Three questions with Sandeep Wadhwa, MD, MBA: Enhanced ambulatory safety and the potential revenue impact

I sat down with 3M Health Information Systems Global Chief Medical Officer Sandeep Wadhwa, MD, MBA, to discuss the need for improved ambulatory safety protocols and how it could impact revenue, incentives and reimbursements.  

In your last blog, you talked about the need for improved ambulatory safety protocols and how it could possibly help keep patients safer. How could enhanced safety protocols in the outpatient setting potentially impact revenue, incentives and reimbursement rates? 

Improving patient outcomes will always be the primary driver for making changes in health care, but we know that those changes can be accelerated when you align payments and incentives. As I mentioned in my previous blog, there has been growing provision of care in outpatient settings that has allowed many procedures to move from the inpatient setting to hospital outpatient departments and increasingly to ambulatory surgical care settings. It’s much more convenient for patients and more efficient for providers. But, with this extraordinary innovation, we do not have the same patient safety infrastructure that exists in the hospital setting.  

That’s why I’m really proud of our 3M HIS team and the work they are doing to bring a comprehensive patient safety system to ambulatory procedures. The new technology will look at outpatient procedures ranging from cataract surgery to more involved orthopedic surgeries, and link follow-up care data after the procedure to shed light on complications patients experience, including hospitalizations, emergency department visits, same day hospital admissions or office visits. There will be more information coming over the next few months about this exciting new solution, but this is a major step we’re taking with our clients to enhance insights into procedural safety.   

That’s very exciting! You mentioned that aligning payments and incentives will help accelerate the adoption of enhanced safety protocols, can you talk about that a bit more? 

Yes, I anticipate several payment-related strategies emerging as we gain more insight into preventable ambulatory complication event rates. Payers may use that information as part of quality improvement efforts with incentives or penalties for reducing preventable outpatient procedures complications. Insights may also inform payment policy around what’s included in a 30-day bundled rate for a procedure and follow-up care that may take into account a threshold complication rate and not include payments for excess complication rates. I also believe insights on potential quality defects may inform selective contracting in narrow network design, either by site or by group.   

What can lawmakers do from a policy perspective to help ensure health system and providers are incented to adopt new ambulatory safety protocols?  

I anticipate a similar trajectory to what we have seen with policies regarding readmissions and inpatient complications. The measures and incentives/penalties for readmissions and hospital acquired conditions are well established and continue to refine as corresponding infrastructure has been built to improve performance. Similarly, I see outpatient procedure measures and incentives/penalty structures following similar path in Medicaid and commercial populations as transparent, clinically relevant measurement systems are introduced and subsequently refined.  

Sandeep Wadhwa, MD, MBA, is global chief medical officer at 3M Health Information Systems. 

Kelli Christman, is senior marketing communications and strategic communications specialist at 3M Health Information Systems.