Compliance: Do We Want to Get on the Airplane?

The following article is written by Joyce Thomas, senior vice president, operations, for Regent Surgical Health.

Do you remember the "good ol days" of traveling? A time when we could schedule our airplane trip and get a real ticket prior to the day of leaving? When we arrived at the airport, our family could go right to the gate and wave goodbye as we passed through the door? Then there came a few more restrictions of going through the scanner - a nuisance but we survived. Soon our families could not meet us at the gate (I still miss that). After 9/11 we had to go through security and cough up all our liquids, lotions and gels, take off our shoes, sweater, etc., and everything went through x-ray as we padded through the scanner. Now they want to check our insides too and x-ray our bodies. Nevertheless, we put up with it because we want to get on the airplane and it is their rules.


Several years ago the Federal government was made aware that many surgery centers (Medicare-certified) had not had ongoing inspections by the states. To correct the situation, the government provided the states with increased funds to hire surveyors. The funds to the states were prorated based on the number of surgery centers within that state. As we have seen increased unannounced surveys, it has been obvious the states are using the funds for the intended purpose. In addition, in May 2009 Medicare revamped the conditions of compliance for ambulatory surgery centers. This first comprehensive change since 1980 has rocked our industry. This change has caused us to pause and think:  Do we want to play the rules of the game and stay on the field?

Regent facilities have successfully weathered the storm of the changes and increased unannounced surveys. This success has been due to the diligence of our clinical directors and the willingness of the facilities to implement change. What we have seen in the industry are the horrid results of centers unwilling to change to meet the new regulations. Most recently, a potential client called us requesting assistance. This financially successful center has been in business for numerous years but did not step up to the plate to remain in compliance. The physicians and leadership were stuck in the "we've always done it this way" mindset. The result of an unannounced Medicare survey was 157 pages of deficiencies and a notice to the facility to close within three weeks. Our question to the partnership has been, "Do you want to remain in business? Are you willing to make the changes necessary to meet the standards?" It is truly a simple decision.

The Medicare hot topics are indeed HOT TOPICS! Come to think of it there are no ''cold topics!" The surveyors are not budging or making any allowance related to infection control history/physical timeliness as related to surgery date or the physical aspects of the facility related to safety. The board must prove they are directly involved in managing the facility, credentialing must be done in a timely fashion and medications must be given under physician order, given timely and documented. Just like the security in an airport, the rules are the rules, and we must ask ourselves, "Do we want to get on the airplane?" Do we want to be Medicare-certified and care for Medicare patients?

For our centers, Regent clinical directors have worked diligently with the facility leadership to create tools for compliance that minimize paper impact on the processes of day-to-day activities. Our goal is to efficiently meet the mandates while facilitating efficient use of the physician and nurses time. It is difficult. I encourage you to talk with your director of nursing and ask to see the May 2009 Medicare standards.


Learn more about Regent Surgical Health.

- Reductions in ASC Private Reimbursements and Flat Revenue Drives New Surgeon and Hospital Alignments


- Regent Surgical Health Partners With Chicago's Swedish Covenant Hospital, 23 Physicians on New Surgery Center


- 7 Common Patient Complaints About Surgery Centers – and How to Prevent Them

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