Should compliance with the Surgical Care Improvement Project (SCIP) process measures determine Medicare and Medicaid reimbursement rates?
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.
Carilion Clinic, Roanoke Memorial Hospital, Roanoke, Virginia, USA. nmgarcia@carilionclinic.org
Nicole
N
Garcia
Sandy
S
Fogel
Christopher
C
Baker
Stephen
S
Remine
Jim
J
Jones
D006801:Humans; D008484:Medicaid / Q000191:economics*; D006278:Medicare / Q000191:economics*; D010349:Patient Compliance; D011183:Postoperative Complications / Q000191:economics*; D017064:Process Assessment, Health Care / Q000191:economics*; D058996:Quality Improvement; D012051:Reimbursement Mechanisms / Q000706:statistics & numerical data*; D014481:United States