Welcome to the monthly HFAP newsletter for Ambulatory Surgery Centers (ASCs). Each issue will focus on one or more educational topics relevant to your organization. We may highlight a regulatory change or newer standard, take a close look at a frequent deficiency citation, or offer a best practice.

We’ll keep this content brief and actionable. If there are specific topics you’d like to see addressed in this way, drop us a note at info@hfap.org. Use “DYK ASC suggestion” in your subject line. We look forward to hearing from you!

Outpatient Procedure Options Expand

ASCs are poised to see significant growth in the next few years as procedures transition out of the hospital. In December 2020, the Centers for Medicare and Medicaid Services (CMS)  announced its intent to end the inpatient-only list in calendar year 2024. To accomplish this goal, CMS will have a three-year transitional period that reduces the inpatient-only list incrementally each year. For 2021, approximately 300 primarily musculoskeletal-related services were removed from the inpatient-only list.

Healthcare costs are a driving factor for moving procedures into the ASC setting. Third-party payers like UnitedHealthcare and Anthem require documentation to support medical necessity for procedures to be performed in the hospital rather than an ASC. Cost studies from the UnitedHealth Group and CMS highlight savings for their programs, as well as the patient. Based on 2018 data, commercial payers and CMS will see a 20% cost savings for hip replacements and a 17% cost savings for knee replacements. In addition to the cost savings, CMS states that it supports increasing choices for patients and encouraging site-neutrality.

Beyond the focus on direct cost-savings when procedures move to ASCs, other factors are equally important. Surgical site infections are just one example. In hospitals, 3% to 4% of patients contract infections, including 1% to 2.5% who experience surgical site infections following hospital joint replacement surgeries. In contrast, only .03% of ASC patients developed surgical site infections.

As with all surgical procedures, documentation is critical and includes at least the following: history and physical examination including patient weight and co-morbidities; a surgical plan; and assessment of anesthesia risk. As procedures move off the inpatient-only list, additional documentation will be required for hospitals to justify using that setting instead of an ASC. Each commercial payer may require specific documentation for the surgical procedure, so best practice for ASCs includes regular communication with their commercial payers to ensure full compliance with documentation requirements.

Although it is exciting to see the expansion of surgical procedures for ASCs, proper preparation is needed to maintain compliance with accreditation requirements. For example, assessment of physical space, different tools and processes, and credentialing and privileging of physicians for the new procedures. We will explore what the addition of procedures means to your accreditation in future issues.

Sources

1. https://www.cms.gov/newsroom/fact-sheets/cy-2021-medicare-hospital-outpatient-prospective-payment-system-and-ambulatory-surgical-center-0
2. https://www.unitedhealthgroup.com/content/dam/UHG/PDF/2020/UHG-Ambulatory-Surgery-Centers-Brief.pdf
3. https://www.uhcprovider.com/content/dam/provider/docs/public/policies/comm-medical-drug/outpatient-surg-procedures-site-service.pdf
4. https://www.natlawreview.com/article/payors-pick-pace-curbing-preventable-spending-surgical-care

Accreditation Requirements for Ambulatory Surgery Centers Errata

An error in the numbering sequence in Chapter 12 made it past our editing process for the 2020 edition of Accreditation Requirements for Ambulatory Surgery Centers. There was a duplication in the use of 12.01.01 and 12.01.02 that caused the next eight standards also to shift in error. The correction appears as a correction at the front of the manual and the corrected numbers and sequence are as follows:

12.01.03 Effectiveness of Sterilization Cycles are Monitored
12.01.04 Sterilization Data Requirements
12.01.05 Load Control Numbers
12.01.06 Cold Sterilization
12.01.07 IUSS in Surgical Settings
12.01.08 Preparing, Assembling, Wrapping, and Distributions of Sterile Equipment and Supplies
12.01.09 Storage of Sterile Packages
12.01.10 Process for Monitoring Supplies
12.01.11 Loaner Equipment
12.01.12 Compliance with Cleaning and Sterilization of Surgical Instruments and Scopes

Want to learn more about HFAP Ambulatory Surgery Centers Accreditation?
Visit our Program & Services page.