QAPI Studies: A Study on GI Case Cancellations

Ep. 104: Kathy Wilson – QAPI: A Study on GI Case Cancellations

Here’s what to expect on this week’s episode. 🎙️

In this episode of This Week in Surgery Centers, Kathy Wilson, Executive Director of the ASC Quality Collaboration, walks us through her 10-step process for conducting an effective QAPI study. Using a real-world example from a GI center, she shares how her team tackled case cancellations—ultimately reducing same-day cancellations to 6.8%.

Here is Kathy’s 10-Step QAPI Process:

1️⃣ Define the Purpose – Why does this issue matter?

2️⃣ Set a Performance Goal – Internal or external benchmarks help guide success.

3️⃣ Plan Data Collection – Identify what you need to track.

4️⃣ Collect the Data – Use reports, spreadsheets, or software to track key details.

5️⃣ Analyze the Data – Identify trends and root causes.

6️⃣ Compare to Goal – Did you hit the target?

7️⃣ Implement Corrective Actions – Revise patient instructions, engage physicians, implement tech solutions, etc.

8️⃣ Remeasure the Data – Track post-intervention results.

9️⃣ Adjust if Needed – Implement further corrective actions if goals aren’t met.

🔟 Communicate Findings – Share results with staff, leadership, and surveyors.

For a more detailed walkthrough, listen to the episode in full on your favorite podcast platform or on YouTube.

Episode Transcript

[00:00:00] Welcome to this week in Surgery Centers. If you are in the ASC industry, then you are in the right place every week. We’ll start the episode off by sharing an interesting conversation we had with our featured guest, and then we’ll close the episode by recapping the latest news impacting surgery centers.

We’re excited to share with you what we have, so let’s get started and see what the industry’s been up to.

Erica: Hi, everyone. Here’s what you can expect on today’s episode. Today we are wrapping up our three part series on QAPI studies with Kathy Wilson, the executive director of the ASC Quality Collaboration. I have to say, I learned so much from this conversation, so I’m really excited for all of you to hear it as well.

Erica: Kathy takes us through a real life QAPI study that she worked on using her 10 step repeatable approach. And what’s great about this method is that it really made the whole process so much easier to follow and feel so much less daunting. [00:01:00] In this case, the study focused on reducing case cancellations at a GI center and they saw significant and measurable results.

Erica: So whether you’re new to QAPI studies or just looking for a more structured approach, I think you’ll walk away from this episode with some really useful takeaways. After my conversation with Kathy, we will switch to our data and insights segment. HST released our annual state of the industry report in September, which analyzed client data from 590 surgery centers.

Erica: We’ll break down ortho profitability per case and compare 2023 to 2024. Then talk about why more and more patients and payers are choosing to have these ortho procedures done in an outpatient setting. The demand just keeps growing and there are some key trends driving this shift. Hope everyone enjoys the episode and here’s what’s going on this week in surgery centers.

Erica: Hi, Kathy, welcome back to the podcast.

Kathy: Thank you. Good to see you, Erica.

Erica: [00:02:00] You too. In case any of our listeners missed your first episode, I think we did a deep dive into the wrong site quality measure, if I remember. Can you please share a little bit about yourself and your ASC experience?

Kathy: Sure. Yeah. Right now I’m the executive director of the ASC quality collaboration.

Kathy: I’ve been doing that for a few years now, but before that I was a surgery center administrator for 15 years and then went into management company work as VP of quality and risk management.

Erica: Very cool. You are actually closing out our three part series on QWAPI studies, and I’m excited to walk through a study that you did from start to finish, so everyone can see a real life example of how these things go, and the 10 step process that you use.

Erica: First Tell us what the study was, how you identified it, and why you ultimately decided to move forward with it.

Kathy: Yeah, this study is about [00:03:00] cancellations, which I think everybody has concerns about cancellations because they just lead to the utilization of resources is not taking place.

Kathy: Patients are disappointed. They can’t get in, somebody’s already taken their place and then they cancel. So cancellations is just a frustrating area of efficiency in ASC operations. So we decided on that one. In this particular case, it was a GI center. And they were also at the same time looking at cancellations due to poor prep.

Kathy: But it all went together. So that’s why we decided on it.

Erica: Sure. I’m sure a lot of people listening can relate to those concerns you mentioned. And we actually published our state of the industry report a few months ago and found that I think it was 21 percent of cases are canceled on average.

Erica: We did a full breakdown. Of why, and not all, but some are preventable. So I think this is a really good [00:04:00] area to dive into. So let’s start with step one. When you’re doing your 10 step process, what do you consider step one?

Kathy: So step one is really the statement of the purpose. And this is as simple as why is this important to us?

Kathy: So in this case, because of cancellations, we’re losing money. Because we’re putting resources there that aren’t getting utilized, where patients can’t get in that otherwise would be able to, and it’s just frustrating for staff. So all of those can go into a statement of purposes. Why is it important to the center right now?

Erica: Sure. And is that usually pretty brief, like just a few sentences? Yeah, it

Kathy: can be brief. It can be brief. It doesn’t need to be elaborate at all. Got it. Okay. Next. Step two, you need to identify a performance goal, and that can come from a variety of resources. You may have a benchmark, [00:05:00] an industry wide benchmark.

Kathy: You may have seen something in the literature, or you just might have a feel. For what that goal should be. In this case, we would really like to see cancellations less than 10 percent of the GI volume.

Erica: Got it. Got it. And, yeah, so it’s okay if you use an internal benchmark, external benchmark. Sure.

Erica: As long as you have some sort of qualitative number you’re looking for that covers you.

Kathy: And you can, it can be things like, reduce cancellations by 5 percent or, whatever your intent is. And how you may know more about them, whatever you’re studying as you go into this, or in some cases, you’re going to find out about it through collecting the data.

Erica: Sure. Makes sense. Okay. And what is step three?

Kathy: And then step three is just a description of what data is going to be collected. In other [00:06:00] words, what is your plan for collecting data? What are we going to need to know that’s important in this case? So we look at, which physicians this is happening with.

Kathy: Are there particular patients that are having difficulty? And so you just need to zero in on what those parameters are. Day of the week. might have something to do with it. You can look at your patient instructions. What kind of communication do you have with patients ahead of time about when they’re supposed to arrive, et cetera.

Kathy: So you have to structure your data around what you think are the key issues that are going on and impacting this.

Erica: Got it. And let me ask you a quick question with kind of this whole, the whole 10 step process here. Is this something that you’re using just to keep yourself organized internally, or are we expecting surveyors to look at this 10 step process as well?

Kathy: Really both. One of the reasons we do it is to comply with accreditation and [00:07:00] regulatory standards. I wouldn’t say that’s the most important, but you do want to be able to show surveyors that you’ve done these studies and what you learned from them and that you’ve made a document. That’s one reason, but yes, I think it keeps you organized and especially if you have several studies going on at once.

Kathy: And it also enables you to have something that you can use to report to your staff, report to your physicians, and tell the story of how you’re improving.

Erica: Perfect, that makes sense. Okay, what is step four?

Kathy: Step four then is the actual evidence of the data collection. So you’ve decided, excuse me, what data you’re going to collect.

Kathy: This would say, for example, we used our monthly cancellation report, and we gathered the reason for the cancellation, what procedures, what physicians and then you designate what amount of time you collected the data for, in this case, like March through [00:08:00] July. And we compared it to the year before. You can actually take a little snippet of your data, if you’ve put it in like an Excel spreadsheet, and put it right into the study documentation.

Kathy: So it shows you what data you collected.

Erica: Got it. Yeah, that’s a great point. What do you recommend, obviously spreadsheets, Google sheets? To help surgery centers with this.

Kathy: Yeah, just, depending on how much data you have if it’s small, you may not need that, but it’s nice to have it in an Excel spreadsheet so that you can manipulate it and look at different fields in it.

Kathy: And that’s usually what is people putting into Excel.

Erica: Yeah. Do you have any fancier tools you recommend or most people can Excel

Kathy: more than enough? I think, yeah. And sometimes people will just put it into a table depending on the study topic. And how much, again, how much data there is.

Kathy: It doesn’t have to be real fancy.

Erica: Love it. All right. Step five. [00:09:00]

Kathy: So step five is data analysis and it’s an important one. So you’re going to look at your data. And first of all, you have to clean the data up, see if there are any things missing of it, out of it see if you’ve got a complete set of data.

Kathy: You don’t have to do a huge statistical analysis, but what you want to do is look at trends there so that you’re identifying the source of the problem. and the extent of the problem, if there is one, or you may find out you don’t have a problem. But you have to look at that all together and take into account all those factors that you collected when you were doing your data collection.

Kathy: In this case, you look at certain procedures, the certain procedures impacted it the instructions impacted it. And actually, some of the physicians, it varied by physician. So that’s going to impact what you develop as a solution to the [00:10:00] problem. So you’ve got to identify what you think the causative agents are in the issue, and then that’s where you focus your corrective actions.

Kathy: Got

Erica: it.

Kathy: And who That step is just really analyzing the data, not coming to any actions quite yet with it.

Erica: Got it. Got it. And is that usually one person that is really looking at the data? Do you have a committee?

Kathy: Usually, it’s usually a couple of people, or if you’ve got a team working on this improvement plan, you’d have the whole team look at it together.

Kathy: There may be, people involved on the team that really get into the data and into the data analysis. It can either be the whole team or if somebody wants to take that on themselves and then present it to the rest of the team, that’s good too.

Erica: Perfect. And for those following along, And just listening, I will put all these steps in the podcast episode notes too, just in case.

Erica: So we’ll have a little cheat sheet for everybody as well.

Kathy: [00:11:00] Great.

Erica: Okay. So we’ve analyzed the data. What is step six?

Kathy: Then we’re gonna compare it to the goals that we have set. In this case, we were looking at cancellations less than 10 percent of the GI volume, and there was improvement, and that’s all you have to say in that step, is that we exceeded the goal by whatever percent it is, and you don’t have to even go beyond that.

Kathy: So that, that’s a simple statement comparison to goal.

Erica: Sure. Yeah. Nice and simple. And just to clarify, for this specific study, you weren’t looking at any specific external benchmark to get to, you just knew internally you wanted it to be under 10%. Okay.

Kathy: Correct.

Erica: Got it. Makes sense. Okay. Step seven.

Erica: You’re making this seem so easy.

Kathy: A big one because you’re going to brainstorm with the improvement team on corrective actions. You could get, you can get input from [00:12:00] staff on what needs to be done to correct these issues. And in this case, we reviewed patient instructions and made some revisions to those.

Kathy: We also, knowing which doctors We were having issues with, we went to their offices and reviewed with them the instructions and the prep instructions to make sure that those were clear to patients. And then a big one was with this particular study was taking on a patient texting system. Of being able to communicate with patients up to right before they needed to come to the surgery center.

Kathy: That was obviously an investment of resources to implement that big of a corrective action on this. But as it turned out, it was very productive.

Erica: Yeah, and that actually sparks a thought. Do you find that, let’s say there’s someone internally that does want [00:13:00] a patient texting solution or does want electronic charting, whatever it might be, could they use a QAPI study to prove their case?

Erica: Does that happen? Oh, sure.

Kathy: Yeah, absolutely. Sure. You could call out, how much time it’s taking to do certain things or how much staff time it takes to call patients when you could be texting them. So you can measure those things. And obviously you’ve got a big expenditure that you have to measure it up against, but sometimes that’ll make it very clear the expenditure’s gonna be worth it.

Erica: Yeah. That makes sense. Okay. We’ve implemented some corrective actions. What is step eight?

Kathy: You you’d want to remeasure, make sure that you’re staying on track and if you have to, then you would implement in step nine additional corrective actions. In this case, we didn’t need to. It was clear [00:14:00] that these actions were effective in reducing cancellations, so we were able to stop it there and didn’t have to take on any additional corrective actions for it.

Erica: Do you remember off the top of your head how much or after the texting solution was implemented, what the case cancellation rate dropped to? I’m just curious.

Kathy: I’ve got it in, yes, let’s see, the the total number of same day cancellations number decreased to 15, that was compared to 44 for the previous study period. Wow. That was a 65 percent decrease in the number of same day cancellations. That’s crazy. Pretty dramatic, yeah.

Erica: Yeah.

Kathy: And as a percentage of total cases, the new data showed That they were 6.

Kathy: 8 percent of the total GI cases, cancellations were, and we were aiming for 10%. So [00:15:00] obviously the goal was exceeded in this case.

Erica: Yeah. Wow. That’s fantastic. Okay. So step 8 was remeasurement. Step 9 would have been implementing additional corrective actions. If you needed

Kathy: them.

Erica: And then what is our final step?

Kathy: And then 10 is communication of the findings. This is really an important step in this so that everybody knows the work that was undertaken and the success that was achieved through this. So it really can. Pride in the work that improvement team has put into this. It communicates that you’re really looking at quality and focusing on continuous quality improvement.

Kathy: As we talked about it, you can communicate with surveyors about it and you have the. The demonstration right there that you’re improving and that you’ve put the work into it. So it’s really important that this gets communicated throughout the organization [00:16:00] and that includes to the governing body as well.

Erica: Yeah, that’s a huge win. That’s a. And

Kathy: you need to celebrate those successes. And it makes the staff that’s involved in the improvements feel great about contributing. So

Erica: Yeah, absolutely. Do you have any Final tips or advice for our listeners, just about QAPI in general. I just know you have so much experience.

Erica: I think

Kathy: people tend to get intimidated by, writing down, recording the study and it doesn’t need to be this form that you’ll share with everybody. If you just follow the steps in that what it suggests for each. step, then it’s easy to capture and write it down. So don’t be intimidated by the process and actually recording it.

Kathy: It’s not as bad as it, people think that it is going to be when you get down to just breaking it down into these [00:17:00] digestible steps. Yes.

Erica: For sure. Thank you so much, Kathy. I have one final question for you. We do this every week with our guests. What is one thing our listeners can do this week to improve their surgery centers?

Kathy: Take credit for the improvements that you make because you make them every day. You do something, you tweak a process, you make something better for a patient. Take credit for it, whether it’s a study or not, but celebrate and communicate that to staff. It makes them feel good about the work they’re doing and about the surgery center.

Erica: Love it. Thank you so much for coming on today. We really appreciate it.

Kathy: Glad to be a part of it. Thank you.

Erica: HST Pathways released an updated version of our annual State of the Industry report this past September, highlighting best practices, key process steps, and KPIs for every step of the patient journey and for nearly every recurring administrative [00:18:00] duty. Most importantly, using our own unique data set from our clients, we were able to extract data points so that anyone in the industry could benchmark themselves against their peers.

Erica: Two quick disclaimers, we only pulled data from clients who gave us permission and we omitted any extreme outliers. So today we’re going to take a look at orthopedics and a few trends we saw from 2023 to 2024. Now, if you run a surgery center that offers ortho procedures, you probably already know that this specialty is a major driver of revenue and the numbers from 2024 confirm that it’s still leading the way. So let’s get into it. Orthopedics remains the most profitable specialty in ASCs, and not only that, it saw a 4.5% increase in net revenue per case over the past year.

Erica: In 2023, the average net revenue per case was $6,141, and in 2024, that number jumped to $6,419. Just for comparison, [00:19:00] the second highest specialty, which was cardiology, comes in at 4, 611 per case. That’s a pretty big gap, showing just how dominant ortho continues to be. So what’s driving this? First, demand is super high.

Erica: An aging population, high success rates, and the ongoing push for outpatient joint replacements instead of inpatient hospital stays all contribute to ortho’s continued growth. Patients and payers alike see the benefits of shifting these procedures to ASCs and that demand is not slowing down. There’s also two really interesting cultural shifts at play here that are continuing to drive demand.

Erica: You might think I’m crazy, but let’s talk about pickleball. The American Academy of Orthopedic Surgeons recently reported that pickleball related injuries 90 times over the past 20 years. More people are picking up a paddle, which is great for fitness, but not so great for knees, shoulders, and hips, and [00:20:00] that means more orthopedic surgeries.

Erica: Another trend is the explosion of GLP 1 medications like Ozempic and Wagovi. As these weight loss drugs become more accessible, more people are losing weight, becoming more active, and unfortunately, sustaining injuries that lead to orthopedic procedures. I’m not going to sit here and tell you that pickleball And glp 1 medications are the only drivers they are not but I do think it’s really interesting to see how cultural trends can impact Our surgical landscape, but the big financial takeaway is that payers are adjusting So ortho is in this sweet spot right now where for once the demand for these Procedures is matching an increase in reimbursement from payers.

Erica: Thinking about GI, I reported on a story recently how the demand and need for colonoscopies is going up, but reimbursements is going down, which is, a terrible place to be in. But the nice thing about ortho is that the demand and the reimbursement are both going up together.[00:21:00]

Erica: So as more complex procedures like total knee and hip replacements move to ASCs, payers are starting to recognize the cost savings ASCs are can offer compared to hospitals and they’re adjusting rates accordingly. And leading surgery centers are leveraging data and outcomes to negotiate even better contract rates, ensuring that these high demand cases remain profitable.

Erica: Implant costs are also a major focus with ortho procedures. Implant costs can make or break a center’s profitability. More ASCs are using data driven tracking to identify case profitability and optimize their pricing and supply chain. This kind of visibility is critical in keeping ortho not just the highest revenue specialty, but also one of the most profitable.

Erica: So to sum it up, ortho is still killing it in the surgery center industry and 2024 is proving that the specialty continues to grow. High demand, payer adjustments, and better cost tracking are all playing huge roles. But if you’re an ASC leader, the key takeaway for me here is [00:22:00] that data matters. The more you track and leverage your numbers, whether it’s reimbursement trends, implant costs, or even shifts in patient demographics, the more strategic you can be in keeping your ortho cases profitable.

Erica: If you’re interested in more data points and use cases, subscribe to our podcast so that you don’t miss any upcoming segments or head to our website to check out the full state of the industry report to get your hands on even more data. And that officially wraps up this week’s podcast. Thank you as always for spending a few minutes of your week with us.

Erica: Make sure to subscribe or leave a review on whichever platform you’re listening from. I hope you have a great day and we will see you again next week.