Medicare's oversight of ambulatory surgery centers: a data brief
- Collection:
- Health Policy and Services Research
- Series Title(s):
- Data brief (United States Department of Health and Human Services, Office of Inspector General)
- Contributor(s):
- United States. Department of Health and Human Services. Office of Inspector General. Office of Evaluation and Inspections, issuing body.
- Publication:
- [Washington, D.C.] : U.S. Department of Health and Human Services, Office of Inspector General, September 2019
- Language(s):
- English
- Format:
- Text
- Subject(s):
- Ambulatory Care Facilities -- standards Credentialing Government Regulation Medicare Surgicenters -- standards Certification Infection Control Licensure State Government Humans United States Centers for Medicare & Medicaid Services (U.S.)
- Genre(s):
- Technical Report
- Abstract:
- Why OIG Did This Review. Because ASCs often perform complex medical procedures, including invasive surgeries under general anesthesia, we examined how Medicare ensures that ASCs meet minimum health and safety requirements through its State survey process. States also conduct investigations of complaints that allege poor care or other problems at ASCs. Medicare beneficiaries are increasingly using ASCs for outpatient surgical procedures. In fact, Medicare payments to ASCs increased from $3.4 billion in 2011 to $4.6 billion in 2017. OIG previously assessed the frequency of ASC State certification surveys in 2002, when we found that nearly a third of nondeemed ASCs had gone 5 or more years without a survey. Since that time, outbreaks of healthcare-associated infections have raised concerns about patient health and safety at ASCs. How OIG Did This Review. We analyzed data provided by Medicare: (1) State data on ASC certification surveys for nondeemed ASCs; and (2) complaints about deemed and nondeemed ASCs from FY 2013 to FY 2017. Using these data, we assessed State survey performance against Medicare’s requirements and analyzed trends in deficiency citations from State surveys and trends in complaint surveys. State Survey Coverage: States largely met Medicare’s requirements to survey 25 percent of nondeemed ASCs in fiscal year (FY) 2017, and nearly half met Medicare’s requirement to have surveyed all ASCs within the prior 6 years. Trends in Deficiencies: States cited 77 percent of nondeemed ASCs with at least one deficiency in their most recent survey, and one-quarter of ASCs had serious deficiencies. From FY 2013 to FY 2017, infection control deficiencies were the most frequently cited category of deficiency, making up about a fifth of all deficiencies. Trends in Complaints: From FY 2013 through FY 2017, States received complaints for fewer than 4 percent of ASCs each year, but the share of those complaints that required an onsite survey more than tripled. What OIG Concludes. The Centers for Medicare & Medicaid Services (CMS) has made progress in strengthening oversight of ASCs and addressing vulnerabilities that the Office of Inspector General (OIG) has previously identified, and more can be done. The results of this new analysis can support CMS in further strengthening its oversight—particularly of the few States that are falling short of meeting its requirements. It can also help CMS focus on ASCs’ recurring challenges in meeting health and safety requirements, especially for infection control.
- Copyright:
- The National Library of Medicine believes this item to be in the public domain. (More information)
- Extent:
- 1 online resource (1 PDF file (23 pages))
- Illustrations:
- Illustrations
- NLM Unique ID:
- 101757671 (See catalog record)
- Permanent Link:
- http://resource.nlm.nih.gov/101757671