Why Seek Ambulatory Endoscopy Center Accreditation?

Comprised of ten chapters, ASGE’s Policy and Procedure Reference Guide for Ambulatory Surgical Centers (ASCs) is intended to provide an organized list of ASGE guidelines that may be considered appropriate for adoption in an endoscopy facility.

Presented in chart form, the Reference Guide highlights ASGE guidelines that meet standards and conditions in the Centers for Medicare and Medicaid Services (CMS) Condition for Coverage.

For a quick summary of recommendations when reviewing any of the ASGE Guidelines we recommend going to the “Recommendations” section located at the bottom of each ASGE Guideline.

To read the overview or additional chapters, please click here.

Why Seek Ambulatory Endoscopy Center (AEC) Facility Accreditation?

Accreditation is a voluntary process through which an organization can compare the quality of its services and operations against nationally recognized standards. The accreditation process involves a self-assessment by the organization, as well as a thorough review by the accrediting body’s surveyors. The accreditation certificate is a symbol that an organization is committed to providing high-quality health care and that it has demonstrated that commitment by measuring up to externally recognized standards.

The decision to seek accreditation should be motivated by the organization’s desire to demonstrate its commitment to high-quality patient care and to learn methods of improving the quality and efficiency of its operations. The steps involved in applying for accreditation and preparing for the survey encourage a detailed self-assessment of center policies and procedures. An assessment commonly results in changes; including improvements to facilities and center processes which can enhance patient safety, compliance with external regulations, and economic efficiency. Successful accreditation recognizes the organization’s willingness to examine itself critically and to make changes to comply with recognized best practices.

There are also many more practical reasons for seeking accreditation. These may include, at the most basic level, the ability to legally operate an AEC. Accreditation by a recognized outside party is required for licensure of Ambulatory Surgery Centers (ASCs), including AECs, in many states. Currently, more than thirty states and the District of Columbia either require or recognize accreditation of certain types of ambulatory surgical organizations. The number of states that recognize accreditation as fulfilling certain regulatory requirements continues to expand each year.

Accreditation is becoming an increasingly marketable achievement. Earning an accreditation certificate demonstrates that the organization has a commitment to providing the highest quality health care, which is meaningful to insurance companies and other third-party payers, government agencies, as well as the general public. Highly publicized adverse events, such as the infection of patients with Hepatitis C Virus (HCV) in certain centers, have brought patient safety concerns into the limelight. Well-educated patients search for markers of quality (including accreditation) in selecting where to receive health care services. Accreditation may also help level the playing field for AECs to compete with hospitals that also offer endoscopic services.

In addition, accreditation may potentially enhance the AEC’s success as a business as well.  Constituting a top-down examination of the endoscopy center’s operations, the organization must implement sound management practices, demonstrate stable cash flow, and adopt a transparent organizational structure to be accredited. This process pays long-term dividends in operational efficiency and profitability.

Many centers seek accreditation in the hopes that recognition may improve their negotiating position with payers. It is difficult or impossible to verify claims that accredited AECs can parlay recognition into higher reimbursement rates. However, insurers and managed care plans increasingly have demonstrated recognition of the value of accreditation (and in many areas have required organizations to be accredited in order to be eligible for ASC contracts).

Finally, liability insurers recognize that accreditation emphasizes and enhances risk management efforts. As a result, accreditation may improve the availability or decrease the cost of an organization’s liability insurance coverage.

Tips for Applying Recommendations from ASGE Guidelines

1. A statement should be made citing the ASGE references as recommendations from a nationally recognized specialty society that were used in the development of this reference.

2. If other nationally recognized society guidelines are also being used to develop policies and procedures, it is important to review those policies and reconcile differences so that contradictory policies are not developed.

3. The Association of Operating Room Nurses (AORN) has specific policies requiring surgical attire, staffing, and restricted areas that endoscopy facilities may not wish to adopt. In the interpretive guidelines, AORN’s standards are mentioned as an example of nationally recognized standards. CMS surveyors, therefore, may hold facilities to those standards unless they have specifically adopted others.

4.  Documentation of the adoption of ASGE guidelines should be referenced in the meeting minutes of the organization’s governing body. The reference should include the guideline, the portion of the guideline to be adopted, and an education plan for staff and providers as needed.