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Progress on the Surgical Care Improvement Project (SCIP) Special Study: The Unique Role of a Surgeon Organization and Quality Surgical Solutions Hiram C. Polk, Jr. MD, FACS John N. Lewis, MD, MPH Jan P. Van Vlack, RN February 2005

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Progress on the Surgical Care Improvement Project(SCIP) Special Study:The Unique Role of aSurgeon Organization


Quality Surgical Solutions

Hiram C. Polk, Jr. MD, FACS

John N. Lewis, MD, MPH

Jan P. Van Vlack, RN

February 2005

scip special study from surgical infection prevention sip to scip
SCIP Special Study…From Surgical Infection Prevention (SIP) to SCIP

Centers for Medicare & Medicaid Services (CMS) contract awarded to:

  • Kentucky Medicare Quality Improvement Organization (QIO)
  • Ohio Medicare QIO
scip special study continued
SCIP Special Study continued


  • Kentucky Medicare QIO with Quality Surgical Solutions
  • Ohio Medicare QIO with Oklahoma Medicare QIO
quality surgical solutions qss
Quality Surgical Solutions (QSS)

A surgeon organization whose mission

is to improve quality and decrease costs of surgical care

qss added value to scip
QSS–Added Value to SCIP
  • Surgical quality expertise
  • Surgical research and practice expertise
  • Practiced, accomplished leadership
  • Surgeon network
  • Hospital recruitment and commitment
  • Access to surgeon data on hospital case abstracted data
building physician consensus
Building Physician Consensus
  • Growing awareness of quality movement
  • Quality is more than the avoidance of error
  • Surgeons curiously excluded and/or non-participants in much work to date
scene setting
Scene Setting
  • To Err is Human*and

Crossing the Quality


  • Fundamental conflict with

extreme risks and/or anxiety about

professional liability issues

  • Relative success with SIP
  • Promise of reassertion of physician


* National Academy Press, Washington D.C. 2000 **National Academy Press , Washington D.C,.2001

kentucky a favorable platform for special study
Kentucky–A Favorable Platform for Special Study
  • University of Kentucky Medical Center (UKMC) alpha test site for National Surgical Quality Improvement Program (NSQIP/VA)
  • Early quality initiatives at Norton Hospital
  • Quality Surgical Solutions
  • Health Care Excel of Kentucky
what is qss
What is QSS?
  • 66 surgical specialists
  • 15 hospitals
  • 12 cities
  • 2 health plans
  • 43 protocols/current procedural technology (CPT) codes
specialties represented in qss
Specialties Representedin QSS
  • General surgery to include trauma, digestive, vascular, colorectal, oncology, endoscopy
  • Orthopedic, otolaryngologic, urologic, gynecologic surgery
fundamental hypotheses
Fundamental Hypotheses
  • Better quality surgical care is associated

with reduced direct and overall expenses

  • Physician–led initiatives work
  • Commitment to prove concepts and

ethically reward its doctors

  • Only effective public role is that of patient advocate
record of achievement locally
Record ofAchievement Locally
  • Confidentiality of data
  • Prompt spread of agreed upon goals
  • Surgeons more prone to emulate other surgeons
create an environment of transformational change
Create an Environment of Transformational Change
  • Innovate, report, refine, publish
  • Quality Improvement Conference
  • Value of the “near miss” and the praise of heroes and heroines
  • Examine routine and/or outdated printed orders
personal role generally helpful
Personal Role–Generally Helpful
  • Accept secondary and tertiary referrals without pain
  • Longstanding commitment to surgical excellence
  • Trained (partly or fully) many of Kentucky’s surgical specialists
  • Halo effect of QSS and having discussed it with hundreds of surgeons and administrative leaders
  • Personalized letters seeking surgeon support for SCIP through their hospitals
which six and why
Which Six… and Why?

A Lap GB D CABG/valve

B Hysterectomy E CR resections

C Major vascular F Total Knee/Hip


  • Not limited to Medicare beneficiaries
  • Primarily large volume hospitals
  • Significant complications and death
recruitment for scip pilot
Recruitment for SCIP Pilot
  • Group meetings for potential hospital participants and often their surgical specialists
  • Follow-up meetings, letters, and telephone calls
  • Recognition of the impact of current data submissions with invisible or meaningless feedback
conference calls
Conference Calls
  • Interest groups for each procedure
    • Lewis, Garrison, Polk, Van Vlack, and 2-5 specialists for the procedure
    • Prolonged sessions
    • Physicians very knowledgeable of current literature
    • Immediate agreement on process measures

and feedback

detailed development of qss involvement
Detailed Developmentof QSS Involvement
  • Laborious development of doctor report forms
  • Alpha test of forms
  • Surgeon-leader reports
  • Begin to match hospital and surgeon reports
  • Broad-based education–laboratory for student success (LSS), grand rounds, collaboratives
an overview
An Overview
  • Hospital contributions

- Multiple procedures and surgeons

    • Honest sampling
    • Detailed, accurate abstraction

- Tremendous enthusiasm

  • Surgeon contributions

- Pre- and postop data

    • Detailed outcomes
    • Documentation of patient education
unique opportunity to match hospital and physician reporting
Unique Opportunity to Match Hospital and Physician Reporting
  • More complete outcomes
  • Validation of accuracy for both methods of reporting
  • Consolidate surgeon and hospital performance into homogenous profile of quality
patient education
Patient Education
  • Far better done in surgical specialists’ offices–how to document and promulgate
  • How can we quantitate and then assess quality?
  • Discussion
atmosphere that promotes patient safety
Atmosphere that Promotes Patient Safety
  • Near miss and specific praise for the hero or heroine
  • Value of the process that targets the very rare disaster
    • The analogy between a plane crash and a pulmonary embolus–prophylaxis of the latter carries both risks and costs
we have achieved our goals in reining in the professional liability dragon
“We have achieved our goals in reining in the professional liability dragon.”
  • Physicians must now take the lead in identifying and solving problems of patient safety. We are now more protected than ever and can be the patient advocate we all want to be.
  • Allow doctors to clearly identify methods that provide improved quality.

June, 2004 G.E. McGee, M.D., FACS

peer reviewed publications
Peer-Reviewed Publications
  • Allen JW, DeSimone KJ. Valid peer review for surgeons working in small hospitals. Am J Surg 2002;184:16-18.
  • Allen JW, Hahm TX, Polk HC Jr. Surgeon-led initiatives cut costs and enhance the quality of endoscopic and laparoscopic procedures. J Soc Laparosc Surg 2003;7:243-247.
  • Galandiuk S, Rao MK, Heine MJ, et al. Mutual reporting of process and outcomes enhances quality outcomes for colon and rectal surgery. Surgery 2004; 136:833-841. [Presented at the Annual Meeting of the Central Surgical Association, March 2004].
  • McCafferty MH, Polk HC Jr. Addition of “near-miss” cases enhances a quality improvement conference. Arch Surg 2004;139:216-217.
  • Shively EH, Heine MJ, Schell R, et al. Practicing surgeons lead in quality care, safety, and cost control. Ann Surg 2004;239:752-762 [Presented at the Annual Meeting of the Southern Surgical Association, 2003].
  • Galandiuk S, Carter MB, Abby M, eds. When to Refer to a Surgeon. St. Louis, MO: Quality Medical Publishing, 2001.

A multifaceted endeavor with the ultimate goal of significantly improving surgical care in the United States through the prevention of complications associated with surgery


With a goal to reduce surgical complications and mortality 25% by 2010, the following estimated complications could be prevented annually for Medicare beneficiaries.

13,000 perioperative deaths

271,000 surgical complications

Hunt and Bratzler

the elements of scip
The Elements of SCIP
  • The Partnership
  • The Program
  • The Pilot
The SCIP Partnership

A coalition of organizations interested in:

  • the improvement of surgical care through the reduction of post-operative complications
  • the development of performance measures and a data collection tool
scip partners
SCIP Partners
  • Agency for Healthcare Research and Quality (AHRQ)
  • American College of Surgeons (ACS)
  • American Hospital Association (AHA)
  • American Society of Anesthesiologists (ASA)
  • Association of periOperative Registered Nurses (AORN)
scip partners continued
SCIP Partners continued
  • Centers for Disease Control and Prevention (CDC)
  • Centers for Medicare & Medicaid Services (CMS)
  • Department of Veteran Affairs (VA)
  • Joint Commission on Accreditation of Healthcare Organizations (JCAHO)
  • Institute for Healthcare Improvement (IHI)
The SCIP Program

Technical elements, consisting of process measures (including specifications), outcome measures (including appropriate risk adjustment methods), and the “SPOT” database and electronic data collection tool

The SCIP Pilot

A Medicare demonstration pilot designed to assess the feasibility of engaging private sector hospitals to reduce the incidence of post-operative morbidity and mortality

where do we go from here

Where Do We GoFrom Here?

Completion of pilot data collection

Final reports

Finalization of performance measures

for 8th SoW

National rollout

for more information

For more information…

Visit the National SCIP Web site

Contact the Kentucky Medicare QIO

(800) 300-8190

Contact Quality Surgical Solutions

(502) 583-7579

This material was prepared by Health Care Excel of Kentucky, the Medicare Quality Improvement Organization (QIO) of the Commonwealth, under contract with the Centers for Medicare & Medicaid Services (CMS), a federal agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy. Pub #HCEKI 01-2005