BEYOND THE STARS Do you know what patients are saying about you online? Are you marketing your positive reviews, and counteracting any negative ones?

Between the quality measures that government agencies collect, the performance statistics you report to benchmarking services and the levels of satisfaction your patients feel after their surgical experiences, there's a lot of information out there to rate how you're doing your job. Recent years have seen more and more of this type of information becoming publicly available, to the point that a potential patient can make a judgment on the care you provide without even setting foot in your facility. But you can use these details to your advantage if you know how to make healthcare transparency work for you.

When quality is quantified
It's not hard to figure out where the increasingly educated healthcare consumer came from. "Healthcare shouldered them with more of a financial burden," says Jerry Hadlock, CRNA, director of anesthesia at St. George (Utah) Surgical Center, which has begun posting the prices of surgeries it offers on its website (sgsc.net). "If they have to pay more, they're going to look for a good price, quality and safety." As a result, they're demanding and relying on available data to find it.

Medicare has been seeking out the best deals in health care as well. Its quality measures reporting program for ASCs and value-based purchasing incentives for hospitals link performance indicators to fiscal consequences. And many states require public reporting of healthcare-associated infection rates and other patient safety data.

If you're already collecting and reporting these quality measures, why not put them to use? "We've been discussing the idea of people proactively posting their Medicare quality indicators on websites, or pushing them on social media," says Joan Dentler, MBA, president and CEO of Avanza Healthcare Strategies in Austin, Texas. "Consumers are very, very interested in that information, and incorporating it into a marketing plan is free and easy."

What's more, it's a goal you're already striving for in the name of patient care. "We're focused on CMS and Joint Commission surveys, we definitely want to pass their standards," says Mr. Hadlock. "We release infection rates, utilizing them in marketing to educate the public. If you're doing everything you can to ensure quality and safety, there shouldn't be too much concern" about the information that gets disclosed.

"Infection rate is No. 1 right now," says Ann Geier, MS, RN, CNOR, CASC, chief nursing officer for SourceMedical Solutions. "What are you doing to ensure your infection rates are as low as possible? If you are doing well, use that in your marketing, on your website, in your brochures. If not, don't promote it, but use it to improve. Then make sure you maintain that improvement."

All in this together
"ASCs were expecting this when it arrived," says Ms. Geier. "We'd known it was coming when hospitals started having to collect and report data."

A diverse panel of representatives from the ambulatory surgery industry and healthcare quality organizations convened to discuss data diligence. The result of those discussions, the ASC Quality Collaboration (ascquality.org), arose to develop and publicly report standardized ASC quality measures just ahead of the 2007 hepatitis C outbreak sparked by shoddy practices at a Las Vegas endoscopy center, an incident that precipitated greater government scrutiny of ASC operations. "We were proactively involved and we were ready when the government pulled the trigger," says Ms. Geier.

The collaboration is one of many sources through which surgery centers can benchmark themselves and their performances against a range of other facilities. "It's like a mirror," she says. "Everything lets you look at yourself more closely, and measure up to the best of the best." And if you exceed the best? "You can say, 'The industry average is x, and look at us, we're better.'"

Twice a year, the Accreditation Association for Ambulatory Health Care's Institute for Quality Improvement issues a benchmarking report on a chosen procedure, from beginning to end, as practiced at ASCs nationwide. Regardless of the specialty, best performers can promote their standings to the media, their communities or even to payors with whom they're contracting, says Naomi Kuznets, PhD, senior director and general manager of the Skokie, Ill.-based institute.

For example, short wait times between a patient's arrival at the reception desk and her arrival in pre-op say a lot about a center's scheduling and efficiency, says Dr. Kuznets. "Discharge times show sufficient staff, appropriate discharge criteria and that patients aren't overmedicated."

Patients are spreading the word
"Health care has always acted as if it isn't subject to the same customer service requirements that other consumer products are," says Ms. Dentler. Given the rise of the educated patient and social media's impact on the economy, she adds, "we're losing that special category."

"The healthcare sector is just now experiencing what a lot of other sectors have already experienced," says Mr. Hadlock. "Online, connected people who are willing to offer feedback, like we've seen in the travel and hotel industry," and potential patients who are influenced by those reviews.

"Going forward, it's going to come down to individual healthcare consumers who are leading us to step up our performance," he says. "Those reviews, good and bad, are important all the same. If we don't take them seriously, we could see a loss of business."

During a recent meeting with ASC clients, Ms. Dentler searched the local-business-reviews website Yelp for "I need a knee scope," and showed them the results. "They were devastated, how many of them were being blasted," she describes. "Do you know if you have negative reviews out there?"

She recommends Google-searching your facility and surgeons' names on an ongoing basis and routinely monitoring what people are saying on consumer review websites. "When there is a negative experience, respond to it, don't ignore it," she says. And if your facility doesn't already have some form of Internet and social media presence, make that a priority. "At minimum you should be proactively putting positive information out there, publishing patient satisfaction letters," says Ms. Dentler. "Spend a few minutes every quarter on your own marketing efforts to counteract any negative reviews."

Future developments
The rating and scoring and reviewing that healthcare transparency brings isn't going away. More is on the way, says Dr. Kuznets, in part through 2 government-initiated programs.

The Centers for Medicare and Medicaid Services are currently developing an outpatient and ambulatory surgical component for their Consumer Assessment of Health Providers and Systems patient experience of care survey. At the same time, the Agency for Healthcare Research and Quality is surveying the culture of safety at ASCs, hospital outpatient departments and endoscopy centers. In combination with quality measures reporting, these patient satisfaction and safety findings could raise clinical practices to another level, says Dr. Kuznets. "Care is patient-centered. If you're not paying attention to what patients need, you're missing an opportunity for improvement."

WORD ON THE STREET
Which Indicators Are Most Meaningful?

HOW DO YOU MEASURE UP? Infection rates, benchmarking successes, and even patient satisfaction scores can be used to promote your facility.

Two recent studies present contrasting views on the value of insights that publicly available healthcare ratings offer.

In the first, published in the March issue of the journal Health Affairs (tinyurl.com/pd5ffzr), researchers from Johns Hopkins, Harvard and other academic institutions suggest that the hospital quality and safety rankings regularly published by U.S. News & World Report, Consumer Reports and other media outlets are more confusing than clarifying, since each rating method follows a different focus to a different conclusion. Comparing ratings assigned between July 2012 and July 2013, the researchers noted that "no hospital was rated as a high performer by all four national rating systems," and that "only 10 percent of the 844 hospitals rated as a high performer by one rating system were rated as a high performer by any of the other rating systems."

In the other study, published online by the Journal of General Internal Medicine (tinyurl.com/phvocy8), McKinley Glover, MD, MHS, a clinical fellow in Massachusetts General Hospital's department of radiology, found a positive correlation between how highly a hospital is rated in social-networking site Facebook's 1-to-5-star reviewing feature, and how low its rate of readmissions within 30 days after discharge is. "Since user-generated social media feedback appears to be reflective of patient outcomes," writes Dr. Glover, "hospitals and healthcare leaders should not underestimate social media's value in developing quality improvement programs."

— David Bernard