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New York Law: Fact Sheets

 

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In July 2007, the State of New York passed a law mandating that all doctors performing surgeries in their offices have their offices reviewed and accredited by July 14, 2009, or face penalties from the state medical board. In addition, beginning Jan. 14, 2008, all “adverse events” occurring in these offices must be reported to the state Department of Health.

New York OBS Accreditation: Specific Issues to Note

There are specific issues that are unique to being accredited as an OBS in New York as stated by the New York State Department of Health (DOH). Read the full text here.

Frequently Asked Questions

Below are frequently asked questions on the New York accreditation law and about AAAHC and its accreditation process. To view the answers, click on the question line.

Sections:

New York State Law FAQ: Accreditation Mandate for Office–Based Surgery Facilities

AAAHC FAQ: Accreditation for Ambulatory Health Care Organizations

Acquiring Accreditation FAQ: AAAHC Survey Information

 

New York State Law FAQ: Accreditation Mandate for Office–Based Surgery Facilities
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What is the definition of office-based surgery under the law?
The new law defines office-based surgery as a surgical or invasive procedure requiring general anesthesia, moderate or deep sedation, and certain liposuction procedures performed in a location other than a hospital. It excludes minor procedures, including those requiring “minimal sedation” and procedures with local or topical anesthesia. The law applies to physicians and physician assistants (PAs). Dentists and podiatrists are not subject to the law.
How does the law define “minor procedures”?
“Minor procedures” means (i) procedures that can be performed safely with a minimum of discomfort where the likelihood of complications requiring hospitalization is minimal; (ii) procedures performed with local or topical anesthesia; or (iii) liposuction with removal of less than 500 cc of fat under unsupplemented local anesthesia. (New York State Public Health Law Sec. 230-d)
How does the law define “minimal sedation”?
“Minimal sedation” means a drug-induced state during which (i) patients respond normally to verbal commands; (ii) cognitive function and coordination may be impaired; and (iii) ventilatory and cardiovascular functions are unaffected. (New York State Public Health Law Sec. 230-d)
What “adverse events” must be reported?
“Adverse event” means (i) patient death within thirty days; (ii) unplanned transfer to a hospital; (iii) unscheduled hospital admission within seventy-two hours of the office-based surgery, for longer than twenty-four hours; or (iv) any other serious or life-threatening event. Adverse events must be reported to the Department of Health’s Patient Safety Center (PSC) within one-business day of the occurrence. (New York State Public Health Law Sec. 230-d)
Will those reports be kept confidential?
Reports to the Patient Safety Center are confidential and exempt from discovery in civil proceedings and from disclosure under New York State’s Freedom of Information Law. However, the PSC may refer the report to the Office of Professional Medical Conduct, if appropriate. In addition, accrediting agencies will be required to report aggregate data on adverse events for all office-based practices they accredit. The Department of Health is permitted to disclose aggregate data to the public.
What are the accreditation requirements under the law?
Beginning on July 14, 2009, all office-based surgery practices are required to obtain and maintain full accredited status with a nationally recognized accrediting agency, as determined by the New York State Commissioner of Health. After July 14, 2009, office-based surgery in a non-accredited office-based practice will be prohibited, and would constitute professional misconduct by the physician. The physician could lose his or her license.
Which agencies have been selected by the Commissioner of Health to accredit office-based surgeries?
To date, the New York Department of Health has not designated approved accrediting agencies. However, the Accreditation Association for Ambulatory Health Care expects to be an approved organization based on actions by other states, all of which have recognized AAAHC as an accrediting organization when they pass legislation requiring the accreditation of office-based surgery practices.
What other states have mandatory accreditation of office-based surgery?
States that mandate accreditation of office-based surgery include California, Florida, South Carolina, Tennessee, and Rhode Island. A more complete list can be found on the AAAHC Web site.
Are all New York practices, regardless of size, subject to the accreditation requirements – even if only one physician in the practice performs these procedures?
Yes. The requirement for accreditation applies to practices of all sizes and to the practice as a whole, regardless of how many physicians are in the group. Each site performing office-based surgery must be accredited.
Will accredited office-based surgery practices receive any enhanced fees from Medicaid?
No. Medicaid, however, does not prohibit office-base surgery practices from negotiating enhanced fees from private insurers.
Will accredited office-based surgeries be able to bill insurance companies the same rates as an ambulatory surgery center?
No. Under the New York law, accreditation has nothing to do with billing. Accreditation is not the same as being licensed or Medicare-certified as an ambulatory surgery facility. The law focuses on patient safety. However, accreditation shows payers that an office-based surgery practice is interested in safety, and can be used as a bargaining point when negotiating contracts.

For more information, check the New York State Department of Health Web site at http://www.health.state.ny.us/professionals/office-based_surgery/ or email obs@health.state.ny.us

 

AAAHC FAQ: Accreditation for Ambulatory Health Care Organizations
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What is the Accreditation Association for Ambulatory Health Care?
The Accreditation Association, also known as AAAHC, is a private, non-profit organization formed in 1979 specifically to develop national standards for ambulatory health care centers and to provide a peer-based accreditation processes that concentrates on patient safety, quality and value. AAAHC and the AAAHC Institute for Quality Improvement, also provide educational programs for ambulatory care centers and survey reports on best practices.
What is accreditation?
Accreditation is a voluntary process through which an organization is able to measure the quality of its services and performance against nationally recognized standards. The accreditation process involves self-assessment by the organization, as well as a thorough review by the Accreditation Association’s expert surveyors. The accreditation certificate is a symbol that an organization is committed to providing high-quality health care and that it has demonstrated that commitment by measuring up to the Accreditation Association’s standards.
What types of organizations would seek AAAHC accreditation?
AAAHC accreditation is specifically for organizations that provide diagnostic or medical care on an outpatient basis – where an overnight stay would not be required. These might include outpatient health care clinics or surgery centers, birthing centers, immediate/urgent care centers; diagnostic imaging or radiation oncology centers;  outpatient surgical centers and office surgery practices; some large multi-specialty medical or dental group practices; podiatrist or chiropractic offices; specialty treatment centers for lithotripsy, endoscopy, pain management, occupational or women’s health; managed care and health maintenance organizations; or college/university and Indian health centers.
Is accreditation mandatory for ambulatory health care organizations?
Accreditation requirements are made on a state-by-state basis with a wide range of regulations. For example, beginning on July 14, 2009, all office-based surgery practices in New York State are required to obtain and maintain full accredited status with a nationally recognized accrediting agency.

Twenty-five states and the District of Columbia require or recognize accreditation of certain types of ambulatory surgical organizations including Arizona, California, Delaware, Florida, Georgia, Indiana, Kansas, Maryland, Montana, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, Ohio, Oregon, Pennsylvania, South Carolina, Tennessee, Texas, Utah, Virginia and Wyoming. In all of the states that have accreditation requirements, AAAHC is recognized as an accrediting organization.

For office-based surgery procedures requiring moderate to high levels of anesthesia, Connecticut, Kansas, New York, Ohio, Oregon, Pennsylvania, Rhode Island, South Carolina and Tennessee require accreditation. California and Florida require state certification or accreditation. Louisiana, North Carolina and Texas exempt accredited settings from surgery/anesthesia standards. Alabama, Illinois, Mississippi, New Jersey and Virginia have adopted anesthesia or surgery regulations. Arizona prohibits treatment under general anesthesia in unlicensed physician offices. Washington has guidelines that make accreditation voluntary, but recently enacted legislation directing its Medical Quality Assurance Commission to adopt rules governing the administration of sedation and anesthesia.

Seven states also recognize AAAHC accreditation for quality assurance reviews of HMOs (Florida, Georgia, Kansas, Oklahoma, Pennsylvania, Nevada and Texas).
If accreditation is voluntary, why should an organization seek accreditation?
Earning the AAAHC Certificate of Accreditation shows that the organization has a commitment to providing quality health care, which is meaningful to insurance companies and other third-party payers, government agencies and the public. In addition, the survey process presents best practices in ambulatory health care, which can be educational for centers.
How does the AAAHC differ from other accreditation groups?

The AAAHC concentrates on providing quality accreditation programs specifically and exclusively for the ambulatory health care community. Its volunteer surveyors are actively involved in ambulatory health care; they understand the specific issues facing outpatient organizations and have in-depth knowledge of the field.

AAAHC's survey model for accreditation is peer-based. Surveyors are physicians, registered nurses and administrators allowing for a collaborative and consultivve approach that is educational and adaptable for the specific needs of an organization.

 

Acquiring Accreditation FAQ: AAAHC Survey Information
download as a PDF

How does my organization apply for accreditation?
In order to prepare for a survey, all organizations must obtain a copy of the standards and fill out and submit an application for survey. Click here for more information.
Who performs the accreditation surveys?
Accreditation Association surveyors are volunteer physicians, dentists, podiatrists, pharmacists, nurses and administrators who are actively involved in ambulatory health care. Only experienced professionals who meet stringent recruitment qualifications are selected in a rigorous application process. Training programs for new surveyors are held regularly to ensure an adequate number of surveyors to meet the survey volume.
What does the Accreditation Association look for when surveying an ambulatory health care organization?
When surveying an organization, AAAHC observes patient care during a procedure or surgery; reviews an organization’s procedural manuals, charts, personnel files, and other records; and speaks with patients, physicians and office personnel to ensure the organization meets the AAAHC’s standards for quality health care.
How long does a survey take?
Depending on the organization’s type, size and range of services offered, a survey can take from one to a few days to complete, and may be performed by one or more surveyors.
What is the fee for the accreditation survey?
The fee for an accreditation survey ranges from around $4,000 for an office-based practice to several thousand dollars for a bigger practice where several types of procedures are performed.
What happens after the on-site survey?
Accreditation Association staff members review the survey report, surveyor recommendations, including the survey team’s overall recommendation regarding accreditation, and any other relevant information, and make an independent recommendation to the Accreditation Committee of the AAAHC. The Accreditation Committee, active AAAHC surveyors who are board and non-board members, reviews each survey report and surveyor and staff recommendations before making a final decision.
What happens if an organization does not succeed in meeting the AAAHC standards and is deferred or denied accreditation?
An organization that is not granted accreditation may apply for another survey.
How long does accreditation last?
AAAHC awards an organization accreditation for three years when it concludes that the organization is in substantial compliance with the standards, and the committee has no reservations about the organization’s commitment to continue providing high-quality care. The AAAHC awards an organization accreditation for one year when a portion of the organization’s operations are acceptable but other areas need to be addressed and the organization requires sufficient time to achieve compliance. A six-month term of accreditation is awarded when an organization is in substantial compliance with the standards but is not eligible for a three year term because it does not meet certain requirements, e.g., the organization has not been operating for six months.
How is accreditation maintained?
Organizations must undergo full, regular surveys at least once every three years.
How many organizations have received AAAHC accreditation?
The Accreditation Association currently accredits more than 3,600 organizations.

 

 

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