More Regulations for Surgery Performed in Physician

Offices
By Cynthia Hayward
Originally printed in the
SpaceMed Newsletter
Summer 2009
www.spacemed.com

BACKGROUND
Outpatient surgery from the removal of lumps and bumps to knee repairs accounts for more than 65 percent of all surgeries in the U.S. Due to the development
of shorter-acting anesthesia and minimally-invasive surgical techniques, a significant amount of outpatient surgery has shifted from the hospital-based surgery suite
to outpatient facilities and physician offices over the past two decades. These outpatient settings typically offer more convenient scheduling, improved patient access, and lower costs. About 45 percent of these procedures occur in hospitalbased outpatient facilities which are operated by highly regulated hospitals. An additional 38 percent of these procedures are performed in more than 5,000 ambulatory surgery centers which are typically certified by the federal Center for Medicare
and Medicaid Services, are accredited by an independent agency, and may also
have to be licensed by their state. To be accredited, facilities must meet stringent
standards for equipment, operating room safety, personnel training, and surgeon
credentials. Physicians in states with no regulations may perform surgery solely
under the physicians medical license with no formal licensing or accreditation requirements. Some physicians may choose to be voluntarily accredited by one of
three agencies that perform the inspections, but the process can be costly.
Some facilities that call themselves surgery centers are often nothing more than
glorified physician offices that are not accredited or certified by Medicare. For example, to qualify as an ambulatory surgery center, a facility cannot share waiting
space or other business operations with non-surgical patients and additional quality
control processes for anesthesia and a formal backup procedure for medical emergencies are required.
CURRENT TREND
Due to some highly publicized cases where a patient died while undergoing surgery
in a physicians office, states are beginning to regulate the estimated 35,000 to
45,000 physician offices in the U.S. that also perform surgical procedures representing about 17 percent of all outpatient surgical procedures. Only a fraction of
these physician offices are accredited. California, New York, Florida, Indiana, Nevada, and Arizona are now regulating these procedures. For example, in New York,
the states roughly 3,000 physician offices, that perform surgery under moderate to
deep sedation, must have their facilities inspected and accredited by independent
review agencies or face penalties from the New York state medical board:
CONCLUSION
This may force physicians to rethink performing surgery in their offices and result in
the transition of these cases to accredited ambulatory surgery facilities or even
back to hospital surgical suites.
Cynthia Hayward, AIA, is founder and principal of Hayward & Associates LLC.

2009.2.3

Copyright SpaceMed

www.spacemed.com

Page 1 of 1