Office Surgical Suites
While not a new concept, office surgical suites have certainly become more prevalent in recent years. They can provide a safe alternative to using full ambulatory surgery centers for many procedures. It is often easier for ophthalmologists to treat their own patients in-office rather than contending with the scheduling conflicts that may occur at many ambulatory surgery centers. Generally, procedures are performed in an office surgical suite for the convenience of both the ophthalmologist and the patient. Additionally, office surgical suites provide an increased and more cost effective revenue stream for the physician.
OMIC supports the use of office surgery suites for many procedures. Naturally, patient safety is of paramount importance. If an ophthalmologist is going to perform procedures in an office surgical suite proper precautions should be taken to ensure patient safety and good outcomes.
The following OMIC Underwriting Guidelines should be implemented by insureds prior to performing intraocular procedures in an office surgical suite:
- The facility must follow all federal, state, and local laws and regulations applicable to office-based surgery (if any).
- If the ophthalmologist wishes to perform intraocular procedures in their office surgical suite it must be accredited (or pending accreditation) by any of the following: AAAASF, AAAHC, The Joint Commission, or ACHC (formerly HFAC).
- Patients must be at least 18 years of age to undergo incisional intraocular surgery in an office setting.
- Patient selection criteria is critical and operations must be limited to ASA Physical Status Class P1 or P2.
- Anesthesia must be limited to topical, local injection, and minimal sedation (anxiolysis). Exceptions to permit moderate (“conscious”) sedation may be granted subject to Underwriting review.
- Any requested oculoplastic procedures desired to be done in an office surgical suite must be reviewed through OMIC’s physician review process.
- OMIC should also be notified to ensure proper coverage is in place.
In addition to these requirements, physicians should ensure that the level of care provided during the procedure is the same as would be provided in a traditional outpatient surgery center or hospital setting. The physician and facility should also be prepared to handle any intraoperative emergencies that may arise, and it is recommended that the physician maintain admitting privileges at the nearest hospital. A robust system for follow-up care should also be in place. As is always recommended, proper informed consent procedures should be followed.
Finally, the administration of anesthesia (other than local or topical) is best done by an anesthesiologist or Certified Registered Nurse Anesthetist.
Office Based Surgery for Adults: A Deeper Dive
Some ophthalmic surgical procedures can be safely performed in an office surgical suite. Others with higher risk profiles raise a number of concerns. If a patient experiences a serious complication or poor outcome and decides to sue the ophthalmologist, all aspects of the care will be questioned, including the decision to perform the procedure in the office.
Regardless of the setting of the surgery (office, ASC, or hospital), the same standard of care applies, and the safety of the patient should be the guiding principle in the decision-making process.
OMIC has published suggested risk management recommendations (RMRs) on a variety of topics to help you ensure patient safety and reduce your professional liability risk should adverse events occur.
Our RMR guide for office based surgery for adults covers the following recommended practices and protocols and includes detailed explanations and examples for each item:
- All procedures and protocols should be in writing and reviewed and updated regularly with staff.
- Procedure and patient selection criteria should meet all recognized professional standards.
- A detailed plan for monitoring patients should be implemented and well documented.
- Worst case scenarios should be anticipated with response actions rehearsed and relevant emergency equipment available.
In addition, we include links to many related resources so that you may research and implement the appropriate plan for your practice.
Contact Underwriting
If you have questions, please contact your underwriting representative.
Contact My Representative | underwriting@omic.com | 800-562-6642 x1