Oversight of ASCs dubbed 'a system in neglect'

WASHINGTON — Accreditation of ambulatory surgery centers is “a system in neglect,” according to a scathing government report released March 1. Oversight of the surgical facilities is more important than ever, the report said, because of the growing number of centers and the astronomical increase in numbers of procedures performed in them.

The report, prepared by the Office of Inspector General (OIG) of the Department of Health and Human Services, said recertification of ambulatory surgery centers (ASCs) by the Centers for Medicare & Medicaid Services (CMS) is failing and lacks accountability.

The CMS pays out more than $1.6 billion for procedures performed in more than 3,000 ASCs, according to the OIG’s "Quality Oversight of Ambulatory Surgical Centers: A System in Neglect."

Ophthalmology’s heavy concentration of procedures performed in ASCs is not ignored by the report. The opening page cites a case in which cardiac arrest and death occurred in an ASC during “one of the most common procedures in Medicare,” cataract removal.

Among the findings in the report:

The number of ASCs more than doubled from 1990 to 2000, and during that time the number of major procedures performed in them increased by 730%. Nearly a third of ASCs certified by state agencies have not been recertified in 5 or more years. While accredited ASCs are surveyed every 3 years, the process devotes little attention to verifying compliance. Further, the CMS does little to hold state certification agencies and accreditors accountable to the Medicare program and the public.

The OIG recommends that the CMS should determine an appropriate minimum cycle for surveying ASCs certified by state agencies, and it should update the Medicare conditions of coverage for ASCs. The CMS should also hold state agencies and accreditors accountable to the Medicare program as well as to the public for their performance overseeing ASCs.

"We urge CMS to devote a sense of urgency to the early warning signal we provide and to develop an action plan detailing the specific actions it will take to improve ASC oversight," the OIG report recommends.

The full report is available at http://oig.hhs.gov/w-new.html or http://oig.hhs.gov/oei/reports/oei-01-00-00450.pdf