As many ambulatory surgery center administrators prepare for initial or renewed ASC accreditation, two industry professionals weigh in on recent updates to AAAHC standards — and what you should know about the process.
Mary Wei is the assistant director of accreditation services at the Accreditation Association for Ambulatory Health Care in Skokie, Ill. Sandy Berreth, RN, is the administrator of Brainerd Lakes Surgery Center in Baxter, Minn., and a surveyor for AAAHC.
Ms. Wei and Ms. Berreth answer six questions about what has changed with AAAHC's certification and how administrators can stay on top of regulations.
1. How did the accreditation process change in the last year? AAAHC released this year's standards March 1, and one major change was the length of accreditation terms.
Previously, ASCs could opt for three-year, one-year or 6-month accreditation periods. However, now the accrediting body only certifies centers for three-year periods. The change largely reflects member feedback, Ms. Wei says.
One timeframe should help streamline the process and make it easier for centers reapplying. It can be reassuring for payors, as well. "[Surgery centers] can state to public and state agencies and third party payors, 'We are accredited for three years,'" she says.
Another addition this year was to send updated handbooks to currently accredited organizations to help them stay up-to-date with changing standards. "It gets folks started," she says. "They have an idea of what is changing so they can take the document and compare it to the current year's handbook."
Other modifications were mostly minor and involved making the language more specific. "We had different words mean the same things," Ms. Wei said. "[Words like] providers, practitioners and professionals can mean the same thing or different things according to the situation. We found there was confusion regarding those types of words."
2. What changes can be expected for next year? The public comment period begins at the beginning of September. AAAHC releases potential changes for the 2013 standards and invites administrators, physicians and members of the public to submit comments, suggestions and requests for clarification, Ms. Wei said.
All feedback is analyzed and considered until March 1, 2013, when a new set of standards is released. And Ms. Wei says to expect a large overhaul of AAAHC standards in March.
One change will be to eliminate redundancies. Some standards appear in more than one place for emphasis, she says, but some requirements make the process unnecessarily confusing.
Also, members can expect to see handbook chapters and subchapters rearranged or condensed. "It's always more noticeable when we renumber the chapters," Ms. Wei says.
The AAAHC also plans to start giving review guidelines to help people narrow down what they need to be doing and to give ideas for how standards can fit within an organization.
"At first it's going to be general review guidelines," she says. "A number of standards we tried to focus in on are standards that seemed to be the least clear to begin with. We will keep working on developing those in future iterations of the handbooks."
3. What is the biggest obstacle for most applicants? Applicants seem to struggle the most with the quality improvement standards and differentiating between activities and studies, though both have separate AAAHC requirements, Ms. Wei says.
A quality improvement activity involves looking at a center's processes for indicators, such as internal or external benchmarking or links between a peer review and risk management. A study is a written compilation of a center's activities that is determined with a specific goal in mind.
"In order to have a study," Ms. Berreth says, "we have to compile our activities and ascertain what they mean to us. Studies show us how we can improve our activities and what our end result is based on our activities."
To assist in properly meeting quality improvement standards, the accrediting agency developed a worksheet for applicants to help them review required elements. The sheet walks them through how to analyze a study individually and see if their studies meet AAAHC standards.
"A lot of people conduct their studies based on their basics, like cost of care, looking at turnaround times, duration of procedures and implementation efficiencies. What's included in the standards is a requirement for internal and external benchmarking," Ms. Wei says. "They can make great use of benchmarking by seeing where they are in comparison to similar organizations in the region or nationwide."
4. How can applicants properly prepare for a survey? Ms. Berreth first received accreditation for Brainerd Lakes Surgery Center in 2005 and has maintained it ever since. The simplest step she took to receive and upkeep her AAAHC accreditation was pouring over the handbook frequently. She recommends that new surgery centers base their initial regulations on the processes instead of trying to amend processes to fit the rules later.
Separating the chapters out can also make the process seem less daunting, she says.
"It was important for me to make sure my standards and my processes were very much in line with my handbook," she says. "I have three-ring binders that deal with every chapter. If it is required, I have it stuck in those three-ring binders."
Ms. Berreth works to keep her binders updated whenever changes are issued. Her system also allows for any surgery center employee to view compliant processes anytime, even when she is unavailable. Having your entire staff educated on standards and procedures makes implementation more seamless.
"If you take really good care of your patients, if you have high standards of meeting care, you will meet the standards," she says.
5. What does it take to maintain compliant processes? Staying constantly aware of new standards and updating practices accordingly is the best way to retain accreditation and compliance, Ms. Wei and Ms. Berreth agree. Even though new AAAHC policies are released in March, one document — the CMS’s Appendix A — is online; reading these will keep you ahead of the standards; and will give people an idea of what will be changing, Ms. Wei says.
"Don't wait until March to start acting," she says. "The idea of accreditation is that it's ongoing. Make changes, update programs you put in place at the beginning. Don't set up a program to leave it after you've completed survey until next time. Prep for your next survey shouldn't start in the three months preceding your application."
Be aware of changes made by CMS and your accrediting body, even if it's not a reaccredidation year. "The standards I had to comply with in 2005 [for my first accreditation] are nothing compared to the standards in 2012," Ms. Berreth noted.
Certification may last for three years, but Ms. Berreth recommends making changes every year to avoid problems with recertification. Quick changes won't stick. Have your governing body meet regularly to ensure standards are discussed and updated.
6. Overall, what does accreditation mean? Accreditation can serve as a signal to physicians and other surgery centers of a facility's high quality assurance.
"If you see the emblem of AAAHC, you know you will receive the best, safest, cleanest possible care in a surgery center," Ms. Berreth says. "Healthcare is constantly changing and technology changes. We as practitioners need to change with it. We have accreditation standards to live up to; this indicates our dedication to quality.”
Receiving additional certification also makes a surgery center more appealing to commercial payors. Some third party payors, such as Aetna and Blue Cross Blue Shield programs, require third-party accreditation in addition to Medicare certification. While not all require it, they may reward a center monetarily for achieving accreditation. "I've seen centers get a percentage increase on top of regular rates," Ms. Berreth says of some commercial payors.
Payors also appreciate the assurance that your surgery center is taking care of patients properly, even if certification means little to the patients themselves.
"Patients don't want to see the AAAHC emblem or the CMS emblem," she says. "They want to be taken care of. That's what patients pay attention to, but third party payors want a guarantee we are taking care of their covered lives. Accreditation means we meet the standards; it's proof we are excelling in quality patient care."
More Articles on Accreditation:
ASC Leader to Know: Tamar Glaser of Accreditation Services
Laser Spine Institute Receives Three-Year AAAHC Accreditation
Dr. Ronald M. Wyatt Named Medical Director of Joint Commission's Division of Healthcare Improvement
Mary Wei is the assistant director of accreditation services at the Accreditation Association for Ambulatory Health Care in Skokie, Ill. Sandy Berreth, RN, is the administrator of Brainerd Lakes Surgery Center in Baxter, Minn., and a surveyor for AAAHC.
Ms. Wei and Ms. Berreth answer six questions about what has changed with AAAHC's certification and how administrators can stay on top of regulations.
1. How did the accreditation process change in the last year? AAAHC released this year's standards March 1, and one major change was the length of accreditation terms.
Previously, ASCs could opt for three-year, one-year or 6-month accreditation periods. However, now the accrediting body only certifies centers for three-year periods. The change largely reflects member feedback, Ms. Wei says.
One timeframe should help streamline the process and make it easier for centers reapplying. It can be reassuring for payors, as well. "[Surgery centers] can state to public and state agencies and third party payors, 'We are accredited for three years,'" she says.
Another addition this year was to send updated handbooks to currently accredited organizations to help them stay up-to-date with changing standards. "It gets folks started," she says. "They have an idea of what is changing so they can take the document and compare it to the current year's handbook."
Other modifications were mostly minor and involved making the language more specific. "We had different words mean the same things," Ms. Wei said. "[Words like] providers, practitioners and professionals can mean the same thing or different things according to the situation. We found there was confusion regarding those types of words."
2. What changes can be expected for next year? The public comment period begins at the beginning of September. AAAHC releases potential changes for the 2013 standards and invites administrators, physicians and members of the public to submit comments, suggestions and requests for clarification, Ms. Wei said.
All feedback is analyzed and considered until March 1, 2013, when a new set of standards is released. And Ms. Wei says to expect a large overhaul of AAAHC standards in March.
One change will be to eliminate redundancies. Some standards appear in more than one place for emphasis, she says, but some requirements make the process unnecessarily confusing.
Also, members can expect to see handbook chapters and subchapters rearranged or condensed. "It's always more noticeable when we renumber the chapters," Ms. Wei says.
The AAAHC also plans to start giving review guidelines to help people narrow down what they need to be doing and to give ideas for how standards can fit within an organization.
"At first it's going to be general review guidelines," she says. "A number of standards we tried to focus in on are standards that seemed to be the least clear to begin with. We will keep working on developing those in future iterations of the handbooks."
3. What is the biggest obstacle for most applicants? Applicants seem to struggle the most with the quality improvement standards and differentiating between activities and studies, though both have separate AAAHC requirements, Ms. Wei says.
A quality improvement activity involves looking at a center's processes for indicators, such as internal or external benchmarking or links between a peer review and risk management. A study is a written compilation of a center's activities that is determined with a specific goal in mind.
"In order to have a study," Ms. Berreth says, "we have to compile our activities and ascertain what they mean to us. Studies show us how we can improve our activities and what our end result is based on our activities."
To assist in properly meeting quality improvement standards, the accrediting agency developed a worksheet for applicants to help them review required elements. The sheet walks them through how to analyze a study individually and see if their studies meet AAAHC standards.
"A lot of people conduct their studies based on their basics, like cost of care, looking at turnaround times, duration of procedures and implementation efficiencies. What's included in the standards is a requirement for internal and external benchmarking," Ms. Wei says. "They can make great use of benchmarking by seeing where they are in comparison to similar organizations in the region or nationwide."
4. How can applicants properly prepare for a survey? Ms. Berreth first received accreditation for Brainerd Lakes Surgery Center in 2005 and has maintained it ever since. The simplest step she took to receive and upkeep her AAAHC accreditation was pouring over the handbook frequently. She recommends that new surgery centers base their initial regulations on the processes instead of trying to amend processes to fit the rules later.
Separating the chapters out can also make the process seem less daunting, she says.
"It was important for me to make sure my standards and my processes were very much in line with my handbook," she says. "I have three-ring binders that deal with every chapter. If it is required, I have it stuck in those three-ring binders."
Ms. Berreth works to keep her binders updated whenever changes are issued. Her system also allows for any surgery center employee to view compliant processes anytime, even when she is unavailable. Having your entire staff educated on standards and procedures makes implementation more seamless.
"If you take really good care of your patients, if you have high standards of meeting care, you will meet the standards," she says.
5. What does it take to maintain compliant processes? Staying constantly aware of new standards and updating practices accordingly is the best way to retain accreditation and compliance, Ms. Wei and Ms. Berreth agree. Even though new AAAHC policies are released in March, one document — the CMS’s Appendix A — is online; reading these will keep you ahead of the standards; and will give people an idea of what will be changing, Ms. Wei says.
"Don't wait until March to start acting," she says. "The idea of accreditation is that it's ongoing. Make changes, update programs you put in place at the beginning. Don't set up a program to leave it after you've completed survey until next time. Prep for your next survey shouldn't start in the three months preceding your application."
Be aware of changes made by CMS and your accrediting body, even if it's not a reaccredidation year. "The standards I had to comply with in 2005 [for my first accreditation] are nothing compared to the standards in 2012," Ms. Berreth noted.
Certification may last for three years, but Ms. Berreth recommends making changes every year to avoid problems with recertification. Quick changes won't stick. Have your governing body meet regularly to ensure standards are discussed and updated.
6. Overall, what does accreditation mean? Accreditation can serve as a signal to physicians and other surgery centers of a facility's high quality assurance.
"If you see the emblem of AAAHC, you know you will receive the best, safest, cleanest possible care in a surgery center," Ms. Berreth says. "Healthcare is constantly changing and technology changes. We as practitioners need to change with it. We have accreditation standards to live up to; this indicates our dedication to quality.”
Receiving additional certification also makes a surgery center more appealing to commercial payors. Some third party payors, such as Aetna and Blue Cross Blue Shield programs, require third-party accreditation in addition to Medicare certification. While not all require it, they may reward a center monetarily for achieving accreditation. "I've seen centers get a percentage increase on top of regular rates," Ms. Berreth says of some commercial payors.
Payors also appreciate the assurance that your surgery center is taking care of patients properly, even if certification means little to the patients themselves.
"Patients don't want to see the AAAHC emblem or the CMS emblem," she says. "They want to be taken care of. That's what patients pay attention to, but third party payors want a guarantee we are taking care of their covered lives. Accreditation means we meet the standards; it's proof we are excelling in quality patient care."
More Articles on Accreditation:
ASC Leader to Know: Tamar Glaser of Accreditation Services
Laser Spine Institute Receives Three-Year AAAHC Accreditation
Dr. Ronald M. Wyatt Named Medical Director of Joint Commission's Division of Healthcare Improvement