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As ASCs Adapt to Change, ASCA Stands Ready to Help

by William Prentice

Changes in the interpretive guidelines for ASC surveyors that the Centers for Medicare & Medicaid Services (CMS) issued recently are causing many ASCs to reexamine their policies concerning advance directives and to make changes in those policies to remain compliant. One of the key issues that ASCs are addressing involves the new language in the guidelines that explicitly states that ASCs may not have blanket policies in place that indicate that they refuse to comply with patients’ advance directives.

Under federal law, an advance directive is defined as a “written instruction, such as a living will or durable power of attorney for health care, recognized under state law (whether statutory or as recognized by the courts of the state), relating to the provision of health care when the individual who has issued the directive is incapacitated.” In accordance with this definition, advance directives routinely include do not resuscitate (DNR) orders and establish a representative who can make decisions on the patient’s behalf should the patient become incapacitated.

Under the new interpretive guidelines, if state law allows, an ASC may still decline to implement elements of its patients’ advance directives as long as the ASC includes a clear and precise statement of limitation in its advance directive policies and agrees to follow other aspects of the advance directives that can be honored in the ASC. For example, if an ASC does not want to comply with a patient’s DNR order, the facility’s statement of limitation may indicate that it will “always attempt to resuscitate a patient and transfer that patient to a hospital in the event of deterioration.”

ASCs with a statement of limitation would need to provide the statement to patients before beginning surgery. ASCA members interested in reviewing the full guidelines can go to ASCA’s web site at They are also available on CMS’ website.

Ultimately, the state in which an ASC is located will determine an ASC’s obligations regarding advance directives, because state law takes precedence over CMS requirements if the state law is more restrictive. In addition, Medicare requires that an ASC identify the state law that gives it the ability to decline to implement some aspect of a patient’s advance directive if the ASC plans to do so. Medicare also requires ASCs to provide patients with a description of the state’s applicable advance directive laws and, if requested, official advance directive forms that the state provides.

Thus, as a first step, it is critical that an ASC familiarize itself with its state’s laws on advance directives. ASCA has compiled a list of advance directive laws by state, including links to the state’s advance directive forms. That list is available on the ASCA State Law Database found at

Other steps that ASCA is taking to help ASCs comply with the new interpretation of Medicare’s advance directive regulations for ASCs include sending email notices about the changes to ASCs, offering compliance insights in the association’s ASC Focus magazine, providing recorded copies of a special webinar that ASC offered on the topic during May, and more.

Providing updates on key regulatory developments is only one of the many benefits and services that ASCA offers the ASC community. To make certain that ASCs have the information and assistance they need to continue to function at peak levels as they continue to adapt to the rapid changes taking place in health care today, ASCA also provides a wide variety of other resources. Two that many in the ASC community have been requesting for some time are being introduced for the first time this year: a new ASCA Benchmarking program and the ASCA Training Series.

ASCA Benchmarking is designed from feedback that ASCA received from its members over many years and will provide a comprehensive, state-of-the-art clinical and operational benchmarking tool that ASCs can use to improve the already outstanding patient care they provide and protect and improve their bottom line. The new program will offer ASCs quick-entry reporting capabilities, easy access to data reports and continual monitoring and evaluation of the data the program collects.

Special features include:

  • 100 percent Internet-based survey and reporting tool;
  •  instant 24/7 access to all data;
  • access to industry-wide and specialty-specific data;
  • superior reporting technology, allowing for customization and quick comparisons;
  • improved ‘save-as-you-go’ capabilities; and
  • deeply discounted rates for ASCA members who participate.

ASCA is administering ASCA Benchmarking in partnership with Voyance, a health care surveying technology and perception management company that has long supported the ASC community.

The ASCA Training Series is a new online education program that offers essential ASC training courses that ASCs can use to:

  • orient new staff;
  • assist in meeting regulatory and accreditation standards;
  • help assess competency;
  • engage all team members in improving quality of care;
  • adapt to changing technology and techniques; and
  • achieve top outcomes in their clinical and business operations.

Topics in this series include infection prevention, preventing surgical fires, identifying and managing safety risks, safe medication administration, the Health Insurance Portability and Accountability Act (HIPAA), ways of identifying victims of domestic abuse and more.

ASCA is providing the new ASCA Training Series in partnership with HealthStream, a software-as-a-service provider for health care employees in the US.

I invite all ASCs across the country to make use of the information about Medicare’s new surveyor guidelines available on ASCA’s web site at and to take advantage of these two important new ASC management tools.

William Prentice is the chief executive officer of the Ambulatory Surgery Center Association.

For more information, contact ASCA at or 703.836.8808.



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