CMS informed states on Nov. 5 that resources for initial surveys would be severely limited. In a memo CMS stated that new providers and suppliers would be to be given the lowest priority -- and that providers that have accrediting organization options for accreditation, as ASCs do, were strongly encouraged to seek third-party accreditation rather than state surveys in order to avoid unnecessary delays. According to Fred Ortmann III, the founder and CEO of Ortmann and Associates, the delays vary by state, and ASCs in development should check with the appropriate state authorities to determine just the extent to which surveys will be delayed.

"We recently opened two new surgery centers in Florida, [which] has announced that new facilities are in Tier 4 of its priority sequence and are therefore discretionary to some extent, and will therefore experience significant delays," says Mr. Ortmann. "Significant here can mean in excess of one year."

Fortunately there is an alternative -- although one that is a bit costly.

"A center can have its chosen accrediting body do the Medicare Certification review, but we discovered a part of that process that can further slow the process," says Mr. Ortmann. "We therefore were pursuing a review by the accrediting body; however, we were informed that we first needed a Life Safety review; Florida has perhaps the most extensive and in-depth Life Safety inspection process in the country, and upon completion of this survey, the state actually completes the CMS 2786 report, which is the 'Fire Safety Survey Report -- Ambulatory Surgical Centers' for Medicare. This means that any other survey done by an accrediting body would be redundant."

"We asked the accrediting body about this, and it agreed to waive the survey if we provided a copy of the CMS 2786," Mr. Ortmann continued. "I spoke with Skip Gregory, chief of the Florida Health Facilities Division; he contacted the Florida Agency for Health Care Administration licensure division and it has agreed that, in the future, its surveyors will leave a copy of the CMS 2786 at the facility. The facility can then present this to its accrediting body and ask for a waiver of the Life Safety Survey. When we did this, our accrediting body approved our request and immediately started scheduling the Medicare Certification survey. This saves several thousand dollars in survey fees and helps get the center approved by Medicare more rapidly, which can also save many thousands of dollars."

According to Mr. Ortmann, this process applies only to Florida at this time, but those who are developing ASCs in other states can check with their state to see if the same conditions apply and, if so, can consider using this approach.

For ASCs, there are several options for accreditation, including the Joint Commission at (202) 783-6655, the AAAHC at (847) 853-6073, the AAAASF at (847) 775-1970, and the American Osteopathic Association at, (312) 202-8060.