Insuring a Safe Environment

Insuring a Safe Environment

By Susan Chmieleski, APRN, FASHRM, JD

While the long-term viability of an ambulatory surgery center (ASC) is driven by a multitude of factors, focusing on patient safety, sound clinical practices, and preparation for potential liabilities should be leadership priorities.

ASC management must keep current with the standard of care for all services that are provided and must annually review policies and procedures to ensure that they are both consistent with the standard of care and are an accurate reflection of how care is provided at the center.

Patient safety and clinical practices that management should focus on include:

• Implementation of all of the National Patient Safety Goals, regardless of accreditation status 
• Appropriate credentialing of all surgeons and anesthesia providers, adoption of global privileges, and awarding of specific privileges to each provider of care 
• Ensuring that each patient engages in an informed consent discussion with both the surgeon and anesthesia provider and that consent for each procedure is documented in the clinical record 
• Consistently following infection control procedures and using tracking mechanisms to trend data and include it in the performance improvement process 
• Use of a non-punitive event reporting process that includes near misses, investigations, and proactive responses to events 

Each ASC decides how it will deal with risk — avoid it, keep it, or transfer it by purchasing insurance. In preparation for potential liability remember the following tips:

• Establish medical staff bylaws or rules and regulations that specify the minimum amount of professional liability insurance that providers must have. Obtain copies of each provider’s policy on an annual basis 
• Work with an independent insurance agent/broker who understands ASC exposures and has access to specialty insurers that offer ASC-specific coverage 
• Understand the key policy terms and conditions of all insurance policies such as whether your policy is a claims-made policy, requiring a claim or medical incident to be reported to the insurer within the policy period in which it occurs; or an occurrence policy, which is designed to cover an event that occurs during the policy period, even if the legal claim arises years after the policy expires 
• There is no standard practice for pricing ASC insurance policies. This means you should determine how you are being charged. More complex procedures may have more risk associated with them; premiums should be based on the type as well as number of procedures performed 
• When purchasing insurance it is important to look for services in addition to the policy itself, such as risk management and loss control support 
• These services help to mitigate potential loss and reinforce the central role each individual employed by the ASC plays in managing risk

The Right Person for the Right Job

“The vast majority of ASCs are small organizations that the owners operate in a very cost-effective manner, usually with a registered nurse (RN) manager who barely has time to handle all the clinical functions and paperwork for the center. Those facilities that want to grow and be prepared to meet eminent changes need to retain a skilled/knowledgeable chief executive officer (CEO). A qualified CEO also can advance the ASCs growth and persevere in today’s competitive world. While FWI Healthcare offers this management assistance on a consulting basis, the surgery center industry should be staffing its top positions with master degreed leaders who can carry our permanence forward.” 
— Roger Pence, MHA, president and CEO, FWI Healthcare, Inc.