For ASCs, accreditation challenges abound but technology can help

When it comes to accreditation, ASCs are all too familiar with the manual, paper-based process. Preparing for surveyors and then hosting them onsite is time consuming and stressful for all involved.


In October, at Becker's ASC 26th Annual Meeting: The Business and Operations of ASCs in Chicago, Medline hosted an executive roundtable discussion featuring two ASC leaders: Lawrence Parrish, MBA, administrator of Chicago-based Illinois Sports Medicine & Orthopedic Surgery Center, and William Neugebauer, managing partner at Corona, Calif.-based Neugebauer Strategic Solutions/American Surgical Facilities. During the roundtable, the leaders discussed ways to accelerate the accreditation process.

Commonalities among accreditation agencies are few

Different accreditation agencies tend to focus on distinct market segments. For example, small plastic surgery offices may gravitate toward AAAASF, while larger organizations lean toward The Joint Commission. AAAHC is often favored by large organizations with multiple units.

Each of these agencies has different standards. Mr. Neugebauer noted, "It's interesting because they are all providing Medicare 'deemed' status. You would think there would be more conformity among accreditors. If you analyze the standards, however, the lack of consistency is head-scratching."

In addition, CMS validation surveys introduce more complexity into the mix. Mr. Parrish explained, "We were recently selected randomly for a CMS validation survey which was performed by the Illinois Department of Public Health. It turned out to be more painful than the AAAHC survey. The state architects cited us on life-safety issues that were designed into plans that the same department had approved a few years before."

Preparing for accreditation surveys: Technology could address common challenges

When preparing for accreditation surveys, early preparation is a best practice. Mr. Parrish said, "I always believe in the philosophy that you need to prepare for a survey a year in advance. My director of nursing and I get an early start on inspecting [safety], as well as reviewing and updating policies."

There's consensus in the industry that the survey process is time consuming. One of the biggest challenges at small to mid-sized organizations is finding the time to prepare. "At smaller entities, there are fewer administrative staff and those people wear multiple hats. In addition, the director of nursing may be in surgery for most of the day. Streamlining the paper-intensive process with technology could definitely help," Mr. Neugebauer said.

Mr. Parrish also sees the value of transitioning accreditation-related information to electronic forms. If logs and other files were digitized, surveyors might be able to conduct some work offsite. Although this wouldn't eliminate the need for unannounced surveys, it could shorten them dramatically.

"Think how nice it would be if the survey visit could be reduced from three days to two or even one," Mr. Parrish said. "My philosophy is the less time surveyors spend in your facility, the less opportunity they have to find fault."

Mr. Neugebauer believes software tool Surgical Center Toolbox is a promising solution. He commented, "Preparation is so exhausting when it's paper driven. In addition, surveyors don't want to take the time to thumb through binders to find information. Surgical Center Toolbox eliminates the tedious work of finding things on paper and increases the human interaction between surveyors and ASC staff. With this solution, a survey could be a one-day process."

Technology could transform quality assurance and improvement

One issue facing ASCs is that CMS and the accrediting bodies are looking for more licensed accountability for quality assurance, quality improvement, benchmarking and everything in between. Ten years ago, surgical techs handled much of the sterilization and infection-control work. Surveyors now want a licensed individual who oversees and is accountable for infection control. It's a big efficiency issue.

At Illinois Sports Medicine & Orthopedic Surgery Center, the director of nursing is primarily responsible for quality assurance and quality improvement. She, the medical director and other nursing managers participate in a QA committee. The organization has engaged an outside clinical director of operations who visits on a quarterly basis to keep everyone current with accreditation standards.

According to Mr. Parrish, electronic access to changes in accreditation standards would make life much easier. "Today, we rely on a human who is part of a management consulting firm to keep us informed about changes in the standards. It's not the most efficient way of doing things," he said.

In an era of consolidation, continuity of operations can be challenging

As the principals in physician-owned surgery centers approach retirement, many consider exiting the business through joint venture opportunities. Mergers, acquisitions and consolidation may lead ASCs to use different accrediting bodies. If the organization is acquired by another surgery center corporation, the new owner will probably want to standardize and use one accreditation agency for all ASCs. Hospitals or health systems will be familiar with The Joint Commission, but if the acquired surgery center remains a separate entity, they may not care who the accrediting agency is. In contrast, a private equity firm probably will have no vested interest in what organization the surgery center uses for accreditation.

Mr. Neugebauer commented, "When you talk about consolidation, it will all be technology driven in the near future. It's just a matter of time. Surgery Center Toolbox enables ASCs to aggregate people onto a single system. Technology at its best can hold people accountable, while providing more systemization and uniformity."


Accreditation isn't going away, and for now, standardization across accrediting agencies is a dream. Given these realities, ASCs can respond by adopting new technologies that will streamline preparation and the survey process itself.

As Mr. Parrish commented, "The relationship with a surveyor is developed in the first 10 to 15 minutes, from the way you greet them to how you demonstrate that you are organized and prepared. This sets the tone for the rest of visit."

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