A growing number of states are regulating outpatient procedures being performed in previously unregulated doctors’ offices, or weighing measures to do so, the Wall Street Journal reports. States considering these measures include California, Indiana, Florida, Arizona, New York and Nevada. The New York state medical board will begin enforcing a law this month that for the first time requires the state’s approximately 3,000 doctors’ offices that perform surgery under moderate or deep sedation to have their facilities inspected and accredited by independent review agencies. Violators face penalties. Click title to read more…

Outpatient surgery now accounts for more than 65% of all surgeries, up from about 20% two decades ago. Advances in anesthesia and minimally invasive surgical techniques have allowed outpatient surgery to offer lower costs, more convenient scheduling, and faster recovery and healing times than hospital inpatient procedures. About 45% of outpatient procedures take place in hospital outpatient departments, operated by highly regulated hospitals, and an additional 38% are performed in over 5,000 ambulatory surgery centers (ASCs). However, ASCs are typically certified by CMS, are accredited by an independent agency, and may also have to be licensed by their state. To be accredited, facilities must meet strict standards for equipment, operating-room safety, personnel training and surgeon credentials.

Up until now, doctor’s offices in states with no such regulation could perform surgery solely under the medical license of the physician with no formal licensing or accreditation requirements. Some doctors chose to be voluntarily accredited by one of three agencies that perform the inspections, but the process is expensive, typically costing several thousand dollars.

Last year, the state of Arizona put rules in place governing surgery taking place in a physician’s office. Doctors are now required to have equipment necessary to safely perform procedures, administer and monitor sedation, and rescue a patient who enters a deeper state of sedation than intended. The new regulations followed several high-profile cases in the state, where a patient died after staff were unable to revive a patient before emergency personnel could arrive.

The leading ASC accrediting group, the American Association for Accreditation of Ambulatory Surgery Facilities, produced a study at accredited outpatient centers from January 2001 through June 2006 and found 23 deaths among 1.1 million procedures. The most common procedure associated with the deaths was abdominoplasty, or tummy tuck, followed by face-lift surgery. The study also showed that risks increased when multiple procedures were performed during the same visit. The leading cause of death was a pulmonary embolism, but other causes of death included heart attacks following surgery, heart and breathing problems related to anesthesia, and abuse of pain medications given after surgery.

Source: Wall Street Journal

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