02/05/2015

CMS Makes Changes to Interpretive Guidelines Regarding Patient Discharge

Recently the Centers for Medicare & Medicaid Services (CMS) released a memo to surveyors stating updates to the State Operations Manual, Appendix L: Guidance for Surveyors – Ambulatory Surgical Centers, otherwise known as the “Interpretive Guidelines." The most notable update is in the area of patient discharge. There are also updates to reflect the recent rule change from last spring regarding radiologist on staff requirements. The memo can be downloaded here CMS Surveyor memo and the ASC information begins on page 18.

The change regarding patient discharge is positive for ASCs and clarifies the physician order requirements. The prior guidelines indicated that the patient was expected to leave the facility within 15-30 minutes of the time the discharge order was signed by the physician who performed the surgery or procedure. This has been an area of concern for many ASCs. The guidelines now reference that it is permissible for the operating physician to write a discharge order indicating “the patient may be discharged when stable,” even if that is past the 15-30 minute timeframe.

The Interpretive Guidelines, Laboratory and Radiologic Services, §416.49(b), was revised to:

• Make explicit that radiologic services may only be provided in an ASC when integral to surgical procedures offered by the ASC
• Require the ASC’s governing body to appoint an individual who is responsible for overseeing radiologic services. This individual can be someone already working in the ASC who is qualified in accordance with State law and Federal regulations

CMS also further clarified other sections including:

• Hospitalization; emergency transfers, §416.41(b)
• Physical Environment; operating room requirements, §416.44(a)
• Exercise of rights and respect for property and person, signatures required for informed consent, §416.50(e)