- During their most recent state-government inspection, 77% of ambulatory surgery centers had at least one violation, and 25% of them had serious deficiencies, according to a new report from the HHS Office of the Inspector General. Infection control was more common than other issues, with states citing 55% of ASCs with one or more deficiency.
- From 2013-2017, infection control issues were the most frequently cited type of deficiency, making up about one-fifth of all violations, OIG reported.
- Infection control was also a recurring issue among patient complaints, ranking as the second most common category of complaint (24%) after quality of care and treatment (35%). During the same time period, state governments substantiated nearly half of the 632 complaints they investigated through on-site evaluations, according to the OIG.
Payers, including Medicare, are pushing to move more procedures and patients to ASCs and away from costly hospital settings. The number of ASCs grew 25% from 4,490 in 2006 to 5,603 in 2017, according to OIG. Medicare spending on ASC procedures also increased from $3.4 billion in 2011 to $4.6 billion in 2017, according to the report.
And CMS periodically adds new procedures to its coverage list for ASCs. For example, it added many types of cardiac catheterization procedures to the list in 2019 and removed total joint replacements from the inpatient-only list in 2018.
Given the rapid growth of ASCs, oversight of the centers through CMS' certification process is crucial to ensure that patients receive safe and high-quality care. Infection control has been an ongoing issue at ASCs, according to OIG, which said the Government Accountability Office recommended in 2009 that CMS improve its data collection on infection control practices at ASCs.
To meet Medicare's certification requirements, ASCs undergo an on-site inspection by their state or seek accreditation through a CMS-approved organization. States also respond to complaints from patients or others, conducting on-site investigations for the most serious matters.
In 2017, the OIG also found that a majority of states (35) met CMS's requirement that each year they inspect 25% of the facilities that choose the state certification process. For those that missed the mark, seven states were within one inspection of doing so, and eight were two or more surveys short.
But only about half of the states (22) met another CMS requirement — inspecting each ASC every six years. Some 24 other states came close, surveying between 90% and 99% of ASCs within the past six years. Eleven states failed to meet both requirements. Hawaii, Nevada and New Jersey missed both requirements by large margins, OIG said.
In addition to infection-control deficiencies found during the most recent survey of ASCs, states cited 37% of centers for issues with pharmaceutical services, 33% for environmental conditions, 30% for patients' rights, and 28% for admission, assessment and discharge deficiencies.
Overall, the performance of ASCs on the certification inspections improved over time. The mean number of deficiencies per survey decreased from 6.1 in 2013 to 4.2 in 2017. However, OIG said, "These decreases could reflect improvements in ASC performance and/or changes in how states assessed compliance."