Quality improvement in gynecologic surgery: the new frontier.

The continual and disproportionate increase in health care costs without showing improvement has regulatory organizations and purchasers of surgical care demanding comparative documentation of surgical quality and outcomes. Support for implementing performance standards is derived from 2 risk-adjusted national surgical quality improvement programs which documented substantial decreases in perioperative morbidity and mortality. These dramatic improvements in patient outcomes and corresponding decreases in health care costs are transitioning to "pay-for-performance" for surgical disciplines. With the requisite budget-neutral environment, quality incentive payments will be offset by reduced reimbursement for substandard performances. For specialties that have not developed specific performance metrics, the implications are substantial. Therefore, the gynecologic surgical community has an exigent need to develop standards and methods to assess quality within our discipline that are specialty specific, equitable and risk adjusted.