Monday, January 27, 2020
The Challenges of ASC Accreditation
Dr. Arnaldo Valedon is a fellowship-trained anesthesiologist at WellSpan Health and a longtime ASC field surveyor. He will be speaking at the OVBC 2020 conference about how to navigate state and federal regulations and how to prepare for an all-important ASC site survey visit. In this interview, he shares what he’s learned as a field surveyor, the unique challenges facing today’s ASCs, and where he sees the field going from here.
As told to Lauren McGill. Edited for clarity and conciseness.
Tell me about your role as an ASC field surveyor?
I’ve been a surveyor for The Accreditation Association for Ambulatory Health Care (AAAHC) for 25 years – I can’t believe it’s been that long! I’ve done over 60 surveys in the U.S. and abroad in South America and Central America.
As part of those duties, I have also become a surveyor for the Center Medicare and Medicaid services as part of AAAHC’s Deemed Status Program. I’ve been able to see ambulatory healthcare develop and I’ve seen perioperative care evolve in so many different ways over the years. I have also observed how the survey process has changed over time.
How has your medical background informed your perspective on ASC management?
My experience as an anesthesiologist has influenced my perspective a great deal. I consider anesthesiologists to be perioperative managers. Our involvement in patient care as anesthesiologists is not just in the operating room, but we really need to prepare and deal with patient conditions long before the patient arrives at our door. We also deal with patients not just when they’re here, but also when they go home which requires planning.
There will also be consolidation of the market – it’s already happening and I fully expect that will continue to increase.
What are some of the challenges facing ASCs?
I think that the top pain point is an ever-changing regulatory landscape for facilities. Ambulatory Surgery Centers (ASCs) are very heavily regulated facilities and it is difficult to keep up with laws and regulations, at both the federal and state levels. Also, profitability is part of the challenge because reimbursement is ever-changing.
The evolution of outpatient surgery has made us very aware of financials and of regulations, but also of the latest and greatest of what goes on in our field.
If there is something that I’ve learned in the last 25 years, it’s that a successful, efficient, high-quality centers must involve a team approach.
Why is reaching accreditation an important milestone for ASCs?
There are several reasons why accreditation is meaningful. There are certain facilities – particularly those that are seeking CMS certification – that require accreditation. But for other facilities, it is more of a feather in their cap. It’s a sign of meeting quality standards, many of which are evidence-based at this point, which span from straight clinical standards to administrative guidelines.
Medical facilities that really commit to the accreditation process can get very organized by doing so. It’s very much about benefiting from the process, which can certainly highlight the pieces that are going to create an organization of high quality.
It is my opinion that ASCs will win by a long shot in being able to provide equal or better care at a lesser price.
Why is it important to have a multidisciplinary team present when discussing how to operate a successful ASC?
If there is something that I’ve learned in the last 25 years, it’s that a successful, efficient, high-quality center must involve a team approach. We all depend on each other to identify potential snags in the process that can derail efficiency. It really takes a village!
It starts in the surgeon's office when they see that patient. Outpatient surgery really involves patient cooperation and not everyone is a candidate. The surgeon really plays a huge role in determining who is appropriate and who is not appropriate to be done in an outpatient setting. The scheduler in that office has a role to make sure that everything is put in correctly. Then the ASC basically takes it from there – from that point until the patient goes home. The physicians, anesthesiologists, and nurses, etc. must be in unison in order for it to work well.
How do you think ASCs fit into the value-based care model?
They fit hand-in-glove. It’s been shown that free-standing ASCs can be a very safe, efficient, and less expensive model of care. When we look at clinical outcomes, ASCs have been shown to have equal or better outcomes than some inpatient facilities. Also, there are billions of dollars that can be saved by having procedures done in a freestanding ASC. It is my opinion that ASCs will win by a long shot in being able to provide equal or better care at a lesser price.
Because outpatient surgery has developed the way that it has in the last 40 years in the US and worldwide, the role that ASCs have taken has really expanded. What it has shown me, working in as many facilities as I have, is that every aspect of managing an ASC is of vital importance for 1) making it efficient 2) making it evidence-based 3) choosing the procedures, medications, and equipment that will make it more affordable.
I think the OVBC 2020 conference is a perfect example of why it’s important to keep your finger on the pulse of what’s happening.
How will ASCs continue to evolve?
I believe that there will be more regulations for ASCs. Certainly, CMS in the United States is changing the landscape of the types of procedures that are being done. Physician ownership has been extremely successful in the past, and I expect that will continue. There will also be consolidation of the market – it’s already happening and I fully expect that will continue to increase. As for the number of ASCs, the rate of growth of freestanding ASCs has slowed down. It’s not the ever-increasing curve that we saw in the 1980s and 1990s. The rate of growth has slowed down because there is a finite amount of surgeons and regions where ASCs can be licensed.
What value do you think the OVBC 2020 conference brings?
I think the OVBC 2020 conference is a perfect example of why it’s important to keep your finger on the pulse of what’s happening. Orthopedics is a quickly evolving specialty within the field of outpatient surgery because it lends itself to the kinds of patients that can safely be done in freestanding ASCs – total joints and spine surgery are the two of the fastest growing types of outpatient surgeries.
At the conference, I will be talking about ASC accreditation, particularly with AAAHC. I’m also very much looking forward to discussing specialty accreditation in orthopedics, which will be mostly concentrated on total joints. We’ll also look at some evidence-based outcomes for which patients can be safely done and should be done in these facilities. It promises to be exciting!
In addition to his anesthesiology duties at WellSpan Health, Dr. Arnaldo Valedon serves as an ASC surveyor for AAAHC and CMS. He is the past president of SAMBA and has published articles on outpatient anesthesia safety in the Anesthesia and Analgesia medical journal. Come hear him speak about how to prepare for an accreditation site visit on Friday, February 28, 2020 at the Orthopedic Value-Based Care conference as he co-hosts an ASC accreditation panel.