The short answer is, it depends.
The CMS interpretive guideline 416.2 defines an ASC as “any distinct entity that operates exclusively for providing surgical services to patients not requiring hospitalization and in which the expected duration of services would not exceed 24hours following an admission.” [1] Therefore, not all state ASC regulations allow for overnight recovery observation. However, several states allow for a prolonged recovery period for observation of patients. It is important to know your state regulations to maintain compliance. Some states allow for 23-hour observation. Some allow for 23-hour and 59 minutes of observation.
Understand ahead of time when the observation clock starts ticking. CMS, and most states, start the clock at admission. Therefore, if you are admitting a patient at 7:00 a.m., you must discharge them at either 6:00 a.m. or 6:59 a.m. the next day, depending on your state regulations.
Be aware of the regulations regarding limitations of ambulatory surgical procedure operating room time and direct supervised recovery time. Common regulations indicate operating room time and supervised recovery time should not exceed four hours. If these regulations apply to you, patients would also need to meet the criteria for discharge from PACU.
If you do keep your patients “overnight,” ensure policies are in place for their prolonged care. Include provisions for an available shower, food preparation, nutrition, and dietary consultations. Additionally, develop an appropriate staffing plan to ensure quality care is provided throughout the stay. If you are prepping patients at 6:00 a.m. and simultaneously discharging 23-hour patients, a flurry of activity can occur. Have a plan to keep things calm and orderly.
Another vital component to consider is your managed care contracts. Do they include reimbursement for the observation stay? There are no financial gains to be made by providing this care. Some payors do not cover this option. If they do reimburse you, it may only be $400-500/night. With staffing costs, you may break even. The important thing is to have knowledgeable expectations.
Lisa Austin – Vice President of Facility Development
[1] https://www.cms.gov/Medicare/Provider-Enrollment-andCertification/CertificationandComplianc/ASCs.html
