Healthcare Check-up: Medicare on the Move

Not in 25 years have the Medicare standards for certified Ambulatory Surgery Centers in the US had such a comprehensive overhaul by the Centers for Medicare and Medicaid Services (CMS). This Federal overhaul in Medicare standards for ASCs had a deadline of May 18th, 2009 for both implementation and compliance. As you can imagine, when the government makes changes which affect any industry at the operational level, they bring both challenges and opportunities for any organizations affected.

The ASC industry is known not only for being a predominantly for-profit business, but a sector known for its resilience and ability to rapidly change. Nonetheless, these governmental changes will further test the resilience and creativity of all ASCs across the country, testing both administrative and staffing resources.

Many ASC organizations have the misconception that the Medicare standards for ASCs affect only the Medicare patients treated at their surgery center. They realize their mistake when their State licensing authority, or Medicare and/or their Accrediting organization, visit their center to perform an unannounced compliance audit or an unannounced accreditation survey.

Both Medicare and most State licensing authorities for ASCs use the Medicare Standards for ASCs (Conditions for Coverage) as the minimum standard of care. This is because in some states there are no licensing standards for an ASC, and hence the Medicare standards for ASCs are applied as the minimum standard of care for both State compliance and that expected from patients and their insurance companies. Therefore, if Medicare shows up at an ASC for a routine compliance audit, an overdue compliance audit, or a complaint, Medicare has an open opportunity to review the standard of care delivered within that ASC.

Many might say that a significant number of the newly updated Medicare standards for ASCs are simply a reinterpretation of existing standards in effect since 1982. However, some in the industry believe that after years of finding inconsistent application and significant misinterpretation of the Medicare Conditions for Coverage for ASCs, Medicare has responded with an updated and complete set of interpretive guidelines of the Medicare standards for the Medicare/State surveyors who show up at facilities.

Therefore, it is highly recommended that all ASCs possess a complete version of the current Medicare Conditions for Coverage for ASCs as a constant reference for their administrative and clinical staff. More importantly, they should also have the complete copy of the Medicare Interpretive Guidelines for Surveyors as an available reference.

Moreover, all of the Accrediting Bodies for ASCs who perform “deemed status surveys”, otherwise known as a combined Accreditation Survey for Quality and a Medicare Certification Survey, apply these standards and Medicare Interpretive Guidelines during their organizational surveys for ASCs. These organizations are:

• TJC–The Joint Commission has deeming authority by CMS (The Centers for Medicare and Medicaid Services) to perform both Medicare certification surveys and Accreditation surveys.
• AAAHC – Accreditation Association for Ambulatory Health Care has deeming authority, granted by CMS, to perform Medicare Certification surveys and accreditation surveys.
• AAAASF – American Association for Accreditation of Ambulatory Surgery Facilities has deeming authority, granted by CMS, to perform Medicare Certification surveys and accreditation surveys.

Overall it has been one of the most challenging years of change in administrative and clinical compliance for ASCs in decades. For example, the announcement this past week by the ASC Association that 12 states in the US have been volunteered by their states for Medicare tracer compliance audits on or before September 23rd of this year. This means that any and all ASC’s in these states have the potential to have a full Medicare Conditions for Coverage Compliance audit, using a Tracer methodology inherently invented by The Joint Commission for auditing compliance with Accreditations surveys by following the path of the patient thru the organization.

Therefore, let’s all take this as the ultimate challenge to prepare, brainstorm, and comply with all of the updated Medicare standards for ASCs. Let us all get to work to achieve the certainty that we can all have ongoing compliance and vigilance to meet these new Medicare standards of care for ASCs, with the ultimate goal of improving the standard of care for all patients.

References:
1.) Ambulatory Surgery Center Association - www.ascassociation.org
2.) Centers for Medicare and Medicaid Services - CMS - www.cms.hhs.gov
 

Kim Reints, Director of Clinical Operations, West
Regent Surgical Health
P. 708.492.0531
F. 708.731.5134