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23 hour CMS rule

Proposed CMS changes to the 23 hour rule state, "ASC means any distinct entity that operates exclusively for the purpose of providing surgical services to patients not requiring an overnight stay following the surgical services....". "Overnight stay" is being defined as "patient's recovery requires active monitoring by qualified medical personnel, regardless of whether it is provided in the ASC, beyond 11:59 p.m of the day on which the surgical procedure was performed." Ultimately, there would be no planned 23 hour stays allowed under this rule, correct? What impact would this revision have on your ASC? Please comment.

CMS's changes can be viewed at the following site: http://www.ascassociation.org/redlinecfc.pdf

Started by: Mary Haskins (Director, Surgical Services/Director of Nursing) at January 6, 2012 (12:27 pm)

Comments and Responses

 

Plastic Surgeons prefer to allow cosmetic surgery patients to spend the night for comfort and high level of care. This is made difficult by the Medicare 23 hour rule - since this rule is applied to all patients - not just the medicare insured patients.
I understand the purpose of the rule is to limit the types of patients and cases done in the facility to those that are healthy and can be ambulatory after surgery.

Richard Greco (Medical Director/Chief Surgeon) at January 9, 2012 (11:04 pm)

Plastic Surgeons prefer to allow cosmetic surgery patients to spend the night for comfort and high level of care. This is made difficult by the Medicare 23 hour rule - since this rule is applied to all patients - not just the medicare insured patients.
I understand the purpose of the rule is to limit the types of patients and cases done in the facility to those that are healthy and can be ambulatory after surgery.

Richard Greco (Medical Director/Chief Surgeon) at January 9, 2012 (11:04 pm)

Mary,

Give me a call at 202-487-0941 and I would be happy to discuss the issue with you. My apologies for any out dated information on ASCA's website.

Jonathan

jonathan beal (Other) at January 9, 2012 (7:33 pm)

Didn't mean to cause panic...read the proposed changes on the ASCA website after researching the possibilities for overnight stays. I have been told by consultants that ASCs should not have planned overnight stays. Supposedly, if patients are trending overnight stays, the QAPI program should evaluate causative factors and attempt to improve/correct. For ASCs who keep patients overnight, is there a physician in the building? I would appreciate more comment on this topic. My impression had always been along the lines of the poster B. Rutledge, whose state (what state are you located in, please?) defines the ASC as a distinct entity that provides surgical care and discharge on the same day. Thank you!

Mary H. (Director, Surgical Services/Director of Nursing) at January 9, 2012 (4:06 pm)

Thanks Jonathan! I appreciate the clarification.

S. Fowler (OR Manager/Supervisor) at January 9, 2012 (1:10 pm)

CMS is not currently considering making any changes to the length of time a patient can stay in an ASC. ASCs are allowed to keep patients up to 24 hours after admission unless state law provides a more restrictive time limit. The Medicare length of stay requirements can be found here:

http://ecfr.gpoaccess.gov/cgi/t/text/text-idx?c=ecfr&sid=56f203d1fb1d156bdb87949f523d07c7&rgn=div5&view=text&node=42:3.0.1.1.3&idno=42#42:3.0.1.1.3.1.1.2

Several years ago, CMS had proposed to prohibit patients from staying overnight at ASCs, however, based on the advocacy of ASCA, state associations, and ASCs across the country, this change was not finalized.

My sense is that this matter is settled. I would not expect CMS, in the foreseeable future, to restrict how long a patient can stay at an ASC. ASCA will however continue to monitor the situation and alert our members of any proposed changes.

Jonathan Beal
ASCA

jonathan beal (Other) at January 9, 2012 (12:58 pm)

Based on the above comments I think there needs to be clarification on this item. When did CMS submit these "proposed" change. ASC Association has not mentioned any thing on this that I have seen either.

Please submit a link referencing this change.

S. Fowler (OR Manager/Supervisor) at January 9, 2012 (12:18 pm)

ASC as a distinct entitiy that provides surgical care and discharge on the same day. Based on that description, we must have all patients out by 11:59. The Medicare statment does not change anything for us.

K. LeJeune (Administrator/Director/Manager/Owner/Executive Officer) at January 9, 2012 (11:56 am)

I also have not heard of this proposed change and would appreciate a valid link or resource to review. The CMS site indicated nothing about this proposed change, nor could I find information on other sources I use. The current CMS definition for an ASC is a "distinct entity that operates exclusively for the purpose of providing surgical
services to patients not requiring hospitalization and in which the expected duration of services would not
exceed twenty-four hours following
admission." The recent update to the CfCs in October did not affect this definition, that I am aware of. Our facility does provide overnight services for some procedures, so I am very interested to find further information.

Missy Soliz (Other) at January 9, 2012 (11:52 am) [last edited on January 9, 2012 (11:53 am)]

I too would like the link. Does it say that no patient can be in the facility past 11:59??

thanks.

Donna Jacobsen (OR Manager/Supervisor) at January 9, 2012 (11:22 am)

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