Should compliance with the Surgical Care Improvement Project (SCIP) process measures determine Medicare and Medicaid reimbursement rates? 2012

Nicole Garcia, and Sandy Fogel, and Christopher Baker, and Stephen Remine, and Jim Jones
Carilion Clinic, Roanoke Memorial Hospital, Roanoke, Virginia, USA. nmgarcia@carilionclinic.org

The Surgical Care Improvement Project (SCIP) is a project that focuses on improving surgical care by reducing surgical morbidity and mortality by 25 per cent by 2010. Starting in 2011, SCIP compliance affects Medicare and Medicaid reimbursement rates. Although SCIP reinforces better practices in surgical care, does compliance with SCIP measures actually result in a decrease in surgical morbidity and mortality? This study examined compliance with the SCIP surgical site infection (SSI) module (prophylactic antibiotic received within 1 hour before surgical incision) during 2009 to 2010 (n = 703) to determine whether patients compliant with SCIP data had a correlation with SSI rates as reported by National Surgery Quality Improvement Program (NSQIP) data for the same time period. We found no statistically significant association in patients that have failed SCIP INF1 in the years 2009 to 2010 (n = 43) and the rates of SSI (n = 0) for the same time period. These data suggest that SCIP compliance should not be used to determine Medicare and Medicaid reimbursement rates because there is no correlation between failure of SCIP INF1 and SSI. Instead, further effort should be placed on developing tools designed to acknowledge outcome measures that result in decreased morbidity/mortality and change practices accordingly such as NSQIP.

UI MeSH Term Description Entries
D008484 Medicaid Federal program, created by Public Law 89-97, Title XIX, a 1965 amendment to the Social Security Act, administered by the states, that provides health care benefits to indigent and medically indigent persons. Dental Medicaid Program,Medical Assistance, Title 19,Dental Medicaid Programs,Medicaid Program, Dental,Medicaid Programs, Dental,Program, Dental Medicaid,Programs, Dental Medicaid
D010349 Patient Compliance Voluntary cooperation of the patient in following a prescribed regimen. Client Adherence,Client Compliance,Non-Adherent Patient,Patient Adherence,Patient Cooperation,Patient Noncompliance,Patient Non-Adherence,Patient Non-Compliance,Patient Nonadherence,Therapeutic Compliance,Treatment Compliance,Adherence, Client,Adherence, Patient,Client Compliances,Compliance, Client,Compliance, Patient,Compliance, Therapeutic,Compliance, Treatment,Cooperation, Patient,Non Adherent Patient,Non-Adherence, Patient,Non-Adherent Patients,Non-Compliance, Patient,Nonadherence, Patient,Noncompliance, Patient,Patient Non Adherence,Patient Non Compliance,Patient, Non-Adherent,Therapeutic Compliances,Treatment Compliances
D011183 Postoperative Complications Pathologic processes that affect patients after a surgical procedure. They may or may not be related to the disease for which the surgery was done, and they may or may not be direct results of the surgery. Complication, Postoperative,Complications, Postoperative,Postoperative Complication
D012051 Reimbursement Mechanisms Processes or methods of reimbursement for services rendered or equipment. Mechanism, Reimbursement,Mechanisms, Reimbursement,Reimbursement Mechanism
D006278 Medicare Federal program, created by Public Law 89-97, Title XVIII-Health Insurance for the Aged, a 1965 amendment to the Social Security Act, that provides health insurance benefits to persons over the age of 65 and others eligible for Social Security benefits. It consists of two separate but coordinated programs: hospital insurance (MEDICARE PART A) and supplementary medical insurance (MEDICARE PART B). (Hospital Administration Terminology, AHA, 2d ed and A Discursive Dictionary of Health Care, US House of Representatives, 1976) Health Insurance for Aged and Disabled, Title 18,Insurance, Health, for Aged and Disabled,Health Insurance for Aged, Disabled, Title 18,Health Insurance for Aged, Title 18
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D014481 United States A country in NORTH AMERICA between CANADA and MEXICO.
D017064 Process Assessment, Health Care An evaluation procedure that focuses on how care is delivered, based on the premise that there are standards of performance for activities undertaken in delivering patient care, in which the specific actions taken, events occurring, and human interactions are compared with accepted standards. Process Assessment (Health Care),Assessment, Process,Process Measures,Assessment, Process (Health Care),Assessments, Process,Assessments, Process (Health Care),Measure, Process,Measures, Process,Process Assessment,Process Assessments,Process Assessments (Health Care),Process Measure
D058996 Quality Improvement The attainment or process of attaining a new level of performance or quality. Improvement, Quality,Improvements, Quality,Quality Improvements

Related Publications

Nicole Garcia, and Sandy Fogel, and Christopher Baker, and Stephen Remine, and Jim Jones
February 2014, Medical care,
Nicole Garcia, and Sandy Fogel, and Christopher Baker, and Stephen Remine, and Jim Jones
December 2008, Surgical infections,
Nicole Garcia, and Sandy Fogel, and Christopher Baker, and Stephen Remine, and Jim Jones
August 2013, Plastic and reconstructive surgery,
Nicole Garcia, and Sandy Fogel, and Christopher Baker, and Stephen Remine, and Jim Jones
November 2012, Plastic and reconstructive surgery,
Nicole Garcia, and Sandy Fogel, and Christopher Baker, and Stephen Remine, and Jim Jones
August 2013, Plastic and reconstructive surgery,
Nicole Garcia, and Sandy Fogel, and Christopher Baker, and Stephen Remine, and Jim Jones
August 2013, The Journal of arthroplasty,
Nicole Garcia, and Sandy Fogel, and Christopher Baker, and Stephen Remine, and Jim Jones
June 2015, JAMA surgery,
Nicole Garcia, and Sandy Fogel, and Christopher Baker, and Stephen Remine, and Jim Jones
August 2012, The Journal of bone and joint surgery. American volume,
Nicole Garcia, and Sandy Fogel, and Christopher Baker, and Stephen Remine, and Jim Jones
July 2015, Anesthesiology,
Nicole Garcia, and Sandy Fogel, and Christopher Baker, and Stephen Remine, and Jim Jones
January 2014, American journal of medical quality : the official journal of the American College of Medical Quality,
Copied contents to your clipboard!