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Ambulatory Service Centers Yield More Positive Patient Experiences

The Leapfrog Group’s Outpatient Surgical Care report showed that patient experience was all-around better in ambulatory service centers than in hospital outpatient departments

The Leapfrog Group published the first part of its Outpatient Surgical Care report, finding that ambulatory service centers (ASCs) generated more favorable patient experience scores compared to hospital outpatient departments (HOPDs) during the pandemic.

The COVID-19 pandemic has altered healthcare delivery for patients; various challenges such as staffing shortages, care access delays, and high infection rates have impacted the care experience for all patients. It has never been more important to assess patient perspectives to ensure that the patient voice is accounted for, the Leapfrog group said.

By using Consumer Assessment of Healthcare Providers and Systems Outpatient and Ambulatory Surgery (OAS CAHPS) survey data, the nonprofit patient safety watchdog group measured the experience of patients undergoing same-day surgery in HOPDs or ASCs.

This report is the first in a three-part series from The Leapfrog Group examining patient experience in HOPDs and ASCs over the course of the pandemic, from a pre-pandemic (2019) to a mid-pandemic (July 2020 to June 2021) timeframe.

Across all domains of patient experience examined through OAS CAHPS, a greater proportion of patients gave ASCs more positive responses during the mid-pandemic timeframe. This most recent survey backs earlier data by The Leapfrog Group.

According to OAS CAHPS results, over 97 percent of patients at ASCs gave favorable responses about the facilities and staff compared to 96.6 percent at HOPDs.

In addition, 89.1 percent of patients at ASCs gave favorable responses for overall facility ratings compared to HOPDs, with 85.2 percent of patients giving good ratings.

Patients were least likely to give a favorable response about their willingness to recommend ASCs and HOPDs. What’s more, the starkest patient experience difference between ASCs and HOPDs was in willingness to recommend, with an average of 87.4 percent of ASC patients and 82.4 percent of HOPD patients stating they would recommend the facility.

Both ASCs (91.3 percent) and HOPDs (90.7 percent) received close ratings for their communication about procedures.

Despite many elective procedures being delayed in 2020 and 2021, the data suggest that patients had a primarily positive experience when their surgeries were performed.

However, when comparing pre-COVID scores, communication about patient procedures worsened during the pandemic.

Clear communication from nurses and doctors about a patient’s procedure is crucial for patient safety, highlighting room for improvement. Yet, these lower scores could be partially explained by the impact COVID-19 had on patient expectations. Since the pandemic occurred, patients want their safety prioritized. Patients are worried about getting sick and want to see measures taken to protect their safety and wellness

"Unfortunately, the findings of this report are not reassuring about patient safety for outpatient surgery during the pandemic, though the data is not definitive yet," Leah Binder, president, and CEO of The Leapfrog Group, said in a public statement. "Patients seem to report more positively about experience with ASCs than hospitals, but because only a subset of outpatient facilities made their data public, we don't know if we have a truly representative sample. Purchasers of health benefits and the American public deserve more data than this."

These results cannot be definitive, as far fewer ASCs voluntarily complete OAS CAHPS surveys and provide those results to CMS than HOPDs, The Leapfrog Group stated. The lack of transparency suggests the potential of selection bias influencing the results.

In addition, the Leapfrog Group has been actively pushing for public access to patient experience ratings, as those scores are critical to ensuring patients have the information they need to make the right healthcare decisions.

Patients with access to hospital quality ratings could also have better health outcomes. A 2021 JAMA Network Open study showed that hospitals with higher online provider reviews tend to have lower mortality rates.

“Patient experience and satisfaction with healthcare are increasingly recognized as important measures of healthcare quality, but data on these factors are less widely collected,” the researchers of the JAMA study wrote. “Favorable evaluations of healthcare are associated with both patient-level outcomes, such as improved medication adherence, and facility-level outcomes, such as lower mortality.”

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