Ambulatory Surgery Centers in the United States of America David Shapiro, MDNational Conference on Ambulatory Surgery Bangalore
Dr. David Shapiro Physician Anesthesiologist (Specialization in Outpatient Anesthesia) Florida Society of ASCs (FSASC) : Board Member ASC Association (ASCA) : Chairman of the Board ASC Quality Collaboration : Co -Chair AAAHC : Surveyor AORN ASC Administrator Course : Faculty Certified Administrator Surgery Center (CASC) by the Board of Ambulatory Surgery Certification Certified in Health Care Quality and Management (CHCQM) by the American Board of Quality Assurance & Utilization Review Physicians Certified in Healthcare Compliance (CHC) by the American Hospital Association Certified Professional in Healthcare Risk Management (CPHRM) by the Health Care Compliance Board Licensed in Healthcare Risk Management (LHRM) by the State of Florida
History of ASCs in the United StatesOpened February 12, 1970 in Phoenix, ArizonaFounded by Wally Reed, MD John Ford, MDNamed “Surgicenter”Originally 4 ORsNow 6 ORs, 4 Endoscopy Suites
First sketch of Surgicentermade on the back of a tenttable ad at Smuggler’s Innin Chicago in 1968.
John L. Ford, MD and Wally Reed, MD in the OR on Surgicenter’s opening day, February 12, 1970.
ASC TimelineWallace Reed, MD, and JohnFord, MD, commit their idea fora freestanding ambulatorysurgery facility to paper for thefirst time and developobjectives for the facility. They The Society of Freestandingbegin collecting endorsements Ambulatory Surgical Carefrom the governmental bodies (ASCA’s original name) isand members of the health incorporated during an ASCcare community to obtain seminar conducted infinancing for the project. Phoenix, Arizona. 1970 1975-1976 1968 1974 Reed and Ford’s idea becomes Rapid growth. A total of 42 reality when on February 12 surgery centers are in Surgicenter, the nation’s first operation in the US by 1975 freestanding ambulatory and an additional 25 surgery facility, opens for facilities open in 1976. business. Five physicians perform five procedures at the facility that day, four requiring general anesthesia.
ASC TimelineThe industry continues togrow, with the number ofASCs reaching triple digits.ASCA and others join together Medicare modifies the ASCto form the Accreditation list to use specific CPT codesAssociation for Ambulatory and expands the list toHealth Care (AAAHC). include 1,535 procedures. 1982 1988 1979 1987 Medicare approves payment The number of ASCs in the to ASCs for approximately 200 US reaches 1,000. Using the procedures, which are placed information from a 1986 in one of four payment groups cost survey of ASCs, with payment rates between Medicare implements a new $231 and $336, based upon a payment system, which cost survey of 40 ASCs. remains the basis for ASC payments today.
ASC TimelineASCs go international whenthe International Associationfor Ambulatory Surgery More than 5,300 ASCs exist(IAAS) is founded during the in the US today, performing1st International Congress on 23 million surgeriesAmbulatory Surgery in annually. Medicare hasBrussels. Medicare expands granted approval for ASCsthe ASC list to cover more to perform more thanthan 2,000 procedures. 3,500 procedures. 2002 1995 2011 Seventy-eight individuals earn the CASC credential, the first- ever ASC-specific credential, establishing the ASC administrator as a separate and distinct career from other health care management and clinical positions.
ASC Regulation• Federal Regulation Center for Medicare & Medicaid Services (CMS)• State Regulation Various State Health Department and/or Agencies• Local Regulation Primarily Building and Fire Code Compliance Enforcement
CMS: Definition of an ASCEffective May 18, 2009 - “means any distinct entity that operates exclusively for the purpose of providing surgical services to patients not requiring hospitalization and in which the expected duration of services would not exceed 24 hours following an admission.” 42 CFR 416.2 DEFINITIONS
CMS• Defines ASCs in Federal Law• Determines Payment Policies – Allowable Procedures – Applicable Rates – Annual Updates• Determines ASC’s Participation in Federal Programs – Conditions of Coverage -Infection Control Checklist• Administer Quality Reporting Programs
ASC AccreditationASCs are Accredited by 4 different Organizations: Accreditation Association for Ambulatory Health Care (~3,010) Joint Commission (~637) American Association for Accreditation of Ambulatory Surgical Facilities American Osteopathic AssociationAs of Spring 2011: Over 70% of ASC facilities in the U.S. are accredited by one of these four organizations