Overview of Outpatient Care Settings and Ambulatory Surgery Centers
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1 Overview of Outpatient Care Settings and Ambulatory Surgery Centers Agency for Health Care Administration Molly McKinstry, Deputy Secretary Health Quality Assurance
2 Surgical Settings Ambulatory Surgery Centers Hospital Inpatient Setting Outpatient Under the Hospital License Physician Office Surgery Registration 2
3 Ambulatory Surgical Centers [Florida Statutes ss (3)] Primary purpose is to provide elective surgical care. The patient is admitted to and discharged from the facility within the same working day. Overnight stays are not permitted. Licensed separately from a hospital. An ambulatory surgical center does not include an office maintained by a physician for the practice of medicine.
4 Ambulatory Surgical Centers [State Procedures Allowed] No specific list of procedures in state regulation Governing board determines policies and activities of the Center Organized medical staff review and approve policies and activities of all departments Anesthesia policies and procedures must be developed by the anesthesia service, approved by the medical staff and the governing board, and reviewed annually 4
5 Ambulatory Surgical Centers [Federal Regulation 42 CFR ] Federal regulations apply for Medicare participation State licensure required ASC is a distinct entity Operates exclusively for the provision of surgical services to patients not requiring hospitalization, not to exceed 24 hours including pre- and post-operative Complies with Federal Conditions for Coverage Limitations apply to all of the ASC surgical services, not just to surgeries for Medicare beneficiaries
6 Ambulatory Surgical Centers [Federal Procedures Allowed] ASC List of Covered Surgical Procedures Addendum AA of the hospital outpatient prospective payment system. Service-Payment/ASCPayment/index.html (a)(1) A physician must examine the patient immediately before surgery to evaluate the risk of anesthesia and of the procedure to be performed. 6
7 Ambulatory Surgical Centers Regulatory Criteria Overall Operations Surgical, Anesthesia, Nursing Services Appropriate Medical Record Maintenance Quality Assurance Risk Management and Adverse Incident Reporting Recovery and Discharge Infection Control Construction Standards 7
8 Ambulatory Surgical Centers Surveys Annual state licensure inspections are conducted at all non-accredited ASCs Accrediting organization survey reports are provided to the Agency State validation inspections are conducted annually on 5% of accredited ASCs to determine ongoing compliance with state licensure regulations Federal validation and re-certification surveys for those facilities that are Medicare certified Complaint Investigations (both state and federal) 8
9 Ambulatory Surgical Centers 429 licensed ASCs in Florida (As of August, 2015) 411 ASCs are Medicare and/or Medicaid certified 379 ASCs are accredited by a national accrediting organization Accreditation Association for Ambulatory Health Care (296) The Joint Commission (82) The American Association for Accreditation of Ambulatory Surgery Facilities (1) 9
10 Ambulatory Surgical Centers Reporting Requirements Patient data is submitted quarterly ASCs with fewer than 200 visits per quarter may request a quarterly exemption Collected by Agency s Florida Center Publish data through FloridaHealthFinder.gov 10
11 Florida Surgical Data (Calendar 2014) 4,393,310 outpatient surgical procedures 2,404,537 in licensed ASCs 1,988,782 in hospital-based outpatient locations Digestive system most common One-third (1,502,781) Includes endoscopy and colonoscopy 664,232 hospital inpatient surgical procedures Excludes physician office surgery 11
12 Top 5 CPT Surgical Code Categories Reported Rank Description Digestive System (Includes colonoscopy and endoscopy procedures) Nervous System (Includes steroidal & anesthetic spinal injections) Musculoskeletal System (Includes a wide range of orthopedic surgery and arthroscopy) Eye and Ocular Adnexa (Includes cataract removal) Integumentary System (Includes plastic surgery and other procedures involving the skin and breast) Freestanding ASCs Hospital Based ASCs 960, , , , , , ,816 66, , ,302 12
13 Top 5 Major Diagnostic Category (MDC) Surgical Code Categories Inpatient Rank Description Count 1 Musculoskeletal System and Connective Tissue 180,762 2 Circulatory System 110,971 3 Pregnancy, Childbirth and Puerperium 86,711 4 Digestive System 67,341 5 Hepatobiliary System and Pancreas 32,267 Total Discharges, ,741,984 (2,075,084 discharges had no procedure performed) 13
14 Physician Office Surgery Registration Physicians must register with Department of Health DOH inspects certain office surgery settings unless accredited Board of Medicine sets Standard of Care for Office Surgery Anesthesia monitoring Education Scope of office surgery 14
15 Emergency / Urgent Care Hospital-based emergency departments Hospital emergency departments (243) (86 hospitals do not have emergency departments) Off-site emergency departments (22) Urgent care centers are not specifically defined Providers of urgent care may include Physician offices Health care clinics (1,812) Health maintenance organization offering services (2) 15
16 Hospital Emergency Departments Operate under hospital license Emergency access - EMTALA Treat emergent medical conditions Specific services must be available Patient arrive by ambulance 24/7 operation with on-call specialists 16
17 Notice of Charge for Services Hospital licensure requires good faith estimate of charges upon request for nonemergency medical services upon written request legislation requires urgent care centers publish and post a schedule of charges for medical services offered to patients. 17
18 Posting of Charges Urgent Care Centers An offsite emergency department of a hospital that is presented to the general public in any manner as a department where immediate and not only emergent medical care is provided An offsite facility of a hospital or a joint venture between a hospital and a provider licensed under chapter 458 or chapter 459, that does not require a patient to make an appointment and is presented to the general public in any manner as a facility where immediate but not emergent medical care is provided A health care that maintains three or more locations using the same or a similar name, does not require a patient to make an appointment, and holds itself out to the general public in any manner as a facility or clinic where immediate but not emergent medical care is provided. 18
19 Posting of Charges Urgent Care Centers Conditions Layperson description Prices for uninsured persons Conspicuously posted in reception area 50 most frequently provided services Size requirements for poster Fines for failure to comply 19
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