. In each specialty, top-performing ASCs will be labeled “High Performing,” underperforming ASCs will be rated “Below Average,” and all others will receive an “Average” rating to denote their performance was not significantly different from expected.
U.S. News included in its evaluation all providers that appeared in the ASC Quality Reporting program database, as well as several hundred other providers identified as ambulatory health care facilities in the NPPES database, as of August 2023. Performance was assessed using Medicare fee-for-service claims records available to researchers via the Centers for Medicare and Medicaid Services’ Virtual Data Research Center (CMS VRDC). These records are generated whenever a provider receives payment from the Medicare program, paid for by U.S. taxpayers. Surgery centers did not need to take any action or submit any data to be considered, nor could they opt out of being evaluated.
U.S. News used data and inputs from CareJourney, a healthcare analytics firm, to evaluate each ASC’s risk-adjusted outcomes in CMS VRDC data. Steps in the analysis included:
- Episode construction. CareJourney grouped Medicare fee-for-service claims from ASCs between 2020 and 2022 into distinct episodes of care. For example, claims for patients who underwent hip replacement were assigned to one episode, while those for spinal fusion were assigned to another. Episodes were further grouped into specialties. A table of episodes associated with each of the four rated specialties appears below. Most episodes included in the ASC ratings have 30-day observation windows; however, episodes for certain procedures that often occur in inpatient settings, such as joint replacement, have 90-day observation windows.
Outcomes. To assess variation in ASC performance, U.S. News and CareJourney identified five outcomes of interest that can be assessed from provider claims data, and tabulated, for each episode, how often each outcome was observed. Patients diagnosed with COVID-19 during an episode were excluded. The five outcomes are:
- Emergency department (ED) visits, excluding those immediately followed by acute care admissions
- Unplanned acute care admissions
- Days spent, if any, in institutional post-acute or long-term care
- Death
- Total allowed payment attributable to episode-related complications
- Risk-adjustment. The observed value of each outcome was divided by an expected value of the outcome to calculate an observed-to-expected ratio (OER). To generate the expected value for each outcome, the probability of a patient experiencing a particular outcome was estimated using a risk-adjustment model that included the following factors: age; dual eligibility status; comorbidity status, specifically, the presence or absence of each risk factor used by CMS to determine Hierarchical Condition Category, as well as the patient’s count of HCC factors; whether the patient experienced hospitalization or long-term institutional stay in the 90 days prior to the ASC procedure; ambulatory payment classification (APC) of the ASC visit; and the Core Based Statistical Area in which the ASC is located.
Construction of composite score. For each specialty, U.S. News calculated a composite score for each ASC to determine its rating. To do this:
- For each of the five outcomes, U.S. News constructed a precision-weighted average of each ASC’s OERs across all episodes within a given specialty. The precision weights, in tandem with additional methods, aid in adjusting the final scores for reliability. The precision weights are based on the volume of cases in an ASC, which means that if an ASC has 500 cases and 10 ED visits, its OER would be deemed more reliable than if it had 50 cases and 1 ED visit.
- U.S. News then combined the five outcomes into a composite score for that specialty. The composite score assigns weights of 30% to ED visits, 30% to unplanned acute care admissions, 30% to complication-associated costs, 5% to mortality and 5% to days spent in institutional post-acute care.
- U.S. News will assign each rated ASC in a specialty to one of three bands: Below Average, Average, or High Performing. Inference that an ASC was Below Average or High Performing was made using a two-sided 75% confidence level. Only ASCs with sufficient data in a given specialty were rated in that specialty.
We look forward to sharing the new ASC ratings with Dashboard users next month and with the public in May.
| Specialty | Episode |
| Colonoscopy & Endoscopy |
|
| Ophthalmology |
|
| Orthopedics & Spine |
|
| Urology |
|
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