Vol. 2, No. 2 Importance of Data Collection and Analysis in


Outpatient Arthroplasty By Daniel Hoeffel, MD


It often seems as if health care providers have been collecting data for the sake of data collection. It is clear that current electronic


health records (EHRs) are relatively cumbersome as tools of outcome analysis. As economic realities and efficiency objectives drive a shift of total joint arthroplasty (TJA) from an inpatient to outpatient procedure, the need for accurate processes and outcome data gains importance. We must move toward converting data to beneficial change for patients, providers and the health care system.


These changes center around changes in processes and efficiency. Cost is not the only measure of significance in this equation. Value is the overriding goal. Meaningful data collection centered on process and outcome will provide greater insight into quality improvement and process efficiency. The continued drive toward bundled episodes of care, with financial performance associated to outcomes, only further amplifies the need for robust data.


Improvement Methodologies Health care organizations continue to adopt and implement Lean and Six Sigma methodologies. These improvement tools benefit from standardized care pathways and data collection. All quality improvement methodologies require data to establish a baseline and measure the impact of process changes on outcomes. To complete the quality improvement cycle, one must measure outcomes


and implement potential process enhancements so that the next cycle can begin.


As our understanding of the prevalence and causes of provider burnout (lack of well-being) grows, further “data burden” on providers is not a solution to ongoing data needs. The importance of simple, transparent data collection directly from patients and EHRs should be the goal. The emergence of digital care navigation platforms offers solutions, with low provider burden, to deliver reproducible patient pathways and concomitantly collect meaningful data.


Digital care navigation refers to software platforms designed to inform, guide and measure patient outcomes of patients under treatment for a specific condition or episode of care (e.g., heart failure, joint replacement and diabetes). These platforms can use text messaging, email and automated phone calls or combinations of these modalities to inform and educate patients. Pathways for outpatient TJA are designed to keep patients “on track” concerning treatment protocols and pre-surgical risk reduction. They can be used to aid in preoperative smoking cessation, postoperative rehabilitation protocols and care reminders, such as dressing changes. Equally as important, standardized outcomes surveys (e.g., HOOS, KOOS, PROMIS) or customized outcomes measures (e.g., facility and provider satisfaction) are collected directly from the patient electronically. The importance of these digital tools is evidenced by strategic alliances being formed between orthopedic manufacturers and digital navigation


In July, the US House of Representatives passed the ASC Payment Transparency Act of 2018 (H.R. 6138). This important legislation would improve access to high-quality outpatient health care. ASCA has long advocated for these policies, so its passage represents a significant achievement for the ASC industry. The bill includes the following critical provisions:


1. Add an ASC industry representative to the Centers for Medicare & Medicaid Services’ (CMS) Advisory Panel on Hospital Outpatient Payment (HOP). This advisory panel helps determine payment policies for hospital outpatient


companies. My experience with digital care navigation (CareSense by MedTrak, Inc. partnered with DePuy Synthes) has resulted in decreased patient risk by addressing correctable co-morbidities and reduced case cancellations.


Putting Data to Work For outpatient TJA data to be of greatest utility, once collected it must be analyzed and interpreted, with the pertinent results communicated. The main audiences for this are patients, payers, governmental agencies and employees. Recognizing the varying needs and requirements of these groups when choosing measurement and survey tools is critically important. Patients are acutely interested in complication rates and overall satisfaction. Payers naturally lean toward a combination of quality and financial measures.


Perhaps the most frequently overlooked value is to the organization itself. Building a culture of continuous improvement using data aligns the organization toward the common goals of improved patient outcome and self-improvement. Outpatient TJA will continue to evolve and improve. This evolution will be driven by robust data collection and analysis.


Daniel Hoeffel, MD, is an arthritis and joint reconstruction specialist in Minneapolis-St. Paul, Minnesota. Write him at dhoeffel@hoeffelortho.com.


The advice and opinions expressed in this column are those of the author(s) and do not represent official Ambulatory Surgery Center Association policy or opinion.


US House Passes ASC Payment Transparency Act of 2018


departments and ASCs. Current statute requires HOP members be employed by a hospital or health system.


2. Disclose criteria used to determine the ASC procedure list. CMS can exclude a procedure from the list because of a general concern for specific criteria. CMS, however, is not currently required to disclose which criteria it uses to exclude a given procedure.


Access H.R. 6138. ASC PHYSICIAN FOCUS 3


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