Quality Verification in Surgical Subspecialty Programs

In 2001, the Institute of Medicine defined 6 domains in quality health care: safe, effective, patient-centered, timely, efficient, and equitable. In 2010, the Affordable Care Act (ACA) or Obamacare, was passed into law. In addition to the well-known health insurance reform, it introduced delivery system redesign based on quality performance. Basically, it heralded a transition of reimbursement from payment for service and volume to payment for quality and value. Defining value is rather elusive; but if one considers that value equals quality divided by cost, payers aim to increase the value of a service either by improving quality, decreasing cost, or, preferably for them, both. The question is who defines value and quality of surgical services. Surgical specialists and their professional organizations should. Such organizations have the knowledge in their specialty but usually lack the infrastructure necessary to do so; but quality verification programs can be established in collaboration with the American College of Surgeons (ACS). ACS has had a long history of establishing quality verification programs; it has the infrastructure and the experienced personnel to do so. All ACS verification programs are based on four guiding principles: Setting standards based on evidence based guidelines, building the right infrastructure based on the standards, collecting the appropriate outcome data, and verifying compliance with the standards by site visit by outside experts. In this article, I outline the reasons for establishing verification programs, the process used to establish and maintain such programs, and their implications using the ACS/SVS (Society for Vascular Surgery) Vascular Verification Program as an example.