In addition to the oversight imposed through Medicare, ambulatory surgical centers (ASCs) are subject to state and local regulations.
• Maryland Maryland has 339 ASCs, the most in the region. Each is required to have federal certification and a state license. Larger centers also require a state-issued "certificate of need." Approval requires a quality check, said Carol Benner, director of the Office of Health Care Quality at the Maryland Department of Health and Mental Hygiene. ASCs are surveyed about every three years by the state, acting on behalf of Medicare.
"The only restriction that we have," said Benner, "is that ASCs cannot keep people for more than 23 hours."
The state has authority to ban procedures, but has never done so. ASCs are not required to report deaths or injuries to state authorities.
Patient complaints are handled by the state Office of Health Care Quality, 877-402-8218, www.dhmh.state.md.us/ohcq/.
• Virginia Virginia's 38 ambulatory surgical centers are regulated by the Center for Quality Healthcare Services and Consumer Protection, a part of the Department of Health. According to Nancy Hofheimer, the center's director, state regulations cover ASCs' organization and management, policies and procedures, staffing, patient care services and physical design standards.
A state license and a certificate of need are mandatory, said Hofheimer; Medicare certification is voluntary. State licensing inspections of ASCs are conducted every other year. Virginia does not dictate which procedures may be performed or which types of anesthesia are used. As in Maryland, patients may not be kept more than 23 hours. Adverse events can be reported to a complaint unit at the center (804-367-2126,www.vdh.state.va.us/quality). ASC officials are not required to report deaths or injuries.
• District of Columbia The District's Health Care Facilities Division (HCFD) of the Health Care Regulation and Licensing Administration (HCRLA) in the Department of Health licenses ASCs. The division certifies the District's six ASCs for compliance with local and federal health and safety standards.
According to Leila Abrar, a spokeswoman for the D.C. Department of Health, inspections are conducted annually for license renewal. For ASCs participating in Medicare, surveys are conducted once every six years or as specified by Medicare officials. District law broadly restricts ASCs to procedures that can be performed safely on an outpatient basis, but does not address specific procedures. The law also requires that general anesthesia be performed under the immediate medical direction of a licensed anesthesiologist.
The Health Regulation Administration (202-442-5888, dchealth.dc.gov/about/index_hra.shtm) responds to consumer complaints and incidents reported by ASC personnel, and conducts investigations if indicated.
-- Ranit Mishori
