Becker's ASC Review interviewed Dan Short to learn more about the processes necessary for meeting CMS' conditions for coverage. These conditions require ASCs to provide patients with written acknowledgement of patient rights, ownership and advance directives prior to the date of service. In order to meet these conditions, ASCs across the country have responded in a number of ways.
Q: How have CMS' new Conditions for Coverage regarding patient rights impacted ASCs?
Dan Short: CMS now requires ASCs to provide written acknowledgement of patient rights, ownership and advance directives to patients prior to their date of service. Additionally, ASCs are required to provide a verbal overview of patient rights, also before the date of service. All of these changes are outlined in section 416.50 of the Conditions for Coverage. CMS recently announced some exceptions to this requirement, but for the most part, ASCs will need to ensure that they are providing these acknowledgements to patients prior to the date of service. Previously, ASCs only had to post patient rights in a central location, such as the waiting room, to meet CMS' requirements. The changes now require much more effort on the part of the ASC and its staff. ASCs have to develop processes to ensure that their center meets these requirements and often these processes take considerable time, effort and expense to carry out.
Q: What are ASCs doing today to ensure they are following these new CMS requirements?
DS: ASCs are handling it in a number of ways. First, you have ASCs who are mailing the documents to patients, which can be costly and takes considerable time and effort. To meet the verbal component, their staff spends additional time calling each patient in advance of their procedure. Other ASCs look to physician offices to provide this information to their patients. The problem here is that they are relying on the physician's office to meet the requirements for them, yet the ASC is ultimately responsible. Using this method, there is no audit trail. Therefore, if an ASC is ever challenged, it would be difficult for them to provide proof that every patient received the information prior to the date of service. Finally, other ASCs are putting these documents on their Web sites and instructing patients to go to the site and download, print and sign the forms. They then require the patients to download yet another document saying they did all of this before the date of service. Here, an additional challenge is that the patient has to remember to bring all the documentation to the ASC the day of his or her procedure and the ASC must still call the patient to provide a verbal overview of their rights.
Q: How can ASCs more effectively meet these requirements?
DS: Fortunately, technological advances are making it easier for ASCs to put processes in place to meet these guidelines while requiring minimal effort on the part of their staff and their patients. For example, Web-based applications are available that allow ASCs to display the necessary content to patients in advance of their procedure and obtain confirmation when a patient acknowledges reading and understanding the documents. Voice file capabilities can also be integrated into these applications, enabling ASCs to verbally communicate rights to patients over the Web. Patients can simply select a hyperlink on the Web site that launches a (sound) file. Following the verbal communication of rights, a check box appears that patients click to acknowledge they listened and understood what they heard.
When choosing a solution, it is important to look for one that has built in tracking and reporting capabilities that allow for automatic documentation upon a patient's review and acceptance. The ability to download these logs for future review is essential in the event an ASC is ever challenged. This process should also allow an ASC to pull a list of all patients that have provided acknowledgment and those that have not. This enables ASCs to quickly identify and establish a process for contacting patients who have not completed the acknowledgements and for ensuring they complete the forms manually.
Whatever process you choose, it should be easy for the patient. Asking a patient to download, print and remember to bring in a packet of documents is challenging and often unsuccessful. If you choose a Web-based application, look for one that requires minimal effort on the part of the patient.
Original Interview by Lindsey Dunn in 2009 can be found here.