ACCREDITATION:

ACCREDITATION:
Raising the Bar — and Expectations — for the ASC Community

By Danielle Maheux

The landscape of surgical services has grown exponentially since 1970, when two physicians sought to establish a surgical services alternative to inpatient hospital care and developed the concept of an ASC. Today, ASCs continue to shine as a high-quality, low-cost option for individuals in need of a surgical procedure—particularly those frustrated by the scheduling headaches, limited operating room availability and equipment-related budget issues typically seen in relation to hospital visits. Additionally, as a result of fast-acting anesthetics, less invasive techniques and minimal recovery time, the range of outpatient procedures that can be performed at an ASC has grown dramatically.

“Each year, more and more procedures are being performed in ambulatory facilities,” says Alan Gold, MD, president of the American Association for Accreditation of Ambulatory Surgery Facilities, Inc. (AAAASF) based in Gurnee, Ill. “This is because costs for performing surgery procedures in an outpatient/ambulatory environment have been proven to be lower than those performed in a hospital setting and because recent advances in surgery practices favor the outpatient setting.”

As a result of their popularity, ASCs must be highly regulated to ensure quality and safety; therefore, all states require them to be licensed in order to operate. ASCs also must ensure that the medical staff that is practicing in the facility meets the standards and requirements set forth by the state.

“Credentialing is the process by which an ambulatory surgery center validates the professional qualifications of a practitioner who wishes to provide services at the facility,” says Kathy Hoole, president of the Credentialing Corporation of America (CCA), based in Rocky River, Ohio. “This is the first step in the facility’s quality assurance program.”

She adds that, though credentialing requirements may vary, most processes incorporate these main elements: verification of education, licensure, malpractice history, work history, sanction history and peer evaluations from professional institutions and peers.

“Ultimately, a strong credentialing program will help to improve overall patient care by assuring that the practitioners are qualified to provide that care,” Hoole says. In addition to licensing and credentialing, ASCs must comply with federal government standards surrounding safety, quality and management, and any facilities that serve Medicare beneficiaries must be individually certified by the Medicare program.

“It is crucial to ensure high standards not only for the physicians through board certification but also to set standards for the ambulatory facilities in which 70 percent to 80 percent of these physicians practice,” Gold says.

So, in light of the rigorous mandated licensure requirements, why are more and more ASCs also choosing to pursue accreditation? Simply put, it’s because many facilities have found that being accredited is a great way to show that they have raised the bar in regard to compliance and care—and, to patients, that demonstrates that the facility they are entrusting with their medical procedure deserves such trust.

“Accreditation is largely a voluntary process by which an ambulatory healthcare organization is able to measure the quality of its services and performance against nationally recognized standards,” says Andrea Lee, director of marketing and communications for the Skokie, Ill.-based Accreditation Association for Ambulatory Health Care (AAAHC). “Accreditation differentiates an ASC by instilling a sense of confidence in the community that it has put policies, procedures and processes in place to ensure the highest level of patient care.”

Ultimately, a potential or current patient will have a higher regard for a facility that is accredited, because it is a testament to an overall commitment to quality patient care.

To an ASC, then, this means that accreditation can be used to distinguish one facility from another; an important factor in today’s crowded healthcare business climate.

“Similar to any business inviting a third party in to audit their practices, accreditation provides proof that a surgery center’s standards and practices are up to par with those in a hospital setting,” says Michael Kulczycki, executive director of The Joint Commission, based in Oakbrook Terrace, Ill. “It also shows that the facility is doing all it can to further enhance patient safety.”

Lee agrees and says that one of the main benefits to becoming accredited is the improved quality of healthcare at the ASC seen throughout the accreditation process itself, which is very learning-oriented.

“Our accreditation process involves a self-assessment by the ASC as well as a thorough on-site review by the AAAHC’s expert surveyors,” she adds. “It is this self-analysis, peer review and consultation that ultimately helps a facility to improve its care and services.”

AAAASF requires a similar self-assessment, Gold says, because maintaining safety and quality of care in the ambulatory surgery setting is a dynamic process that requires constant review and revision of the standards.

“AAAASF rigorously inspects and evaluates each facility seeking accreditation to ensure that it meets their standards of excellence and, after accreditation is achieved, the facility is required to perform an annual in-house evaluation to identify any areas that may need improvement,” he adds.

Following through with this process reflects a facility’s dedication to staying on top of ways to constantly update and revamp their patient care procedures so as to best serve the patient.

“Accredited organizations learn a great deal throughout the accreditation process, which helps in every facet of functionality,” Lee says. “This commitment to better patient care is yet another way accreditation is used to differentiate between facilities.

One of the biggest issues in regard to compliance, however, is that it is difficult to guarantee that a facility is adhering to regulations each and every day. It is easy to see how they may step up their standards during inspection and then digress to a more lax, day-to-day routine.

To address this, accrediting bodies have taken to performing unannounced surveys and re-surveys, so as to check up on ASCs and ensure that they are adhering to local, state and federal regulations as well as the accrediting body’s policies on a regular basis. Trained surveyors, who may be volunteers or actual employees of the organization, are sent to assess each facility’s competency and compliance in accordance to the standards set forth by the accrediting organization.

“Our surveys are done by a cadre of part-time employees of The Joint Commission,” Kulczycki says. “We provide extensive training— two weeks before they begin as surveyors and two additional weeks every year thereafter.”

The high level of training mandated by accrediting bodies for their surveyors ensures that each ASC is carefully examined by someone who knows the principles of the accrediting body in and out and can therefore hold all facilities to the same high standards each and every time they are inspected.

“The on-site interaction and inspection process verifies compliance with standards, provides a resource to the facility’s management through the inspector’s experience and expertise and offers a unique educational opportunity to the surgeons and facility staff,” Gold says. “We strongly believe this is the ultimate in peer evaluation and quality assurance since the inspector can provide invaluable information and insight.”

The surveyors overall focus on safety and continuous compliance furthers the idea of using accreditation to differentiate between facilities—because being an accredited facility tells patients that the ASC is putting their health and wellbeing at the top of its priority list during inspection and every other day.

“More than 50 percent of our ambulatory standards are related to safety, whether it’s the physical environment or the proactive identification of areas that need improvement,” Kulczycki says.

“One such standard requires ASCs to do a Hazardous Vulnerability Analysis, in which the facility anticipates the potential impact of a disaster on the physical structure of their building and the ability of the staff to communicate with patients or family. This helps to identify the best course of action to take before anything actually happens.”

Kulczycki also says that because ASCs are primarily devoted to outpatient surgery, they may be better able to meet the high standards set forth by ambulatory accrediting bodies than a hospital that deals with medical procedures of many types and levels of intensity.

“A Harvard professor uses the term ‘focused factories’ and that applies to ASCs in that these facilities have identified that they will do one thing really well—outpatient surgery,” he adds. “As a result, ASC staff, surgeons and anesthesiologists are devoted to and focused on patient care of the highest quality with the lowest risk.”

The track record of accredited ASCs having safer facilities that are consistently maintaining compliance has not gone unnoticed by regulatory bodies and insurance companies.

“AAAASF has proven that an ongoing accreditation program will help distinguish the high echelon performers from the rest of the field,” Gold says. “State governments and their regulatory agencies have recognized our standards and have often used them as a model for laws and regulations; similarly, insurance companies stand to benefit greatly from alignment with the high echelon performers.”

Some states are also turning to accrediting bodies as a way to help them combat licensure backlog as the growing number of ASCs overwhelms the government’s personnel capabilities. “We are increasingly seeing states looking to use accreditation in lieu of state licensure and other regulation requirements,” Kulczycki says. “Some are doing it because of a lack of manpower and subsequent licensure backlog; some are doing it because they realize that using accreditation as an alternative to licensure enables them to focus their attention on other critically backlogged areas, such as complaint surveys.”

Lee adds that financial and employee cutbacks in regulatory agencies have also opened their eyes to using accreditation, which shares many of the regulatory goals that these agencies require for licensure.

“States are looking more closely at accreditation as fiscal issues have caused cutbacks in state agencies,” she says. “In particular, the move toward state regulation of office-based surgery has facilitated the use of accreditation by states. To minimize the burden on resources, many states regulating office-based surgery have chosen to rely on accreditation exclusively.”

Increasingly, liability insurers also are recognizing what accreditation means in regard to safety—increased awareness practices equal less payouts from insurance companies, and they have begun to reward ASCs for maintaining an accredited status.

Darwin Professional Underwriters, Inc. is one of the forward-thinking insurance companies that see accreditation as a great example of their client’s attempt to minimize liability and therefore choose to ‘thank’ them with financial considerations—namely, credits on premiums.

“We happen to have the advantage of insuring many Joint Commission-accredited organizations,” says Susan Chmieleski, vice president of risk management and client services at Farmington, Conn.-based Darwin. “We feel that accreditation shows objective evidence of a facility’s commitment to and investment in overall safety.”

In fact, Chmieleski says that Darwin has such a high level of respect for the standards promoted by The Joint Commission that the company has adopted them as part of their screening process. Specifically, Darwin looks to the National Patient Safety Goals, which The Joint Commission designed to bring extra attention to areas of greater risk for patients and staff.

“We really believe that fully implementing the National Patient Safety Goals is a way to ensure that a facility is delivering safe patient care and avoiding significant injury to patients,” she adds.

Incentives from liability insurers and governmental bodies truly demonstrate that accreditation is a reflection of an ASC’s commitment to excellence in the ambulatory care industry— but they don’t guarantee that the facility will succeed in an over-saturated market. Therefore, it is up to the facility to use accreditation to their advantage as a means of distinguishing itself from all the other facilities in the marketplace. 

The key is to get the word out to the patients because, ultimately, the success of an ASC depends on their response—which means they need to be assured that the facility they entrust with their surgical procedure is the best facility around.

So, in order to truly utilize accreditation as a means of separating themselves from the crowd, ASCs are turning towards various marketing techniques to let patients know of their overarching commitment to safety and quality care.

In response to this, the accrediting bodies have put together various tools to assist the ASCs in disseminating what it means to be accredited to the public.

“We have a public service campaign called ‘Speak Up’, designed to encourage the patient to take an active responsibility in their care and become engaged in the overall process,” Kulczycki says. “We have a host of brochures in English and Spanish as well as a poster geared toward patients that are available for ASCs to place in their facility and hand out.”

The “Speak Up” program is designed to encourage patients to help prevent healthcare errors by being an active, informed and involved member of their own healthcare team. The Joint Commission allows any accredited facility to download and reproduce their nine brochures for placement in the ASC lobby or patient rooms. In a survey conducted in 2005, of more than 600 accredited organizations, 81 percent reported that campaigns like Speak Up bring value to the accreditation process.

The AAAHC also is dedicated to helping ASCs successfully promote their accredited status and offers helpful tips and guidelines for marketing strategies.

“As healthcare costs rise and quality of care increasingly becomes a public and professional concern, it is important to provide information to patients that will be useful in their selection of appropriate and cost-effective health care services,” Lee says.

A list of suggested communications activities, guidelines for preparing a news release as well as sample releases and announcement letters are available on their Web site.

Helpful tools like these show accredited facilities how to best inform their patients about why the facility chose to pursue accreditation and what it guarantees about the ASCs patient care. This is a key part of using accreditation to its best advantage. If the patients are unaware of what accreditation means to them in regard to the level of compliance and safety at an ASC, then that facility has lost out on the opportunity to distinguish itself from the crowd.

In the large healthcare market, the public has many options of where to turn for their medical procedures and they often look to ASCs for a quality, cost-effective choice. But as the marketplace of outpatient surgery centers continues to grow, competition for patients also continues to develop—which in turn creates a rising need to distinguish one facility from another. Accreditation is being used as the means by which to achieve that goal.

“More than 50 percent of all surgery centers are currently accredited,” Kulczycki says. “And that number is growing 10 percent to 20 percent each year.”

The stringent policies and procedures surrounding accreditation can be used as key selling points for retaining current patients and obtaining new ones, because being accredited is seen as a seal of approval in regard to a facility’s practices.

“The establishment of standards and the site visit process enables surgeons who operate outpatient surgery centers to develop a quality facility, verify that quality with objective assessments against measurable standards, correct and identify deficiencies and ultimately improve the quality and safety of patient care,” Gold says.

Accreditation also suggests that an ASC is holding itself to an even higher standard than regular licensure requirements—and since the health and safety of a facility is a big factor in the decision-making process of any potential patient, that extra level of assurance is certainly helpful. ASCs and surgical hospitals that pursue accreditation are not only helping to establish themselves as top-quality providers, but they are setting themselves up for success by differentiating from the run-of-the-mill outpatient facilities that have overcrowded the health market.

“Accreditation demonstrates an organization’s commitment to provide safe, high-quality services to patients,” Lee says. “And that sends a signal of confidence to the community that the facility serves, which increases an ASC’s competitive edge in the marketplace.”