C. V. Kinnier1,2, A. R. Dahlke1, J. W. Chung1, A. D. Yang1, M. H. Ju1, M. McHugh3,4, K. Y. Bilimoria1 1Northwestern University,Surgical Outcomes And Quality Improvement Center, Department Of Surgery And Center For Healthcare Studies,Chicago, IL, USA 2Massachusetts General Hospital,Department Of Surgery,Boston, MA, USA 3Northwestern University,The Center For Healthcare Studies,Chicago, IL, USA 4Northwestern University,Department Of Emergency Medicine,Chicago, IL, USA
Introduction: The Centers for Medicare and Medicaid Services (CMS) is attempting to encourage participation in clinical registries to spur quality improvement. CMS now includes reporting of participation in a Systematic Clinical Database Registry (SCDR) for General Surgery as part of the Inpatient Quality Reporting Program (IQRP), and policy makers are considering tying registry participation to reimbursement. However, clinical registry participation is resource intensive and often costs upward of $100,000 annually. It is therefore unknown how many and what types of hospitals participate in an SCDR. Our objective was to examine the proportion and characteristics of hospitals participating in a General Surgery SCDR.
Methods: Hospitals performing inpatient surgery were identified from the CMS 2013 Inpatient Prospective Payment System (IPPS) Final Rule Impact File. SCDR-participating hospitals were identified through participation in the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP), the Michigan Surgical Quality Improvement Collaborative (MSQC), or the Surgical Clinical Outcomes Assessment Program (SCOAP). Structural characteristics were identified using the 2012 American Hospital Association Annual Survey. To measure hospital financial health, the 2011 and 2012 Healthcare Cost Report Information System was used to calculate hospital operating margin [(Total Operating Revenue – Total Operating Expenses)/Total Operating Revenue]. Baseline hospital quality was approximated with the CMS Value-Based Purchasing score. Multivariable hierarchical logistic regression models with state-level random intercepts were developed to examine hospital characteristics associated with SCDR participation.
Results: Of 2,998 hospitals, 429 (14.3%) participate in an SCDR. SCDR-participating hospitals accounted for 7,535,597 (31.4%) of all operations, 2,974,330 (34.0%) of inpatient operations, and 4,561,267 (30.0%) of outpatient operations. After adjustment, hospitals were more likely to participate in an SCDR if they were a teaching hospital (OR 5.14, 95%CI 3.88-6.80), were non-profit and non-government owned (OR 2.11, 95%CI 1.53-2.91), accredited by the Joint Commission (OR 1.71, 95%CI 1.11-2.63), were a large urban or other-urban facility (large urban: OR 2.71, 95%CI 1.80-4.07; other urban: OR 2.35, 95%CI 1.57-3.51), or had a greater financial operating margin (OR 1.47, 95%CI 1.02-2.13).
Conclusion: Only 14% of inpatient hospitals currently participate in a General Surgery SCDR. Large, teaching, urban, and financially-healthy hospitals are more likely to participate in registries. To further promote successful quality improvement endeavors, CMS may need to tie SCDR participation to payment incentives or provide grants to reduce the cost of SCDR participation to encourage the remaining 85% of US hospitals to participate in a Systematic Clinical Database Registry.