The long-awaited Final Rule updating Medicare Conditions for Coverage (CFCs) for Ambulatory Surgery Centers (ASCs) has finally been published by the Centers for Medicare and Medicaid Service (CMS). The Final Rule represents the first major non-payment related update to the ASC CfCs since they were originally published in 1982. The requirements of the Final Rule are effective for ASCs as of May 18, 2009.
The Final Rule generally focuses on patient rights and patient outcomes. Among other things, it:
- Bolsters patient rights to disclosure of physician financial interest in the ASC
- Refines the obligations to assess patient pre-operative condition and post-operative condition
- Requires certain ASC governing body actions regarding quality assessment and performance improvement
- Imposes certain infection control requirements
- Requires preparation of a disaster preparedness plan coordinated with state and local authorities
In the Final Rule, CMS ended up backing away from some of the more controversial changes that it had placed in its Proposed Rule. Among the proposals that drew the most criticism from the ASC community and that CMS either removed or modified in the Final Rule were the following:
- CMS backed away from its proposal to require the surgeon to conduct a “thorough assessment” of all bodily systems on each patient prior to discharge. The Final Rule requires that a physician or other qualified practitioner, which includes a registered nurse with post-operative care experience, assess the patient in a manner appropriate the the procedure performed and the patient’s individual condition.
- CMS backed away from its proposed “safe transition to home” language, which seemed to burden the ASC with responsibility for ensuring each patient not only have adequate transportation home but actually make it home safely. The Final Rule generally requires that patients be discharged in the company of a responsible adult.
- CMS backed away from its proposal to require ASCs providing radiological services to meet the more burdensome coverage conditions applicable to suppliers of portable x-ray services. The Final Rule requires that the less burdensome hospital conditions for radiology be met.
- CMS backed away from its proposal to redefine ASCs to exclude facilities that keep patients past 11:59 p.m. Instead, the Final Rule excludes facilities where the expected duration of services exceeds 24 hours.
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