OOSS & Ophthalmic ASC Victory: CMS Finalizes Rule Eliminating Mandatory H&P and Hospital Transfer Agreement Requirements

On September 25, CMS issued a final rule codifying recommendations that the ASC and ophthalmology communities have sought for quite some time.  The rule will become effective 60 days following formal publication on September 30.  CMS is replacing the current requirement that every patient have a comprehensive medical history and physical examination within 30 days prior to surgery in an ASC with a requirement that allows the operating physician and ASC to determine which patients would require more extensive testing and assessment prior to surgery. (The agency cited cataract with IOL implant and after cataract laser surgery as examples of procedures that should not routinely require a comprehensive H&P.)  ASCs would be required to establish and implement a policy that identifies patients who require an H&P assessment prior to surgery. Internal policies must include:

  • The H&P must be completed prior to surgery, encompassing factors including patient age, diagnosis, the type and number of procedures scheduled to be furnished, comorbidities, and anesthesia issues.
  • Upon admission, each patient must have a pre-surgical assessment that is consistent with state health and safety laws completed by the physician or qualified practitioner who is performing the procedures.
  • Pre-existing medical conditions and relevant test results, as well as documentation of any allergies to drugs and biologicals, must be reflected in the medical record.
  • Policies must be based on recognized standards of practice and guidelines, as well as applicable state and local patient health and safety laws.(Hence, it is imperative that facilities review such state licensing and accreditation standards and consider relevant liability and risk management issues.)

OOSS will provide guidance to facilities as you revise your H&P practices.

Hospital Transfer Agreements

CMS is repealing historically troublesome requirements that facilities have a written transfer agreement with a hospital or ensure that all physicians have admitting privileges in a hospital.  ASCs will be required to periodically provide the local hospital with written notice of their operation and patient population served, e.g., hours of operations and procedures performed.

Emergency Preparedness

Under the new regulation, ASCs will be required to review their Emergency Plan every two years, instead of annually.

To review the final rule:
Final Rule

To review OOSS’ comments on the proposed rule:
OOSS 2018 Comments On Proposed Rule

OOSS is delighted that CMS has made these changes in Medicare regulations.  We will be providing further guidance to our members to enable you to be in compliance with these new policies.  Please plan on attending the OOSS Symposium on Saturday, October 12 in San Francisco as we will be addressing these issues during the meeting.  For details and to RSVP visit: Symposium 2019, or RSVP via the OOSS App.

Should you have any questions, please contact our Washington Counsel, Michael Romansky, at mromansky@OOSS.org.

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