OIG report blasts surgery center oversight
OIG report blasts surgery center oversight
If recommendations from a new Office of Inspector General (OIG) report are adopted, ambulatory surgery centers (ASCs) will be required to post their Medicare survey results and their complaint history for all to see.
"I don’t understand, because if they already have approved you, it should be enough to put up the approval for patients to see," says Lawrence Pinkner, MD, immediate past president of the San Diego-based American Association of Ambulatory Surgery Centers and president of the SurgiCenter of Baltimore. Pinkner expresses doubts about whether surgery centers would comply with a requirement to post complaints made against their facility. "It’s like a store putting up a sign: Our food is bad, and our clerks are impolite.’"
The OIG report, Quality Oversight of Ambulatory Surgical Centers: A System in Neglect, states that the system of quality oversight by the Centers for Medicare & Medicaid Services (CMS) is not up to the task. (See recommendations, below. For information on how to access the report, see "Resources" at the end of this article.)
| Recommendations | |
| 1. | The Centers for Medicare & Medicaid Services (CMS) should determine an appropriate minimum cycle for surveying ambulatory surgery centers (ASCs) certified by state agencies. |
| 2. | CMS should update the Medicare Conditions of Coverage for ASCs. Add sections to address patient rights and continuous quality improvement. Make conditions adjustable to match the levels of surgery performed by different ASCs. |
| 3. | CMS should ensure that state agency certification and accreditation strike an appropriate balance between compliance and continuous quality improvement. Monitor state agencies and accreditors to ensure that they protect the public from poor performing ASCs while encouraging the rest to go beyond minimal health and safety standards. |
| 4. | CMS should hold state agencies and accreditors fully accountable to the Medicare program for their performance overseeing ASCs. Use electronic data reporting; federal oversight surveys; and formal, periodic evaluations to monitor and provide feedback to state agencies and accreditors. |
| 5. | CMS should do more to hold state agencies and accreditors accountable to the public for their performance overseeing ASCs. Take steps to increase public information about state agency certified and accredited ASCs and accessibility of state agencies’ and accreditors’ complaint processes. Publish public performance information about state agencies and the accreditors. |
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| Source: Office of Inspector General. Quality Oversight of Ambulatory Surgical Centers: A System in Neglect (OEI-01-00-00450). 2002; Washington, DC. | |
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"States have not recertified nearly a third of ASCs in five or more years, and CMS does little to monitor the performance of state agencies and accreditors," the OIG claims. The OIG points to the explosive growth of surgery centers and the complexity of the procedures performed there. "For these reasons, oversight is more important than ever," the agency says.
This report is not about the quality of care provided in an ASC, but rather how well does Medicare oversee private accrediting bodies and state surveys, maintains Kathy Bryant, executive director of the Federated Ambulatory Surgery Association (FASA) in Alexandria, VA. "Right now, not very well’ is the answer," she says. "However, that doesn’t mean that the Medicare conditions of coverage are not being followed by ASCs."
To help address the issue of quality oversight, the OIG recommends that surgery centers display instructions on how to post complaints to Medicare and accrediting groups. However, there may be a better way than a sign to communicate this information to patients, Bryant says. "One example might be to include [that information] in discharge instructions, which would mean that the patients would have the information when they got home," she says. In addition, the report says, if CMS makes the survey results more widely available, it also should provide comparative data, such as the average number of deficiencies outstanding at all ASCs.
The Wilmette, IL-based Accreditation Association for Ambulatory Health Care (AAAHC) supports comparative data across the board . . . not just deficiencies, says John E. Burke, PhD, executive director and CEO. "Information that is reliable and useful to consumers and presented in an understandable and accessible format would be useful," Burke says.
CMS would need to take great care in ensuring the accuracy and consistency of surveyors, Bryant maintains. Currently there are significant variations among geographic regions in how the state surveyors interpret the Medicare conditions of coverage, she says. "It also varies by surveyors, whether state or private accrediting bodies, and over time," Bryant says. Also, the data would need to be separated by type of ASC, or it would be useless, she says. "A large multispecialty facility might look bad on certain criteria simply because of the cases it does as compared to others," she says.
Pinkner agrees. "You have to differentiate between ambulatory surgery at a hospital, and ASCs that are owned by hospital on campus, and multispecialty surgery centers vs. the small physician’s office," he says.
The changes recommended by OIG do have a positive side, points out Eric Zimmerman, JD, MBA, attorney with McDermott, Will & Emery in Washington, DC. "If done right, it can be helpful; it can demonstrate the high quality of service provided in ASC and not be overly intrusive," he says. "The question is how they fashion that requirement." Information that tells the public about the high quality of service in ASCs is generally a good thing, "but you have to balance that helpfulness with the burden of providing that information," he says.
Bryant also expressed concern about the burden, and she points to the requirement for continuous quality improvement. "In one proposed draft, they were looking at a several paragraph provision where a one paragraph condition now exists," Bryant says. "As they say, the devil is in the details." Also, the report calls on surgery centers to have systems in place to resolve patients complaints, but according to FASA’s outcomes monitoring system, 98.6% of ASCs have such a system. The report also called on surgery centers to have systems in place to "respect patients’ dignity."
"Part of the reason ASCs have been so successful is that they do provide a more patient-friendly environment and more personal attention than larger, more bureaucratic institutions, so I think ASCs already have had a head start on that one," Zimmerman says.
Resources
The report Quality Oversight of Ambulatory Surgical Centers: A System in Neglect (OEI-01-00-00450) is available free on the web: oig.hhs.gov/oei/reports/oei-01-00-00450.pdf. Quality Oversight of Ambulatory Surgical Centers: The Role of Certification and Accreditation — Supplemental Report No. 1 (OEI-01-00-00451) is available free at oig.hhs.gov/oei/reports/oei-01-00-00451.pdf. Quality Oversight of Ambulatory Surgical Centers: Holding State Agencies and Accreditors Accountable — Supplemental Report 2 (OEI-01-00-00452) is available free at oig.hhs.gov/oei/reports/oei-01-00-00452.pdf. To order a free copy by mail, contact:
• Office of Inspector General, Public Affairs Office, 330 Independence Ave. S.W., Washington, DC 20201. Telephone: (202) 619-1343. Fax: (202) 260 8512. E-mail: [email protected].
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