Washington State’s Spine Community
Working to Improve Surgical Quality:
A Proposal to the Bree Collaborative
Neal Shonnard, MD
Spine SCOAP Medical Director
Bree Collaborative Meeting
October 1, 2012
Presentation Outline
• Recap of Bree Collaborative vote at August 1st Bree
Collaborative meeting
• Recap of Spine SCOAP Registry Proposal to Bree
Collaborative
• Background on Spine SCOAP
• Registry components
• Benefits of Spine SCOAP to hospitals/communities
• Enforcement
• Next Steps
2
Spine SCOAP Registry – 8/1
Bree Collaborative meeting
RECAP
Adopted motion at 8/1/12 Bree Collaborative meeting:
• “To support the notion that the community moves in
the direction of reporting all spine interventions to a
community registry such as Spine SCOAP, and will
take into account implementation of this
recommendation at the next Bree Collaborative
meeting when more information is presented.”
3
Proposal of Spine SCOAP
Spine SCOAP requests the Bree
Collaborative establish participation in
Spine SCOAP as a community standard*.
*Starting with hospitals performing spine surgery.
4
What is Spine SCOAP?
•
•
•
•
•
•
Clinician-led quality improvement using clinical data
Performance benchmarking at hospital level
Peer networks
Focus on quality and cost-effectiveness
Spotlighting variation
Impacts behavior through:
•
•
•
•
Benchmarking
Education
Standard orders
Checklists
5
Who runs Spine SCOAP?
• Clinician-led Advisory Board of Experts
– 16 hospitals
– Foundation for Healthcare Quality
• Roles of Advisory Board
– Metrics committee defines standards
– Target new procedures
– Address medical/legal issues
• Funding
– Hospital pays abstractors and a modest yearly fee
– Research grants support growth
6
Spine SCOAP Clinical
Leadership Committee
Physician
Ray Baker
Farrokh Farrokhi
John Hsiang
Chong Lee
Michael Lee
Dean Martz
Neal Shonnard
Raymond Golish
Specialty
Interventional
Radiologist
Neurosurgeon
Neurosurgeon
Neurosurgeon
Orthopedic Surgeon
Neurosurgeon
Orthopedic Surgeon
Orthopedic Surgeon
Affiliation
EvergreenHealth
Virginia Mason Medical Center
Swedish Medical Center
Group Health/Virginia Mason
University of Washington
Providence Sacred Heart
Multicare Good Samaritan
PeaceHealth SWMC
7
Spine SCOAP’s Agenda
• Shared goal: Improve patient access to higher quality,
appropriate spine surgery
• To accomplish goal, need:
– Collaborative of all stakeholders
– Real-world data to know what’s being done and to track
outcomes that matter
• Keys to success
–
–
–
–
Build on success of the WA State surgical community
Spine community owning variability/inviting collaboration
Focus on quality and safety
Later address variability in indications/appropriateness
8
4 year Reoperation After Lumbar
Decompression, by WA State Hospital
Spine SCOAP Development
• Data Sources (abstracted medical record data & surveying for
patient reported outcomes)
• 4000 cases to date, focusing on fusion
• 16 hospitals (80% of eligible spine procedures)
• Consecutive Spine Operative Procedures:
–
–
–
–
Discectomy
Laminectomy
Fusion
Disc replacement
• Patient Reported Outcomes
– Baseline and follow up regarding Quality of Life and functional
11
outcomes through 5 years
Types of Included Data Metrics
•
•
•
•
•
•
Risk adjustment metrics
Indication metrics
Technique metrics
Peri-operative process metrics
Risk adjusted clinical outcome metrics
Functional outcome and pain metrics
Data Submission
• Frequency:
– Real-time:
• Data may be entered directly into the Spine SCOAP
database
• Data is available for querying as soon as it is entered
– At a minimum, many hospitals batch data on a quarterly
basis
• Mechanics:
– Database Vendor: ARMUS
– Data submission via secure web portal
13
Participation Costs: An Example
• Mid-Sized Hospital, 400 procedures/year:
– Annual Participation Fee: $5,000
– Case Abstraction
• Cost varies based on who is doing the abstracting
• If in-house abstraction, cost estimate ranges from $3550/case
• Outsourced abstracting costs range $25-35/case
(depending on vendor, EHR, etc.)--example is using midrange outsourcing cost= $12,000
– Patient Surveying (Baseline through one year): $24,000
– Total Cost (Fee+Abstraction+Surveys): $41,000
14
Transparency
• Washington State Spine Forum: Quarterly public
access to spectrum of Spine SCOAP data
• Planned yearly risk-adjusted, outcome-oriented
reports for hospitals and stakeholders
15
Opportunities/Benefits to
Hospitals & Community
• Reducing variability in quality, cost, and indications for
surgery
– Addresses perception of inappropriate care
• Determine appropriateness by assessing functional
changes over time
• Opportunity for real world comparative effectiveness
research related to value of interventions
– Key component of Washington State Spine Forum
• Hospital-level data is not discoverable as covered by
Washington State CQIP statute
16
Consequences/Risks of
Participation
• Hospitals absorb costs of FHCQ registration and
data abstraction
• Reputational risk to not participating in peerled initiative aimed at improving quality
17
Per Bree Collaborative Legislation:
• Bree Collaborative makes recommendations to the
WA Health Care Authority (HCA) but does not have
authority to enforce implementation of its
recommendations
• HCA reviews the Bree Collaborative’s
recommendations and decides if any or all
recommendations will be applied to state purchased
programs (e.g,, Medicaid, WA Public Employee health
plan, Dept of Corrections)
18
Furthering the Goals of the Bree
• Reducing variability in indications and outcomes
across centers/surgeons
– Quarter by quarter improvements
– Works through peer-to-peer networks and “outlier” effect
• Real world CER and PCOR studies show what works
and what doesn’t, in which patients, and when
• Informs WA State HTA decisions, payment and
regulatory policy
19
Next Steps
• If approved, Spine SCOAP will submit formal
proposal (summation of slides)
20
Proposal of Spine SCOAP
Spine SCOAP requests the Bree
Collaborative establish participation in
Spine SCOAP as a community standard*.
*Starting with hospitals performing spine surgery.
21