If you’re scheduling a same-day surgery or procedure, you may be considering an ambulatory surgery center instead of a hospital or hospital outpatient department. ASCs, as they are known, can be more convenient and likely will cost you less. Today, ASCs provide a wide range of procedures, from cataract surgery to total joint replacements. You may ask your physician where to have the procedure and they may offer to do it in various settings, including an ASC that they co-own or co-manage.  

Unfortunately, today it is almost impossible for consumers seeking the right place for their surgery to obtain independent information on the safety and quality of an ASC — even though over half of surgeries are now done in these settings. But it doesn’t have to be that way.  

Indeed, the story is different for New Jersey hospitals and hospital outpatient departments, where the same procedures and surgeries are often done. In our state, every acute care hospital and hospital outpatient department voluntarily participates in the Leapfrog Hospital Survey. The survey is annual and includes important information when it comes to surgery, including the number of facility-acquired infections, the volume of certain types of surgery (the more, the better), medication errors, hand-washing standards, and more. At the Leapfrog website, you can compare different hospitals and their outpatient departments to determine which of your in-network choices are best in your case.  

If more ASCs in New Jersey participated in the free, Leapfrog ASC Survey, you would also be able to compare and consider those ASCs as a safe site for care. Unfortunately, as of 2023, just five out of 188 licensed eligible ASCs in New Jersey participated in the Leapfrog ASC Survey.  

Without participation in the Leapfrog ASC Survey, there is no other readily available public source of information on the safety and quality of these facilities. Although the federal government (Center for Medicare and Medicaid Services or CMS) requires that states inspect ASCs that participate in Medicare or Medicaid, New Jersey lags behind most of the country on inspections. A 2019 Inspector General Report found that New Jersey was one of just four states that did not meet their inspection responsibility for ASC oversight.   

More ASC inspections needed 

CMS requires that states inspect these facilities at least every six years or in cases of certain complaints. A lot can happen in six years. Having every ASC annually report to Leapfrog is a great way to monitor safety, filling in and identifying issues of concern consistently and publicly within a facility, in between state inspections.  

Even when the state does inspect an ASC, those inspections are not readily available or sometimes ever available. Some inspections can be found on the Department of Health website, but if an inspection is outsourced to a private company, which most are, they are not publicly available. And some inspections are only available by filing an Open Public Records Act request, which almost no consumer would do.  

When the Health Department does inspect an ASC and finds something troubling, it may be public in a penalty letter. Those letters provide a glimpse at what can go wrong and why safety and quality matter. Penalty letters from the past several years tell of ASCs being temporarily barred from performing procedures for having medical instruments marked with “sticky residue” and “red-colored stains.” One penalty letter describes a site where physicians were performing surgeries they were not credentialed to perform, resulting in patients being transferred out of the ASC to a hospital for a higher level of care, including blood transfusions and treatment in the ICU.  

ASCs have proven themselves to be as safe as hospitals, if not safer, in some cases. But that doesn’t mean all ASCs are safe or equally safe. We need greater public information for consumers. 

What can patients and business leaders do? 

Ask about Leapfrog  

First, ask any ASC that you are considering if they participate in the Leapfrog ASC Survey. If they don’t, urge them to report and consider holding off going there until they do. The Leapfrog ASC Survey collects information such as the volume and safety of procedures; patient safety practices; and the experience of patients. 

If you are an employee or a business leader, tell your health plan administrator to put pressure on ASC owners. Reach out to your insurer and tell them you want the ASCs in their networks to report.   

If you are an ASC owner or investor, reach out to us. We are the regional leaders for Leapfrog and we can make sure that you get the assistance you need in making your safety and quality transparent to the community you serve.  

The Leapfrog ASC Survey started in 2019. ASCs have been given nearly five years to voluntarily report. We applaud the few that did. They show consumers and payers their commitment to patient safety.  

There should be little debate. Insurers, patients and consumers want reporting. New Jersey Department of Health Commissioner Kaitlin Baston, M.D., recently called on ASCs to report. The Leapfrog ASC Survey opened on April 1 and ASCs have until November to report.  

We hope 2024 is the year they all step up.