Ambulatory Surgery Centers Accreditation Requirement: Is it Enough?
We always strive to provide a safe healthcare to patients. The focus for most governments is to ensure that patients get access to better healthcare easily, without having long wait times. Additionally, the focus remains on nursing care and doctors themselves, to ensure proper diagnosis and treatment.
However, there is a difference between quality assurance and bureaucratizing of healthcare, which makes unnecessary mandates on regulations.
Offering a safe and effective care and meeting regulations may not be the same thing at all times. We should never build such a high wall that we cannot climb over it! Regulations are required to assure a quality care but they can turn out to be counterproductive if we take them overboard.
To implement any mandate you need to have the necessary resources and tools to carry it out- otherwise it becomes similar to mugging up for exams without grasping anything!
The issue we have in our hands revolves around the allegations of mortality and unsafe patient practices by ambulatory surgery centers (ASC). ASCs have long been considered a cost effective alternative to hospital settings carrying out minor surgeries and procedures.
Now the number of ASCs in USA is more than acute care hospitals and increasing each year. It seems that only hospital settings are not sufficient anymore to accomplish the needs of the patient.
The Importance of the Role of ASCs
We know that ASCs offer high quality healthcare at costs lower than hospitals. The average patient in the age of smartphones and internet is more aware about quality of healthcare and cost savings. The situation leads them to prefer ASCs over hospitals when it comes to providing care.
The number or procedures and surgeries performed by surgical centers are also set to increase with Medicare allowing reimbursement of certain procedures like knee replacement and orthopedic interventions.
Healthcare is becoming patient centric and the population also has a greater range of choices with a shift towards value. ASCs have a unique position to cash in on this position and become a quality care provider.
The Current Problems with ASCs
There has been complaints and increasing number of litigations against ASCs and many patients have also lost their life after undergoing surgeries at the centers. In case of hospitals we know who to blame, but what happens in case of ASCs? Who do we blame?
Some of the surgery centers are even operated by non-physician entities who nothing about medicine. Many times they don’t have any idea about healthcare and all the blame trickles down to the physician.
Another problem is that hospitals and ASCs don’t follow under the same regulatory framework. There are not national authorities tracking the performance or mortality of ASCs. Also, not all states require ASCs to be accredited. The government has taken some initiatives like mandating ASCs to be linked with hospitals for emergency situation and set standards but they exist more on the books than reality.
It has also been notices that ASCs sometimes focus too much on cost reduction. They are not able to manage their expenses and cut back on essential equipments and resources.
We cannot Do without Ambulatory Centers!
The patient deaths and the cases of litigation against doctors and ASCs may not always be the result of their faults. The management of any ASC requires the comprehensive knowledge of the pain points of both physicians and the population along with awareness of individual patient risks.
The administration needs to have both administrative and clinical expertise coupled with structured protocols and disciplinary approach to ensure patient safety and meet compliance and regulations.
But majority of the centers are far removed from the requirement to run it effectively. The increased rates of mortality arise out of many factors and the doctor is not to blame in most cases. The deaths and improper care are results of burdening government mandates, lack of staff training, lack of appropriate protocols, lack of implementing protocols, lack of risk stratification protocol, financial gain, lack of training, lack of resources to meet emergency situations and so on!
The Way Ahead for ASCs
The American healthcare will go berserk if we close down all ASCs and that is not even a solution! Hospitals have transformed to a battleground for monopolistic profit gains, politics and ever restricting bureaucracy.
ASCs have always been forward looking and the model of liberation in healthcare ignoring such politics. They are flexible depending on their size and setting and play a big role in delivering care in the country.
We need accreditation and ASCs need to follow them to ensure positive patient outcomes and prevent allegation brought against the management and doctors. Along with regulations we also need accountability which strengthens the quality assurance process- accountability not just for the organization, but down to individual levels. Accountability and quality assurance should go hand-in-hand to make it a foolproof process for all the ASCs.
ASCs need to stay alive and a structured solution will be able to resolve the current problems- structured protocols, policies, training, monitoring with continuous feedback and corrective actions plans.
ASCs should not be bombarded with increasing mandates which makes it difficult for them to compete with hospitals. We cannot use solutions that we developed decades back for the current problems of ASCs. We require a new approach and pattern of thinking to make transform ASCs into high safety patient centers.
For that, we will need train physicians and staff so that they can handle any situation as ASCs are increasingly treading the path of complex and difficult surgeries traditionally performed by hospitals. The physicians need to be in charge of the processes and they need to implement a structured combination of strategy and technology-based approach.
When ASCs will be able to run everything according to the standards, there will be no difficulty in meeting regulations and mandates.