U.S. News releases its first ratings of ambulatory surgery centers. Here’s how and why they did it.

For 34 years, U.S. News & World Report has evaluated America’s hospitals, and its ratings have gained wide attention from consumers and the healthcare industry.

Now for the first time, U.S. News is releasing ratings of ambulatory surgical centers. The media outlet released its inaugural ratings of ambulatory surgical centers Tuesday morning.

U.S. News examined nearly 5,000 ambulatory surgical centers in four key areas: colonoscopy and endoscopy; ophthalmology; orthopedics and spine; and urology.

Ben Harder, chief of health analysis and managing editor at U.S. News, talked with Chief Healthcare Executive® about the new ratings.

“What we've seen over the past decade is a rapid shift for some services into ambulatory surgery centers, and more of it also going from inpatient to the outpatient setting within hospitals,” Harder says. “And so there's really been this major innovation in how a lot of surgical care is delivered.”

About 700 ambulatory surgical centers - less than 15% of those evaluated - earned a “high performing” rating.

With more people getting treated on an outpatient basis, U.S. News wanted to offer more information for consumers, Harder says.

“For many patients, that's a preferable setting to receive care,” Harder says. “And for many doctors, it's preferable as well. So with the rapid movement of care into the surgery center setting, we felt it was important to be able to provide healthcare consumers with a view of which of those were best and what they're really good at.”

(See part of our conversation with Ben Harder of U.S. News in this video. The story continues below.)

Evaluating data

U.S. News pored over Medicare data in its analysis. U.S. News also partnered with Care Journey, a data analytics firm, to produce the ratings.

For the ambulatory surgical center ratings, U.S. News relied solely on objective data in its analysis, Harder says. That represents a bit of a difference from the U.S. News hospital ratings. While Harder says the vast majority of its hospital ratings rely on objective data, U.S. News utilizes some expert opinion in a few specialties. But they didn’t seek any physician opinion for its ratings on ambulatory surgical centers.

“There's no survey of physicians or healthcare professionals,” Harder says. “There's no subjective component to this whatsoever.”

Ambulatory surgical centers didn’t submit data to U.S. News, Harder notes. U.S. News examined publicly available data.

“We didn't ask them for anything,” Harder says. “They didn't have to even be aware of our work.”

U.S. News examined outcomes involving tens of millions of Medicare beneficiaries, and looked closely at the care they received.

“We built this methodology around patient outcomes, taking account of the differences that individual patients have in terms of how severe their illness was, what they were getting treated for, and so on, and then really looked at which of these surgery centers was adding the most value in terms of the outcomes that are achieved for its patients,” Harder says.

The analysis included risk adjustment. U.S. News took into account factors about the patient’s health, such as if a patient had high blood pressure, and included 100 different comorbidities in its risk model. They also considered factors such as a recent illness or hospitalization, and if the patient had low income. And U.S. News took into account the type of surgery.

“So all of those factors, and more, we took into account in assessing how likely a given patient was to experience an adverse outcome, like having to go to the emergency department after their procedure, or even get hospitalized,” Harder says.

Some surgery centers don’t care for Medicare beneficiaries, and they weren’t included in the analysis.

But Harder says the nearly 5,000 facilities that were evaluated “represents the vast majority of ambulatory surgery centers in the country. So we are looking at essentially every provider of these services. And we're doing it in a completely objective way.”

Interesting takeaways

Some surgery centers specialize in more than one service. Harder notes that some multi-specialty surgery centers may have earned high ratings in one area, but may not have been a standout in another area.

“I think that's an important point to make, that you really need to make sure you're identifying the surgery center that's best at the kind of care you need,” he says.

The top-rated surgery centers can be found all across the country, in big cities, and in smaller communities, Harder notes.

“Every patient, no matter where they live, has the opportunity to seek out better care if they're tapping into resources like ours,” Harder says.

He adds that an average rating for a surgery center isn’t a bad grade.

“That's actually a reassuring finding for most patients, because it means there's no concerning safety profile … this ASC isn't having patients streaming into the emergency department after surgeries,” he says.

In doing the analysis, U.S. News found that ambulatory surgery centers aren’t necessarily aware of what happens to patients after discharge.

“If a patient does have a complication, they aren't coming back to that ASC,” Harder says. “They are going to their local emergency department or a hospital or they may be seeking care … from their primary care doctor.”

With the data, Harder says U.S. News was able to track what happens to patients in the following weeks and months. “That really gave us a very clear view of the entire patient's journey through the healthcare system,” he says.

Some operators of ambulatory surgery centers told U.S. News that they are interested in the analysis to see the “longitudinal view of what's happening to their patients,” Harder says.

When asked if there’s a relationship between top-rated hospitals and high-performing outpatient surgery centers, Harder says U.S. News hasn’t done a deep dive into that question. But he says anecdotally, there “is some correlation.”

Harder notes that while a brand may be powerful in the marketplace, “it doesn’t necessarily mean everything with that brand on the door provides the highest level of care.” So he suggests consumers look at the ratings of ambulatory surgery centers to see how they perform. “If they're just going on brand, they may miss the nuances that we've been able to pick up in the data,” he says. “And so it's worth checking how our ratings capture that particular ASC.”

At a minimum, the ratings reflect a remarkable shift in the delivery of healthcare, with patients getting more complex procedures on an outpatient basis that would have necessitated hospital stays not that long ago.

“Healthcare innovation happens slowly, and then all of a sudden, and all at once,” Harder says. “And I think there has been a very dramatic shift toward faster recovery and faster discharge, which, when it works well, is great. It's great for patients, it reduces costs, it helps doctors move on to the next patient who needs their attention and expertise. But you need to make sure that happens safely.”

“And so that's been the concern as care moves to the outpatient setting … are we sacrificing quality for convenience and cost savings? And so that's one of the things that we're really looking at here, is making sure that ASCs are getting outcomes that are on par with their peers, or even better.”

Top states

These states, listed alphabetically, have the greatest number of “Best Ambulatory Surgery Centers.”

Arizona

California

Florida

Georgia

Maryland

New York

Ohio

Pennsylvania

Texas

Washington