Dr. Antimarino

Are outpatient surgical centers safe?

Posted March 18, 2016

Dear Dr. A, I am thinking about having a cosmetic procedure done but have some concerns about it being done at an outpatient surgical facility. Can you tell me if these are safe and what I should consider when doing my research?

RESPONSE: That is a great question and very relevant in today’s ever changing healthcare environment. The number of outpatient procedures continues to rise because of decreased operating room costs, faster-acting anesthetics, improved safety standards in the equipment used and less invasive procedures. It is important that your surgeon explain why you are a good candidate for an outpatient procedure before your surgery is scheduled. You should also know what to look for in an outpatient facility.

Sometimes it can be difficult to find information about a specific outpatient facility as they are not all inspected by a single organization. Many regulators feel more oversight is needed as private accreditors are paid to evaluate outpatient facilities and each state has different licensing requirements.

I have pulled together a short list that I believe should help in researching your outpatient procedure in Pennsylvania:

1. What is an ASC? An Ambulatory Surgery Center (ASC), also known as an outpatient surgery center or same day surgery center, is a health care facility where surgical procedures not requiring an overnight hospital stay are performed. Such surgery is commonly less complicated than that requiring hospitalization. These facilities may also be referred to as an Ambulatory Surgical Facility (ASF).

2. Federal requirements. In order to participate in the Medicare program, ASCs are required to meet certain conditions set by the federal government to ensure that the facility is operated in a manner that assures the safety of patients and the quality of services. The health and safety standards are set by the Centers for Medicare & Medicaid Services (CMS) and details can be found at the following website: Federal Requirements Governing ASCs

3. State licensing. The Pennsylvania Department of Health licenses and verifies compliance with state and federal health and safety standards in supervised health care facilities as mandated by law, including ambulatory surgical facilities. To determine if an ASF is licensed you can look-up the facility at the following website: PA Dept. of Health – Health Care Facilities

4. Voluntary accreditation. ASCs may also seek voluntary accreditation. There are four accrediting bodies that are recognized by CMS for their high standards of quality care: The American Association for Accreditation of Ambulatory Surgery Facilities (AAAASF), The Accreditation Association for Ambulatory Health Care (AAAHC), The Healthcare Facilities Accreditation Program (HFAP), and The Joint Commission.

5. An ASC may have very different ownership structures including 100% physician; physician & hospital joint ventures; physician & corporate partner; 100% hospital and many other structures. By operating in ASCs instead of hospitals, physicians may have increased control over their surgical practices. Just because your surgeon owns the center does not mean that it is better than one with a different ownership structure.

6. Anesthesiologists are certified by The American Board of Anesthesiology (ABA). Board certification shows a physician’s commitment and expertise in consistently achieving superior clinical outcomes in a responsive, patient-focused setting. The ABA developed the Maintenance of Certification in Anesthesiology Program (MOCA) to help physicians demonstrate their commitment to quality clinical outcomes and patient safety. You can check here to see if your anesthesiologist is meeting the requirements of the MOCA Program: Search Physician Directory

7. Additional questions to ask your surgeon:
   1. What is the emergency plan for the facility and how close is the nearest hospital?
   2. Does the surgeon have admitting privileges at the closest hospital?
   3. Does the facility have current resuscitation equipment on site?
   4. Is the surgeon and the staff trained in advanced life saving techniques in case of emergency?
   5. Is the equipment in the facility clean, appropriate and in good condition?
   6. When was the last time the equipment efficacy was checked?

An outpatient facility is an appropriate option for many patients, but consider a hospital to be a better choice if you have any history of: bleeding disorder, chronic lung disease, congestive heart failure, heart attack within the last six months, a serious arrhythmia, serious weight problems or uncontrolled diabetes.

And lastly, never be afraid or uncomfortable to ask your surgeon for a tour of the ASC before your surgery.