Premier Surgical: Measuring Quality to Ensure the Best Surgical Care

For several years American hospitals have been required to gather and submit data to the federal government that measures the quality of their patient care and services.  The process of collecting and analyzing patient information is a time-consuming, cumbersome, and expensive undertaking that entails many man hours. That’s why few private physician practices attempt to individually tackle the task. Instead, data about their specific physicians’ quality is often part of the data that is folded into the large umbrella of quality data generated by the hospitals in which they practice.

As early as 2012 it became apparent that the industry was moving quickly toward a value-based approach to care. As CMS and other payers began to develop their approach to value based care, Premier’s physicians immediately recognized that we would need to be able to prove our quality, not just assume our quality.

As a result, in strategic planning retreats that followed, the group decided to develop our own physician specific quality measurement and improvement program. What was born of that idea is the Premier Quality Assurance Program (PQAP).

With the full support of all of our physicians, the management team undertook the search for a data partner with software that could appropriately risk adjust surgical patient data. The program has now developed to include multiple facets of measurement and review including among other things, peer-review, specific vascular case review, risk management, quality related documentation, outcomes tracking, program certification and accreditation, department and service level quality measurement, programs to address Physician burnout, review of evidence-based medicine guidelines, evaluation of opioid prescriptions patterns and tracking/100% data review of “the big 8” surgeries discussed below.

Dr. Stone Mitchell, Premier Surgical Medical Director

Premier Surgical Associates, the largest private General and Vascular Surgery practice in the Knoxville, Tennessee, region, has the taken uncommon step of voluntarily developing its own quality initiative. The Premier Quality Assurance Program (PQAP) is headed up by Premier Medical Director and General Surgeon Dr. Stone Mitchell.

“When people are looking for a surgeon, they want to know how good their surgeon is. The quality of a specific surgeon and a hospital are two separate things,” explains Dr. Mitchell.

“Premier has a robust quality program in which we measure procedure-specific quality. This allows us to know that our surgeons are doing good work and having good outcomes.”

The unique effort involves a dedicated Registered Nurse, Mary Frances McDonnel, who pours over the computer medical records of patients. Information such as patients’ length of stay, infections, re-admission rates, mortalities, pain improvement, and surgical outcomes is carefully gathered. The data is presented every other month to Premier’s Quality Committee, made up of the Medical Director and five Premier physicians. The group analyzes the information and looks for trends and areas that need improvement.

When Premier started the program in 2015, the team initially examined and analyzed 1,500 surgeries, 25 cases for each of the practice’s 28 physicians. Now that effort has grown to include every patient who undergoes one of the “big eight” procedures.

“We’re looking at every gallbladder removal, hernia repair, appendectomy, thyroid surgery, colon surgery, peripheral arterial disease procedure, carotid endarterectomy and bariatric surgery,” says Dr. Mitchell.

It’s a huge undertaking.

“Premier’s physicians performed almost 16,000 surgeries last year,” explains Dr. Mitchell. “Looking at big numbers allows you to form a more accurate picture when it comes to data crunching.”

Dr. Mitchell is proud that Premier Surgical is ahead of the curve when it comes to measuring quality.

“As we move into more of a value-based payment system, most healthcare providers will eventually have to show that they measure up. Premier is already doing that.  We’re continuously watching and reviewing our quality and we’re pleased that our numbers are much better than the national averages.

We don’t just say we’re better, we show it,” states Dr. Mitchell.

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