RESUMO
OBJECTIVE: The aim of the study was to determine the association of patient-reported experiences (PREs) and risk-adjusted surgical outcomes among group practices. BACKGROUND: The Centers for Medicare and Medicaid Services required large group practices to submit PREs data for successful participation in the Physician Quality Reporting System (PQRS) using the Consumer Assessment of Healthcare Providers and Systems for PQRS survey. Whether these PREs data correlate with perioperative outcomes remains ill defined. METHODS: Operations between January 1, 2014 and December 31, 2016 in the American College of Surgeons' National Surgical Quality Improvement Program registry were merged with 2015 Consumer Assessment of Healthcare Providers and Systems for PQRS survey data. Hierarchical logistic models were constructed to estimate associations between 7 subscales and 1 composite score of PREs and 30-day morbidity, unplanned readmission, and unplanned reoperation, separately, while adjusting for patient- and procedure mix. RESULTS: Among 328 group practices identified, patients reported their experiences with clinician communication the highest (meanâ±âstandard deviation, 82.66â±â3.10), and with attention to medication cost the lowest (25.96â±â5.14). The mean composite score was 61.08 (±6.66). On multivariable analyses, better PREs scores regarding medication cost, between-visit communication, and the composite score of experience were each associated with 4% decreased odds of morbidity [odds ratio (OR) 0.96, 95% confidence interval (CI) 0.92-0.99], readmission (OR 0.96, 95% CI 0.93-0.99), and reoperation (OR 0.96, 95% CI 0.93-0.99), respectively. In sensitivity analyses, better between-visit communication remained significantly associated with fewer readmissions. CONCLUSIONS: In these data, patients' report of better between-visit communication was associated with fewer readmissions. More sensitive, surgery-specific PRE assessments may reveal additional unique insights for improving the quality of surgical care.
Assuntos
Prática de Grupo , Medidas de Resultados Relatados pelo Paciente , Procedimentos Cirúrgicos Operatórios , Centers for Medicare and Medicaid Services, U.S. , Honorários Farmacêuticos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Readmissão do Paciente/estatística & dados numéricos , Relações Médico-Paciente , Complicações Pós-Operatórias/epidemiologia , Melhoria de Qualidade , Sistema de Registros , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Risco Ajustado , Estados Unidos/epidemiologiaRESUMO
An overview of provisions in the Medicare physician fee schedule final rule and changes in CPT coding that will affect physician reimbursement in 2014. Key elements of the final rule for the fee schedule center on the potential reduction in payment due to the conversion factor update, payment for in-office procedures, PQRS reporting options, public reporting via CMS' Physician Compare website, and the value-based payment modifier. Fundamental changes in CPT coding affect consultation codes, drainage of skin and subcutaneous structures, complex repair, skin flaps and grafts, breast biopsies and imaging, and other surgery-related codes.