Saturday, October 29, 2011

California increases Surgery Center Accreditation Surveillance

On October 9, Governor Jerry Brown signed S.B. 100, enacting a new law that tightens scrutiny of California ambulatory surgery centers through increased oversight by the Medical Board of California (the Medical Board) and its approved accrediting agencies. Under the new law, which goes into effect January 1, 2012, accredited outpatient surgery centers will be subject to increased investigation, increased accountability for adverse actions, heightened requirements for obtaining and maintaining accreditation, and heightened consequences for accreditation violations. In California, physicians are only permitted to perform surgery using general anesthesia in an outpatient setting if the setting is licensed by the California Department of Public Health (CDPH), certified by Medicare, or accredited by an accrediting agency approved by the Medical Board. Historically, all ambulatory surgery centers (ASCs), other than those operated by physicians or medical groups in their own offices, were required to be licensed by CDPH. However, following a 2007 Court of Appeals decision in Capen v. Shewry, CDPH took the position that it no longer had the authority to license ASCs with any physician ownership at all, and began declining to renew the licenses of ASCs with any physician ownership. CDPH deferred regulation of these sites to the Medical Board, which is responsible for overseeing the accreditation process for ASCs and approving agencies to grant accreditation. As a result, many physician-owned ASCs have obtained and maintained accreditation in order to operate in California. Although there are California statutes that provide for Medical Board oversight over the accreditation process for ASCs, accredited ASCs have not historically been as closely scrutinized as licensed ASCs. This lower level of regulatory oversight for accredited sites, which was highlighted by the occurrence of a number of highly publicized deaths that occurred in accredited ASCs in recent years, was a driving force for this new law, which revises existing law to strengthen accreditation standards and give the Medical Board a more active role in overseeing ASCs. As a result of this new law, ASCs can expect the Medical Board and the accrediting agencies they approve to more closely monitor their operations, as described in detail below. Increased Investigation Under the new law, accrediting agencies are now required to conduct a reasonable investigation of the prior history of ASCs, as well as of their physician owners, to determine whether there have been any adverse accreditation decisions made against them. This investigation process will involve querying the Medical Board and the Osteopathic Medical Board of California, as appropriate, to inquire whether the ASC or any of the physician owners have been subject to any adverse accreditation decisions. Further, under prior law the Medical Board and the approved accrediting agencies were permitted, upon reasonable prior notice and presentation of identification, to enter and inspect any accredited ASC to ensure compliance with, or investigate an alleged violation of, any standards of the accrediting agency or any provision of the relevant laws. Under the new law, every ASC that is accredited must be inspected by the accrediting agency at least once every three years, and may also be inspected by the Medical Board as often as necessary to ensure the quality of care being provided. In addition, the notice and identification requirements have been eliminated, so that the Medical Board and accrediting agencies can now perform unannounced inspections of accredited ASCs as they deem necessary. The new law also requires ASCs with multiple service locations to have all sites surveyed for accreditation purposes, whereas the previous law allowed ASCs to elect to only have a sample of their sites surveyed. Increased Transparency for Accreditation Status Under prior law, the Medical Board was required to obtain and maintain a list of all accredited, certified and licensed ASCs and to notify the public, upon inquiry, about the ASC's accreditation, certification or licensure status. Under the new law, the Medical Board is required to obtain and maintain a list of all accredited ASCs and to post accreditation status information (i.e. whether the ASC's accreditation is active or whether it has been revoked, suspended, placed on probation, or the setting has received a reprimand) on its website. The new law also limits the ability of ASCs to re-apply for accreditation after being initially denied. Under prior law, accreditation could be denied if an ASC did not meet specified standards, but the ASC could reapply for accreditation at any time after receiving notice of denial, without limitation. As a result, an ASC could immediately "shop" for a new accrediting agency following a denial decision, without revealing the denial to the new agency. Under the new law, the denial of accreditation, or the revocation or suspension of accreditation by an accrediting agency, is applicable to all other approved accrediting agencies as well. Thus, when an ASC is denied accreditation by one accrediting agency, it may still re-apply for accreditation from the same agency, or it may apply for accreditation from another accrediting agency, but only if it discloses the full accreditation report of the accrediting agency that denied accreditation. Under those circumstances, the new accrediting agency is required to ensure that all deficiencies have been corrected and conduct a new onsite inspection prior to granting accreditation. Further, in the case of denials, the accrediting agencies are now required to report to the Medical Board within three business days if an ASC's accreditation certificate has been denied. Heightened Requirements for Obtaining and Maintaining Accreditation While prior law required the Medical Board to adopt standards for accreditation of ASCs, and in approving agencies to perform this accreditation, to ensure that the accreditation programs included standards for specified aspects of the ASC's operation, the new law specifically requires ASCs seeking accreditation to submit to the agency a detailed plan, standardized procedures, and protocols to be followed in the event of serious complications or side effects from surgery. The new law also allows an accrediting agency that determines that an accredited ASC is not in compliance with the standards to require correction of any identified deficiencies within a set timeframe. The failure to comply within that time frame will result in reprimand, suspension or revocation of the ASC's accreditation. Further, before suspending or revoking a certificate of accreditation, an accrediting agency is required to provide the ASC with the opportunity to agree with the accrediting agency on a plan of correction that gives the ASC reasonable time to supply information demonstrating compliance with the standards of the accrediting agency, or to request a hearing on the matter. During the allotted time, the ASC must post the plan of correction in a location accessible to public view. Within ten days of the adoption of the plan of correction, the accrediting agency must send the list of deficiencies and the corrective action plan to the Medical Board. If the ASC does not comply with a corrective plan within the specified time frame, the accrediting agency must issue a reprimand and either place the setting on probation or suspend or revoke the accreditation. Further, the agency must report to the Medical Board within twenty-four hours if the ASC's accreditation has been suspended or revoked or if the ASC has been placed on probation. In addition, if an accrediting agency receives a complaint from the Medical Board that an ASC poses an immediate risk to public safety, it must now investigate the ASC and report its findings of the investigation to the Medical Board within five days. If an accrediting agency receives any other type of complaint from the Medical Board that does not constitute an immediate risk to public safety, it must investigate the ASC and report its findings of investigation to the Medical Board within thirty days. Heightened Consequences for Accreditation Violations While prior law authorized the Medical Board or the local district attorney to bring an action to enjoin a violation or threatened violation of the relevant statutory provisions, the new law requires the Medical Board to investigate all complaints concerning violations of the relevant statutes. Further, with respect to any complaints relating to a violation of a certain provision of the law, or upon discovery that the ASC is not in compliance with that provision, the Medical Board is now required to investigate, and where appropriate, to bring an action to enjoin the ASC's operation. Finally, the new law does not provide for increased funding to the Medical Board, so it is unclear where the Board will obtain the resources necessary to undertake this amplified role in overseeing accreditation.Compliments of the author: Hooper, Lundy & Bookman | 1875 Century Park East | Suite 1600 | Los Angeles | CA | 90067

California increases Surgery Center Accreditation Surveillance

On October 9, Governor Jerry Brown signed S.B. 100, enacting a new law that tightens scrutiny of California ambulatory surgery centers through increased oversight by the Medical Board of California (the Medical Board) and its approved accrediting agencies. Under the new law, which goes into effect January 1, 2012, accredited outpatient surgery centers will be subject to increased investigation, increased accountability for adverse actions, heightened requirements for obtaining and maintaining accreditation, and heightened consequences for accreditation violations. In California, physicians are only permitted to perform surgery using general anesthesia in an outpatient setting if the setting is licensed by the California Department of Public Health (CDPH), certified by Medicare, or accredited by an accrediting agency approved by the Medical Board. Historically, all ambulatory surgery centers (ASCs), other than those operated by physicians or medical groups in their own offices, were required to be licensed by CDPH. However, following a 2007 Court of Appeals decision in Capen v. Shewry, CDPH took the position that it no longer had the authority to license ASCs with any physician ownership at all, and began declining to renew the licenses of ASCs with any physician ownership. CDPH deferred regulation of these sites to the Medical Board, which is responsible for overseeing the accreditation process for ASCs and approving agencies to grant accreditation. As a result, many physician-owned ASCs have obtained and maintained accreditation in order to operate in California. Although there are California statutes that provide for Medical Board oversight over the accreditation process for ASCs, accredited ASCs have not historically been as closely scrutinized as licensed ASCs. This lower level of regulatory oversight for accredited sites, which was highlighted by the occurrence of a number of highly publicized deaths that occurred in accredited ASCs in recent years, was a driving force for this new law, which revises existing law to strengthen accreditation standards and give the Medical Board a more active role in overseeing ASCs. As a result of this new law, ASCs can expect the Medical Board and the accrediting agencies they approve to more closely monitor their operations, as described in detail below. Increased Investigation Under the new law, accrediting agencies are now required to conduct a reasonable investigation of the prior history of ASCs, as well as of their physician owners, to determine whether there have been any adverse accreditation decisions made against them. This investigation process will involve querying the Medical Board and the Osteopathic Medical Board of California, as appropriate, to inquire whether the ASC or any of the physician owners have been subject to any adverse accreditation decisions. Further, under prior law the Medical Board and the approved accrediting agencies were permitted, upon reasonable prior notice and presentation of identification, to enter and inspect any accredited ASC to ensure compliance with, or investigate an alleged violation of, any standards of the accrediting agency or any provision of the relevant laws. Under the new law, every ASC that is accredited must be inspected by the accrediting agency at least once every three years, and may also be inspected by the Medical Board as often as necessary to ensure the quality of care being provided. In addition, the notice and identification requirements have been eliminated, so that the Medical Board and accrediting agencies can now perform unannounced inspections of accredited ASCs as they deem necessary. The new law also requires ASCs with multiple service locations to have all sites surveyed for accreditation purposes, whereas the previous law allowed ASCs to elect to only have a sample of their sites surveyed. Increased Transparency for Accreditation Status Under prior law, the Medical Board was required to obtain and maintain a list of all accredited, certified and licensed ASCs and to notify the public, upon inquiry, about the ASC's accreditation, certification or licensure status. Under the new law, the Medical Board is required to obtain and maintain a list of all accredited ASCs and to post accreditation status information (i.e. whether the ASC's accreditation is active or whether it has been revoked, suspended, placed on probation, or the setting has received a reprimand) on its website. The new law also limits the ability of ASCs to re-apply for accreditation after being initially denied. Under prior law, accreditation could be denied if an ASC did not meet specified standards, but the ASC could reapply for accreditation at any time after receiving notice of denial, without limitation. As a result, an ASC could immediately "shop" for a new accrediting agency following a denial decision, without revealing the denial to the new agency. Under the new law, the denial of accreditation, or the revocation or suspension of accreditation by an accrediting agency, is applicable to all other approved accrediting agencies as well. Thus, when an ASC is denied accreditation by one accrediting agency, it may still re-apply for accreditation from the same agency, or it may apply for accreditation from another accrediting agency, but only if it discloses the full accreditation report of the accrediting agency that denied accreditation. Under those circumstances, the new accrediting agency is required to ensure that all deficiencies have been corrected and conduct a new onsite inspection prior to granting accreditation. Further, in the case of denials, the accrediting agencies are now required to report to the Medical Board within three business days if an ASC's accreditation certificate has been denied. Heightened Requirements for Obtaining and Maintaining Accreditation While prior law required the Medical Board to adopt standards for accreditation of ASCs, and in approving agencies to perform this accreditation, to ensure that the accreditation programs included standards for specified aspects of the ASC's operation, the new law specifically requires ASCs seeking accreditation to submit to the agency a detailed plan, standardized procedures, and protocols to be followed in the event of serious complications or side effects from surgery. The new law also allows an accrediting agency that determines that an accredited ASC is not in compliance with the standards to require correction of any identified deficiencies within a set timeframe. The failure to comply within that time frame will result in reprimand, suspension or revocation of the ASC's accreditation. Further, before suspending or revoking a certificate of accreditation, an accrediting agency is required to provide the ASC with the opportunity to agree with the accrediting agency on a plan of correction that gives the ASC reasonable time to supply information demonstrating compliance with the standards of the accrediting agency, or to request a hearing on the matter. During the allotted time, the ASC must post the plan of correction in a location accessible to public view. Within ten days of the adoption of the plan of correction, the accrediting agency must send the list of deficiencies and the corrective action plan to the Medical Board. If the ASC does not comply with a corrective plan within the specified time frame, the accrediting agency must issue a reprimand and either place the setting on probation or suspend or revoke the accreditation. Further, the agency must report to the Medical Board within twenty-four hours if the ASC's accreditation has been suspended or revoked or if the ASC has been placed on probation. In addition, if an accrediting agency receives a complaint from the Medical Board that an ASC poses an immediate risk to public safety, it must now investigate the ASC and report its findings of the investigation to the Medical Board within five days. If an accrediting agency receives any other type of complaint from the Medical Board that does not constitute an immediate risk to public safety, it must investigate the ASC and report its findings of investigation to the Medical Board within thirty days. Heightened Consequences for Accreditation Violations While prior law authorized the Medical Board or the local district attorney to bring an action to enjoin a violation or threatened violation of the relevant statutory provisions, the new law requires the Medical Board to investigate all complaints concerning violations of the relevant statutes. Further, with respect to any complaints relating to a violation of a certain provision of the law, or upon discovery that the ASC is not in compliance with that provision, the Medical Board is now required to investigate, and where appropriate, to bring an action to enjoin the ASC's operation. Finally, the new law does not provide for increased funding to the Medical Board, so it is unclear where the Board will obtain the resources necessary to undertake this amplified role in overseeing accreditation. Compliments of the author: Hooper, Lundy & Bookman | 1875 Century Park East | Suite 1600 | Los Angeles | CA | 90067

Monday, May 16, 2011

Surgery Center Owners win $22 Million Dollar Settlement against a BIG PLAYER, One of the Blue(s)

Great News for Surgery Center Owners!!

B/CB/S of New Jersey thought they were going to get out having to pay for claims submitted via out of network facilities.  Think again, to the tune of a settlement of $22 Million dollars, I don't think so!  Read the entire article here

Just a little side note to assist you with your cash flow....  for those of you who have many claims hanging out there in denials due to this issue of in/out of network, maybe making a copy of this article and attaching a copy of the article to each and every claim form and resubmitting them to the insurance company might be your token and start at helping assist you at ending this obnoxious delays for payment?  It sure can't hurt, right? 


 

Thursday, April 7, 2011

This Just In: Breaking News in Surgery > April, 2011 > Georgia Court Strikes Down State's ASC Survey

The Compliance Doctor congratulates the State of
Georgia's ASC Foundation, A victory for the State and a Victory for All Surgery Centers in the message that is delivered in regards to this case and the protection of our patients and their HIPAA responsibility. Read here:


This Just In: Breaking News in Surgery > April, 2011 > Georgia Court Strikes Down State's ASC Survey

Monday, March 14, 2011

CHECK OUT THESE BUSINESSES FOR SALE....

http://www.bizben.com/business-for-sale/non-medical-in-home-care-service-for-sale-north-los-angeles-california-ca-165850.php



http://www.bizben.com/business-for-sale/medical-transport-service-for-sale-los-angeles-california-ca-165216.php

Thursday, March 10, 2011

If you are a newly organized Durable Medical Equipment Company or a DME that has been open but, has yet to become accredited, then this article is for you.

FOR IMMEDIATE RELEASE
(Free-Press-Release.com) February 16, 2011 --
As all of us are aware, The Federal Medicare Program now requires all durable medical equipment companies & home medical equipment companies be fully accredited by one of the nine accreditation organizations that they've approved in order to be reimbursed federal monies of the Medicare patient.

The process of obtaining accreditation by one of the organizations is very time consuming and tedious, leaving the typical dme provider frustrated and overwhelmed. There is a formality that should be followed when applying for a dme license and accreditation. Though undeveloped until now, no one had taken the time to formally write these, which this article outlines below:

1. Identify a business name, name search and then legally file the corporation paperwork in order to receive the state approval stamped document. DME/HME usually incorporates as "S", "C", or "LLC", consult your Attorney for advice on which is best for you and your business.

2. Choose the location for the business. You must have a legitimate business address and it cannot be an office out of your home residence as once it could in the past. The business location should be Medical Zoned for patients, wheelchair accessible, and the standard federal ADA regulations should be applied before executing the lease with terms.

3. Apply for your local city business license. This is usually done through the state franchise boards not confusing this license with the State License that is generated through the department of public health/human services.

4. Depending upon the state your dme business is to reside and furnish dme to patients, the state may or may not have a state license that you must obtain in order to be operational. In the state of California, this is done through the Retail Pharmacy boards. Suggestion: call your state office and find out specifics for your state, do not assume!

5. Locate and Purchase a Policy and Procedures Manual for the operations of your DME. This is very important, as you will have to demonstrate by evidence to your policies to the accrediting organization. Policy and Procedures Manual should contain a table of contents as this manual to meet the minimum regulatory requirements.

6. Determine which accrediting organization you wish to utilize to meet the Medicare requirements, and then call them to obtain the application for DME/HME Accreditation.

7. Follow the specific instructions prepared by Medicare for New Provider Enrollment. Do pay close attention to the instructions of the new provider enrollment; there are supporting documents that must be submitted with the application. Forms 588 & 460 must also be included in the packet to Medicare for new enrollment.

8. At this point you are awaiting accreditation, which can take up to 90 days after the accrediting body has approved your application for the Accreditation of durable medical equipment/home medical equipment provider based business.

9. There are consultants to help you along the way of achieving this accreditation. Firms like The Compliance Doctor, LLC has been instrumental in assisting over 350 DME companies achieve theirs, and they can assist you too.

Wednesday, February 2, 2011

The Compliance Doctor is the Health Care Expert in Accreditation and Medicare Certifications.

The Compliance Doctor is the Health Care Expert in Accreditation and Medicare Certifications

Author:

Troy Lair

We can help!  Our Health Care Consultants are more than eager to assist you at successfully reaching your goals in passing your upcoming survey.  We provide initial accreditation or re-accreditation services that can be totally customized to meet your individual needs regardless of the size of your organization.

If you are in search of an Accreditation Consultant or Healthcare Accreditation Consultants, The Compliance Doctor, LLC is just what you need.

Ambulatory health care is the term used to describe any kind of health care that can be administered without the patient being admitted into the hospital. The term ambulatory applies to the patient being able to 'walk' into the facility for services and able to 'walk out'.  Ambulatory can also be associated with the term outpatient, services that can be delivered without the patient being admitted into the acute care or inpatient care setting. The surgery center consultants at The Compliance Doctor, LLC have the proven expertise to provide you with the answers and information needed during a health care accreditation consultation.

Accreditation Consultants for Surgery Centers, Ambulatory Surgery Centers (ASC), Health Care Facilities, Health Care Centers, Home Health Agencies (HHA), Behavioral Health, Detox, Durable Medical Equipment Companies (DME or HME), Pharmacies, Radiology, MRI, CAT, Infusion Centers, PICC Line Centers, Sleep Medicine, Sleep Apnea, Staffing Registry, IDTF, Behavioral Health, Urgent Care Centers, Rural Health Clinic Designations, and More.

Accreditation is necessary for many companies that wish to submit claims to the Federal Medicare Program.  Most recently, laws were passed with Congress that now require durable medical equipment companies be accredited in order to submit claims for Medicare reimbursements.  More recently, congress has passed the accreditation requirement onto the radiological branch of medicine, requiring companies that perform  CT, MRI, and other radiography type procedures also be accredited by the year of 2011.

THE COMPLIANCE DOCTOR, LLC OFFERS THE MOST AFFORDABLE AND PRACTICAL ACCREDITATION CONSULTATION SERVICES AVAILABLE.

Whether it\'s DME Accreditation, ASC Accreditation, Sleep Medicine Accreditation, IDTF Certification, Rural Health Clinic Designation....The Accreditation Consultants of The Compliance Doctor is what you\'re looking for in a consulting firm.

Our services are guaranteed1! Our customers say our services meet and exceed their expectations, read for yourself their testimonials.

Article Source: http://www.articlesbase.com/press-releases-articles/the-compliance-doctor-is-the-health-care-expert-in-accreditation-and-medicare-certifications-4136813.html

About the Author

Troy Lair, Founder, Principal Consultant

In today\'s ever changing and speedy health care environment, time and money are essential for success. This is why hundreds of physicians, surgery centers, and other healthcare professionals have entrusted The Compliance Doctor, LLC with their specific needs. Our professionally designed road maps for accreditation, licensing, equipment acquisition, physicians\' practice management, and coding/ billing compliance have truly marked the road to success.

Our understanding of health care businesses allows physicians to stay focused on revenue generating activities while we focus on the administrative and regulatory. We understand that you generate revenue when you\'re seeing patients, thus we allow for your energies to be redirected to the bedside of the patient. This gives us a sense of purpose but more importantly, the ownership and responsibility at succeeding. This is our defining difference from our competitors whether local or national.

Never pay for services you don\'t need. On demand, our seasoned support staff is available to our clients. The Compliance Doctor, LLC will work with you every step of the way until you reach satisfaction in obtaining the goals set forth in our engagement letter.

We are not happy until you are happy!

We are committed at maintaining our customer satisfaction rating of 100

Warm Regards,
Troy Lair

Saturday, January 29, 2011

Compliance Doctor Releases Newly Improved Policy Manual for Home Health Agencies



The Compliance Doctor has taken the time to update the National Manual for Home Health Agencies recently published in 2008 and has updated it to meet the 2011 standards rolled out by the changes notifications of states in the US and by the regulatory bodies that govern the HHA Accreditations through the government allowed Medicare Deem Status. Visit the Marketplace of the website for more info on how to get your manual with the newest policies necessary to stay current with state and federal regulations.

Wednesday, January 19, 2011

Does your state require a Transfer Agreement or Admitting Privileges for all your surgeons? Both?

ASC Hospital Transfer Requirements Summary, by State References Courtesy, Outpatient Surgery Magazine
January, 2011

30 States require that the ASC either have a transfer agreement in place with a hospital or physicians performing surgery have admitting privileges at the hospital.14 states require an established transfer agreement.
  •  Alabama
a. Written transfer agreement with a hospital that has a provider contract with the Alabama
Medicaid Agency; and
b. All physicians performing surgery in the center shall have admitting privileges at the hospital.
  • Alaska
Written agreement with a general acute hospital for transfer of patients who require medical or
emergency care beyond the scope of the ability or license of the facility.

  • Arkansas
Written agreement with a local hospital for transfer of a patient in a medical emergency of a
nature which can’t be handled by the ASC.
  • Connecticut
Written agreement with one or more hospitals to ensure patient is transferred from the center to
the hospital and ensured timely admission to the hospital when physician determines it is
medically appropriate.
  • Illinois
Agreement with an acute care hospital that must be located within 15 minutes travel time.
  • Kentucky
The agreement must include designation of responsibility for transfer of information, provision of
transportation, sharing of services, equipment and personnel, provision of total care or portions
thereof in relation to facility and agency capability, and patient record confidentiality.
  • Mississippi
Transfer agreement with one or more acute general hospitals located within 15 minutes travel
time from the hospital for patients requiring attention for an emergency or other condition
necessitating hospitalization.
  • Nevada
Written agreement concerning the transfer of patients with a licensed general hospital.
  • New York
Documented plan and procedure for the transfer of patients to a nearby hospital when
hospitalization is indicated.
  • North Carolina
Transfer agreement required to facilitate the transfer of patients in need of emergency care. The
ASC is still considered to be in compliance if it has documentation to support its efforts to
establish a transfer agreement with a hospital and has been unable to secure an agreement.
  • Ohio
Written agreement with a hospital for transfer of patients in the event of medical complications,
emergency situations, and for other needs as they arise.

  • South Dakota
Transfer agreement with a hospital sufficiently close to accept emergency transfer of patients.
  • Tennessee
Written agreement with a local hospital.
  • Washington
Written agreement with a local hospital licensed under chapter 70.41 RCW and approved by
ambulatory surgical facility’s medical staff.
  • Wyoming
a. Offsite pre-planned transfers shall be made only to other licensed health care facilities that can
provide the level of care necessary to meet the needs of the patient.
b.The ASC shall have a written agreement with any and each licensed facility that admits patients
for post surgical care.


14 states require either an established transfer agreement or physicians performing
surgery to have hospital admitting privileges.
  • Colorado
a. There shall be a written transfer agreement with an emergency center or hospital, or all
physicians performing surgery in the ASC shall have admitting privileges at the hospital.
b.The ASC shall be allowed to have offsite pre-planned transfers to other licensed facilities that
can provide the level of care necessary to meet the needs of the patient.
  • Florida
When the physician does not have staff privileges to perform the same procedure as being
performed at the ASC at a licensed hospital within reasonable proximity, a transfer agreement
needs to be in place with a local hospital within reasonable proximity (not to exceed 30 minutes
transport time)
  • Georgia
a. The ASC shall have a hospital affiliation agreement with a hospital within a reasonable distance
from the facility; or
b. The medical staff at the center has admitting privileges or other acceptable documented
arrangement to ensure the necessary backup for the center for medical complications.
c. The center must have the capability to transfer a patient immediately to a hospital within a
reasonable distance from the facility with adequate emergency room services.
d. Hospitals shall not unreasonably deny a transfer agreement to the center.
  • Indiana
A practitioner who performs a procedure that requires anesthesia in an office based setting, or
who directs/supervises the administration of anesthesia, must have:
a. Admitting privileges at a nearby hospital
b. Transfer agreement with another practitioner who has admitting privileges at a nearby
hospital; or
c. An emergency transfer agreement with a nearby hospital.

  • Kansas
a. Written transfer agreement with a licensed hospital in the community; or

b. Practitioners are privileged to perform these procedures in at least one licensed hospital in the
community in which the ASC is located.
  • Maine
a. Written transfer agreement with a local, Medicare-participating hospital or a local, nonparticipating
hospital that meets the requirements for payments for emergency services under 42
Code of Federal Regulations, Section 482.2.; or
b. All physicians must have admitting privileges at such a hospital.
  • Maryland
a. Written transfer agreement with a local Medicare participating hospital; or
b. All practitioners performing surgery in the ASC are required to have admitting privileges at a
participating hospital.
  • Massachusetts
a. The ASC must either have a written transfer agreement with a hospital; or
b. Physicians with surgical privileges at the center must have admitting privileges at the hospital
c. The hospital must be a Medicaid-participating provider, and must be licensed to operate in
accordance with 105 CMR 130,000 or with its own state’s licensing agency.
  • Missouri
a. Surgical procedures must be performed by physicians who are privileged to perform surgical
procedures in at least one licensed hospital in the community in which the ASC is located;
b. Alternatively, need a working agreement with at least one licensed hospital in the community
in which the ASC is located, guaranteeing the transfer for emergency treatment whenever
necessary.
  • Oklahoma
a. Transfer agreement with a general hospital no more than 20 minute travel distance; or
b. All physicians performing surgery in the ASC shall have admitting privileges at a general
hospital located not more than 20 minutes travel distance from the center.
  • Pennsylvania
a. Written transfer agreement with a hospital which has emergency and surgical services
available; or
b. Physicians performing surgery in the ASF shall have admitting privileges at a hospital in close
proximity to the ASF, to which patients may be transferred.
  • Rhode Island
a. Written transfer agreement for transferring patients to nearby hospital when hospitalization is
indicated; or
b. Permit elective surgery only by licensed practitioners who have similar privileges at a nearby
licensed hospital and approved by the ASC’s governing body.
  • South Carolina
Provide documentation that the applicant has sought cooperative agreements such as transfer
agreements with other facilities, as applicable.
  • Texas
a. The ASC needs a written transfer agreement with a hospital; or
b. All physicians performing surgery at the ASC shall have admitting privileges at a local hospital.

  • Utah
a. ASC shall maintain hospital admitting procedures for all staff; or
b. Shall have a written transfer agreement with one or more full-service licensed hospitals located
within an overall travel time of 15 minutes or less from the facility.

Thinking about building your own Ambulatory Surgery Center?

Want to build your own surgery center?

Author:

Troy Lair

After you estimate your square footage, re-run the pro-forma and subtract 500 or 1,000 feet from the building program and re-run the numbers. The cost to construct the shell and interior of an ASC can be between $165 per square foot to as much as $300 per square foot. The reduction of 1,000 square feet from your construction estimate could save you as much as $165,000 to $300,000 in construction costs, and $30,000 or more in annual operating costs. If the center is properly designed, the reduction in square footage may not cause any change in the function of the building.

New vs. Existing Facilities

There are nonetheless some disadvantages to a completely new construction site. If you select a previously constructed building, the architect will have existing structures which may somewhat limit the facility design, but, conversely, all site development work will have been done and paid for, and construction time can possibly be substantially reduced.

Construction Standards

Those who have not previously developed Ambulatory Surgery Centers often believe that ASC construction is the same as medical office building construction, when, in fact, the two types of structures are different. Because of the obvious life-safety concerns, a single city inspection is now replaced by multiple inspections at the city, state, and federal levels.

Federal Level Regulation

On the federal level, some limited construction information can be found in the Code of Federal Regulations-Title 42, Volume 2, Chapter IV, Part 416-Ambulatory Surgical Services. Some consider the 'Guidelines for Design and Construction of Hospital and Health Care Facilities,' published by the American Institute of Architects, as the bible for construction of Ambulatory Surgery Centers.

State Level Regulation

When you research the construction standards for Ambulatory Surgery Centers, you will find, unfortunately, that there is little uniformity among the states. Some states have no regulations regarding Ambulatory Surgery Centers, while other states have quite lengthy regulations which include many facility standards. For example, Florida has adopted many national construction codes and includes a listing of those codes in their ambulatory surgery state regulation.

 

Local Regulation

Often the city or local entity will require that your construction documents be approved by the city construction office before you can receive a construction license.

 

The Construction Team: You Can\'t Afford Rookies

Often we tend to think of the construction team as simply the general contractor, when in fact the team has many members. The construction team consists of the architect, the engineer, and on occasion structural and civil engineers. The cost for each of these team members should be reviewed as a part of the overall construction costs. An ASC is a complex facility, which requires special knowledge and experience on the part of the entire design team.

 

Selecting a General Contractor

When selecting a contractor, always look for one who has done medical projects, preferably Ambulatory Surgery Centers. Check not only the references of your general contractor, but the references of the proposed sub-contractors as well to ensure they have had experience meeting healthcare requirements. The construction process can be an adversarial process, and at times confrontational, so be careful when selecting a friend as your contractor. If there is a very important person (VIP) on your project, it is the construction superintendent.

 

The Construction Contract

Once your construction contract has been either bid or negotiated, the general contractor will ask you to sign a construction contract. Look for changes to the standard form which were made by your contractor, and don\'t hesitate to have your attorney review the contract. You should always specify a time of completion for the project, and in some states you can even include special penalty clauses to charge the contractor, in the event the work is not finished on time.

 

The Process

Once the construction contract has been signed, a representative of the ASC gives the contractor a notice to proceed, and the contractor will obtain building permits from the local building authority. Thereafter, monthly progress meetings should be held with the contractor, architect and ASC representative (consultant) to resolve outstanding issues, ensure that the facility is being constructed based on the architect\'s plans, and ensure that the timeline for construction is being met.

Change Orders

If the contractor finds a problem with the architectural drawings or if a change is requested by the ASC, then a change order may be requested by the general contractor. Change orders can increase contract costs significantly and must be closely monitored. It is quite common to experience change orders that increase building costs as much as 10 to 20 percent of the total construction cost.

 

Inspections

During the construction process, the construction will be monitored on a daily basis by the superintendent, and the city or county having jurisdiction will make numerous inspections to ensure all city codes are being met. In addition, some states will make periodic inspections, as well as full inspections at the completion of the project.

Boiler inspection if you have boilers on your sterilizers

Emergency power system

Nurse call system

Fire sprinkler system

Depending on the state, the following inspectors may be sent to evaluate the ASC: fire marshal, sanitarian, boiler inspector, construction department, pharmacy board, and licensure office. Construction of an ASC is a complex and heavily regulated process, which requires knowledgeable and experienced participants at every step in the process.

 

 

Article Source: http://www.articlesbase.com/regulatory-compliance-articles/want-to-build-your-own-surgery-center-3925406.html

About the Author

Troy Lair, founder of The Compliance Doctor, LLC has been in health care for over 20 years.  Providing expert consulting the past six years, Lair has focused his last decade on the ambulatory business of health care.  Having working in acute care settings in Kentucky, Chicago, and most recently worked as an executive for Tenet Health Care in Pasadena, CA.  Lair resides in Los Angeles, and provides his services to the entire nation with over 350 Clients served to date.  www.thecompliancedoctor.com

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