As in the past, state surveyors will continue to review existing ASCs for compliance with the Medicare Conditions, as will accrediting bodies with deemed status: Accreditation Association for Ambulatory Health Care; The Joint Commission; American Association for Accreditation of Ambulatory Surgical Facilities; and American Osteopathic Association. New ASCs in most states will need to request a deemed-status early-option type survey to achieve their initial Medicare certification since state surveyors are either no longer performing the initial Medicare surveys or they are a much lower priority for states, which might result in a long delay in getting the survey completed. It is a good idea to check with your state health department to determine the best path to Medicare certification if you are going to be opening a new ASC in the future. I have found the state surveyors in various states to be very helpful and honest about directing us, when appropriate, to seek initial certification from our accrediting body of choice.
To view a cross-walk grid illustrating the changes between the previous and the new ASC Conditions for Coverage, click here (pdf). In the current Conditions, there are 10 conditions including 16 standards. The new Conditions include 13 conditions and 35 standards. Four of the existing conditions contain changes. The ASC Association website provides a red-lined version of the Conditions for Coverage at www.ascassociation.org/coverage. Thanks to the hard work of ASC Association on behalf of members and ASCs everywhere, some of the more onerous changes were amended prior to publishing the final rule. Some of the changes will still present serious challenges for ASCs.
One of the most significant changes is the definition of an ASC, which will be defined as "any distinct entity that operates exclusively for the purpose of providing surgical services to patients not requiring hospitalization." ASCs may not provide services to patients whose primary payor is Medicare or Medicaid if it is anticipated that the patient will require hospitalization after the procedure. In other words: No planned admissions. You may, however, under the new definition (and if allowed by your state), keep a Medicare patient for up to 24 hours if it is necessary to prepare the patient for a safe discharge. Your state defines whether or not you can provide overnight care for any ASC patients.
Another important change is the requirement for ASCs to provide a patient with verbal and written notice of certain rights in advance of the date of the procedure and in a language or manner that the patient will understand. ASCs must disclose the following to their patients: their physician's ownership or financial interest in the ASC, when applicable; information about the ASC's advanced directives and state law; and the ASC must provide a copy of the state's advanced directives form, upon request. This set of requirements will preclude ASCs from performing add-on cases the same day, regardless of the reason for the procedure.
A new condition describes the quality assessment and performance improvement program which requires that an ASC has an ongoing program that must measure, analyze and track quality indicators, adverse patient events, infection control and other aspects of performance that includes care and services furnished in the ASC.
A thorough review of the revised and new conditions must be completed by all of us who develop and manage an ASC. New policies and changes in the way we practice will be necessary. We only have a few months to digest it all, rewrite our policies and educate our staff, physicians and boards in preparation for implementation by May 18, 2009.
Download the 2009 Conditions for Coverage crosswalk (pdf).
Ms. McLane (daquay@aol.com) is chief development officer for Nikitis Resource Group, an ASC development, management and consulting firm with a team that encompasses more than 100 combined years of ASC development and management experience. Learn more about Nikitis Resource Group.