Missy Danforth is the Vice President of Health Care Ratings at The Leapfrog Group. She’s a member of the senior leadership team analyzing programs to drive safety and quality improvements.


Since 2001, Leapfrog has rated the safety and quality of inpatient hospital care for almost 2,000 hospitals across the country. Why is Leapfrog now planning to evaluate hospital outpatient and ambulatory surgical centers? 

As more and more surgery moves to the outpatient setting — hospital outpatient departments and ambulatory surgical centers — we want to provide patients and payers with nationally standardized, evidence-based information about the safety and quality of these outpatient and ambulatory settings and procedures. We’ll start collecting this information on April 1, 2019. Hospitals will be able to report on outpatient procedures on a new section of the Leapfrog Hospital Survey and ASCs will respond to a new ASC Survey.


Is there any reporting now that consumers can use to learn about safety and quality of procedures at hospital outpatient departments or ambulatory surgery centers?

Unfortunately, there’s very little. The Centers for Medicare and Medicaid Services (CMS) collects and publicly reports very little information about ASCs or hospital outpatient departments that can be used by patients or payers. CMS is currently only collecting about a dozen measures from ASCs, and the way those results are made available does not allow patients to search for a specific facility or to compare facilities. We think it’s important for consumers not just to compare ambulatory surgery centers to other ambulatory surgery centers, but also to be able to compare different settings, such as hospital outpatient departments where the same procedures are being performed. Right now, if you needed a routine colonoscopy, you could have that procedure in a hospital outpatient department or an ambulatory surgery center. If you wanted to compare facilities that perform the procedure it would be virtually impossible.


Is there any reason to believe that ambulatory surgical centers are more or less safe than surgery in hospitals?

That’s a good question. We know they are less costly. We really don’t know if they are safer, as safe, or less safe. The data we collect through our two new initiatives will provide some answers to that question.


What has been the reaction among ASCs and others in the health care industry about this initiative?

In the past two years, in talking with hospitals and ASCs, they do seem eager to be able to make quality and safety information available to the public. Many are already working with health plans and employers that are looking to move into value-based purchasing and they need quality data to use along with their cost data. These healthcare leaders know that in order to truly help employers and other payers contract for care based on value all this information is essential.


What measures will be included in the new Outpatient Surgery section of the Leapfrog Hospital Survey and new Ambulatory Surgery Center Survey? 

We’ll be looking at five different areas: basic facility information; medical and nursing staff; volumes of procedures and outcomes, when available; patient safety practices, such as hand hygiene and the culture of safety, similar to what we have on our inpatient survey; and we’ll be asking some questions about patient access and experience. In the first year, we are planning to publish a national report based on the surveys we received. We plan to publish facility-specific ratings in 2020.


How can the Quality Institute and our members advance this survey?

Start a conversation with hospital leaders and ambulatory surgical center leaders. We are looking for ambulatory centers and hospitals to volunteer to pilot the new survey content. We also need a strong commitment from purchasers and payers to use this information in public reporting, network design, and contracting. We expect to highlight differences in safety and quality between participating facilities, and until we tie payment to some of these differences it will be difficult to see the improvements in patient care that we all strive for.