Accreditation of the outpatient surgery center and license suspension by Dr Paul McCool

The Ambulatory Surgery Center (ASC) is an independent outpatient surgery center. The ASC is not a hospital surgical center called HOPD (Hospital Outpatient Department) because it is independent and is not part of the hospital campus. In general, most ASCs do not allow patients to stay overnight and do not perform prolonged pain management or surgeries requiring more than 24 hours of controlled recovery.

ASC is a very effective and efficient option for performing high quality surgical treatment at a cost much lower than in hospitals and often results in greater patient satisfaction. As a result, ASC in the United States has grown rapidly and has become one of the leading providers of outpatient surgery. In the past, hospitals were the provider, but now the expansion of ASC is flourishing with technologies and procedures that allow more outpatient surgery. Doctors, hospitals, insurance companies, and private groups have all developed ASC as a better option for low-cost patient care.

Why is this happening?

One of the main factors is cost reduction. Hospitals typically pay significantly more for the same procedures performed at the ASC – up to 60-80% more. In fact, it is estimated that orthopedic surgery alone can save $ 41 billion a year if all ASC qualified surgeries are actually performed there. But these are not the only cost savings. If the price of the procedure is ASC, the direct cost to the patient will be lower. The coinsurance that most patients have to pay is directly related to the payments the insurer makes to the hospital, and if the payment is much higher at the hospital, the patient pays more.

The infection rate is also low. The Centers for Disease Control and Prevention in 2010 showed that the surgical site infection rate in hospitals was 8.95% per 1,000 patients, compared with 4.84% per 1,000 patients who had surgery at the hospital. ‘ASC. ..

Other factors also play an important role, such as a faster “switch” from one surgery to another in the ASC and room changes. This, along with dedicated ASC staff for specific procedures, improves patient safety. Most ASCs are a single discipline. In other words, we focus on a surgical specialty, such as orthopedics, rather than all the specialties offered by the hospital. A single specialized center is more streamlined, more efficient and often safer and cleaner than a hospital environment.

Rapid growth and security

At a time of unparalleled growth and development in ASC, it is important to ensure that ASC provides the highest quality patient care and safety. California, Texas, Florida, Georgia, Maryland, and New Jersey have the highest number of CSAs in the country. ASC “licenses” are governed by the state. The CSA business license is not the same as accreditation and is sometimes referred to as “accredited”. Accredited ASCs meet the standards set by three major accredited organizations for the quality of care. CSAs in some states do not need to be accredited by an independent organization to operate. In addition, the ASC does not need to be certified by CMS (or Medicare) to operate on the patient.

ASC certification

The main ASC certification in the United States is either AAAHC, JACHO, or AAAASF.

AAAHC – Ambulatory Care Certification Association – was founded in 1979 and plays a major role in the accreditation of surgical centers. AAAHC has achieved “Deemed Status”. This means that Medicare and Medicaid service centers are authorized to certify Medicare ASCs. Currently, the AAAHC has certified the largest number of CHWs in the country.

AAAASF – The American Outpatient Surgical Facility Accreditation Association focuses primarily on ASC accreditation. AAAASF, like AAAHC, has achieved “Deemed Status” for CMS ASC certification. AAAASF has been around for over 40 years.

JACHO – The Joint Commission for Accreditation of Medical Institutions was accredited in 1965. Unlike AAAHC, JACHO focuses more on accreditation of hospitals than ASC.

ASC certification ensures that the ASC meets quality standards for patient and staff safety. To be certified, the ASC must undergo rigorous examinations such as document reviews, interviews, and direct observation of surgery at the ASC. Upon successful accreditation, ASC can achieve accreditation for up to 3 years for continuous operation and meet the requirements set by these organizations and CMS to provide the highest quality care to patients undergoing surgery. I go.

ASC license

The state manages ASC licenses and is known to suspend ASC licenses in some cases. According to Dr. Paul MacKoul, license suspensions are not common and are most often associated with ASC physicians whose license has been suspended by the medical committee. Suspension of a surgeon’s license due to an ASC violation results in state suspension of the ASC’s license, as many ASCs have only one physician or surgeon is the primary surgeon who handles most cases at the ASC. There is a possibility. In the same way.

Suspension of ASC licenses is very rare and the most harmful ASC events are usually associated with physician behavior, so it is possible to fully understand the qualifications of the physician who chose to perform the surgery. It is important. This also applies to CHWs or hospitals. Make sure your doctor is certified and has a good reputation for performing the necessary steps.

Adverse Events at AUC

There are several situations in which adverse events at AUC can have adverse consequences in relation to hospital settings. Massive blood loss in ASCs may require referral to a hospital for transfusions, as most ASCs do not have a blood bank option to transfuse patients. The transportation of the CHW to the hospital in these situations, and the time required to do so, can be very important. More than any other factor, acute hemorrhage in ASC can be a catastrophic event for a patient. Few CHWs provide access to the cell saver, a medical device that allows patients to recirculate blood lost during surgery and allow “autologous” blood transfusions. This increases the safety of bleeding-prone procedures. Cell economizers operated by ASC with this capability require trained and qualified personnel to ensure proper operation of the system. With properly trained staff and the correct use of cell savers at ASC, this device can certainly be a “lifeline”.

Rare surgical emergencies can occur in ASCs as well as in hospitals. The major vascular or organ damage that occurs requires immediate awareness and temporary action to ensure death does not occur during efforts to transport to a local hospital. Prompt and appropriate action by ASC surgeons, anesthesiologists, and clinical staff can deflect unwanted consequences if done correctly.

Final idea

Overall, the ASC provides hospitals with excellent options for most outpatient surgeries. Patients should ensure that the ASC for which they are considering surgery is certified by AAAHC, JACHO, or AAAASF. Certified CHWs meet strict standards for patient safety and care, are more convenient and accessible than hospitals, offer less expensive surgical options, and increase patient satisfaction.

Skilled and board-certified surgeons with experience in managing complex surgeries are the best choice for both ASC and hospital patients, both in terms of surgical quality and management. adverse events.

Dr.Paul MacKoul’s take on the CSA license suspension is that this is a very rare event and is usually related to the license suspension of the physician who is also the owner of establishment.

Accreditation of the outpatient surgery center and license suspension by Dr Paul McCool

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