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
  • 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?


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.



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:

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.

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