OR Manager April 2022 - 29

AMBULATORY
SURGERY CENTERS
Q: What goes into creating and
maintaining safety?
ASCs following Medicare guidelines will
all follow emergency medical service
protocols and will have emergency supplies
available, with daily and monthly
checks as well as required drills.
Any new service line that comes
to an ASC requiring significant capital
costs calls for a feasibility study. This
is a very in-depth feasibility study based
on the pro forma, to assess capital,
supply and staff needs, and anticipated
growth related to net revenue. Consider,
what is the current volume of those
cases, payer mix, American Society of
Anesthesiologists patient classification,
etc?
We will start pulling out those volumes
and see what the reimbursement
is for those procedures based on CPT
codes and Medicare procedures that
can be performed in the ASC. I also
look closely at
the state rules. Can
these procedures be brought to the
ASC? We start really whittling away the
initial information with a minimum of a
years' worth of data.
Your governing board should ask:
is this a strategic plan for our hospital
partner, for our physician group? And
what is your time frame for this? There
is a multi-focal approach to decide
whether you are going to introduce a
service line at any ASC, not just cardiac
procedures, at a surgery center.
Q: How do you select patients?
We have preselection criteria for our
surgery centers. This includes patient
history, physical assessment, comorbidities,
and allergies. Each service line
will have specific needs related to patient
selection. In the cardiac and vascular
population, the center will need
to understand antiplatelet risk assessment,
anticoagulant blood test needs,
EKG and other tests, medication, sedation,
and anesthesia requirements to
perform the procedure.
We work with anesthesia personnel
and the cardiologist. We do not want
www.ormanager.com
Safety snapshot of cardiac procedures in ASCs
Which cases are appropriate?
➤ Vascular procedures
➤ Lower and upper extremities, A/V fistula,
embolectomy, vein ligation and
ablation, dialysis catheter access
➤ Cardiac rhythm management
➤ Pacemaker insertion, defibrillator insertion,
loop recorder, generator exchange
➤
Percutaneous cardiac intervention
➤ Diagnostic coronary catheterization
including right and left ventriculogram,
aortic visualization, 1 vessel
intervention with run off (percutaneous
transluminal coronary angioplasty
and stent placement)
What equipment will you need?
➤ Portable units (C arm and table) versus
stand-alone single system with C
arm and bed in one unit (Floor versus
ceiling mount)
➤ Injector
➤ Emergency backup supplies
➤ Anesthesia needs machine, cart, gas
analyzer, mixer, monitor, defibrillator/
pacer
➤ Lead screen
➤ Interventional needs
➤ Sterile processing department (SPD)
needs
➤ All other ASC needs (peri-anesthesia,
registration, and business office)
What types of patients should not
get treatment?
➤ Unprotected left main stenosis or
three vessel coronary artery disease
➤ Any cardiac or noncardiac signs of
clinical instability
➤ Significant peripheral artery disease-
limiting femoral and radial access
➤ Severe aortic stenosis
➤ Severe contrast allergies
➤ Decompensated congestive heart failure
➤
Recent transient ischemic attack/
stroke
➤ Left ventricular ejection fraction
➤ Chronic kidney disease
➤ Anemia
➤ Acute coronary syndrome
➤ Severe pulmonary hypertension, advanced
chronic obstructive pulmonary
disease
Reference
OR Manager Conference. 2021. Presentation
by Deb Yoder, MHA, BSN, RN,
CNOR, vice president for clinical operations,
Surgical Management Professionals.
patients
with life-threatening issues. Are
they in renal failure or have other comorbidities?
Work with your team to determine
that list (sidebar, Safety snapshot
of cardiac procedures in ASCs).
Bottom line, any service line can be
implemented with consistent checks
and balances in place, and we have
developed that for all service lines covered
in ASCs throughout the nation.
Just because you can do a procedure
does not mean you should do it. I do
not necessarily want a patient with a
BMI over 50 if I'm putting them prone.
We want to make sure what we are
doing is safe for everyone that walks
through our doors. ORM
-Jennifer Lubell is a freelance medical
and health policy writer based in
Rockville, Maryland.
References
ASA Physical Status Classification System.
American Society of Anesthesiologists.
Last amended December
13, 2020.
Report to the Congress: Medicare Payment
Policy. Medicare Payment Advisory
Commission. March 2021.
OR Manager | April 2022
29
https://www.asahq.org/standards-and-guidelines/asa-physical-status-classification-system https://www.medpac.gov/wp-content/uploads/import_data/scrape_files/docs/default-source/reports/mar21_medpac_report_to_the_congress_sec.pdf http://www.ormanager.com

OR Manager April 2022

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