from patients to meet the reporting requirements. After the 2017 final rule, ASCA ramped up its advocacy, pushing for a delay of mandatory implementation of the survey until it is shortened and an electronic option is


available. Both developments


would significantly reduce the cost and administrative burden to ASCs and make the survey easier for their patients to complete. In the 2018 rulemaking cycle, CMS


delayed the mandatory implementa- tion of OAS CAHPS, and this delay has continued while CMS tests an electronic option and discusses other proposed changes. ASCA expects CMS to revisit mandatory adoption of OAS CAHPS in the 2022 proposed rule. At press time, the proposed rule had not yet been released, but ASCA’s website—www.ascassociation.org— will contain more information as it becomes available.


Survey and Certification Over the years, ASCA has worked closely with CMS staff responsible for ASC survey and certification. ASCA strongly supports CMS standards that ensure ASCs are providing safe and high-quality care, but over the years, ASCA has advocated for changes to requirements that were viewed as unnecessary or overly burdensome.


Same-day surgery notifications Prior to the fall of 2011, notification of patients’ rights and ASC physician financial interests were required to be provided to patients before the day of surgery. This resulted in an undue burden for ASCs attempting to sched- ule a surgery the same day the refer- ral is made. CMS agreed with ASCA, and as of December 23, 2011, ASCs are considered to be in compliance with this requirement if the notifica- tions are provided the same day as surgery as long as they are delivered prior to the surgery.


ASCs to have a radiologist on their medical staff. ASCA had long advo- cated for this change noting that requir- ing ASCs to have a radiologist on staff does not make sense given that radio- logic services in an ASC are generally limited


to intra-operative guidance


that does not require interpretation by a radiologist. Additionally, ASCs had reported difficulty finding radiologists willing to be part of their medical staff. Instead of requiring a radiologist


The ASC community celebrated its 50th anniversary last year, and has much to be proud of over the course of its history. The past decade alone has been full of advocacy achievements.”


—Kara Newbury, ASCA Emergency equipment


In May 2012, CMS announced it would no longer mandate a specific list of emergency equipment in ASCs. Instead, an ASC’s governing body and medical staff would have the flexibility to determine which emer- gency equipment would be necessary to best safeguard the safety of the patients the ASC serves. In making the change, CMS echoed the concerns ASCA had expressed to the agency, noting that it had “learned from the ASC community that some of these equipment requirements are outdated, while other equipment requirements would not be applicable to the emer- gency needs of all ASCs.”


Radiologist on staff In May 2014, CMS announced it was removing the provision in the Condi- tions for Coverage (CfCs) requiring


on staff, the new language, found at §416.49(b)(2), states: “If radiologic services are utilized, the governing body must appoint an individual qual- ified in accordance with State law and ASC policies who is responsible for assuring that all radiologic services are provided in accordance with the requirements of this section.” ASCA member input was instru- mental in securing this change to the regulation.


Physician Discharge Prior to 2015, ASCA often heard from members that the CMS State Opera- tions Manual, Appendix L: Guidance for Surveyors—Ambulatory Surgical Centers—commonly referred to as the “Interpretive


Guidelines”—guidance


on physician discharge was unduly burdensome. The guidance indicated that the patient was expected to leave the facility within 15–30 minutes of the time the discharge order was signed by the physician who performed the sur- gery or procedure. Physicians were often forced to return to the ASC long after the surgery was over to sign the discharge order. ASCA argued that physicians should be allowed to spec- ify that a patient be released when sta- ble and not be required to adhere to a specific timeframe. In 2015, CMS updated


the Interpretive Guidelines


to clarify that it is permissible for the operating physician to write a dis- charge order indicating the patient may


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