Accreditation provides an organization with the ability to distinguish itself as having met or exceeded the operating standards set forth for the industry in which it does business. For the past 25 years, the Accreditation Association for Ambulatory Health Care (AAAHC) has allowed ASCs and others to achieve recognition for providing quality care and services. More than 300 volunteers from an array of backgrounds and disciplines represent the AAAHC as surveyors. “Our general philosophy is that we’re a peer-based, voluntary organization,” says Gerald Edds, MD, FACS, president of AAAHC.

With almost 2,000 organizations currently accredited by the AAAHC, the number seeking to gain this status continues to grow. “Currently we’re doing in excess of 80 surveys per month,” says Edds. “Our organization varies in scope from surveying and accrediting a single-physician, single-OR, office-based surgery center all the way up to large multi-specialty clinics and government organizations with many locations and providers.”

Edds, a facial plastic surgeon, completed a new clinic for his practice in 1990 that contained a surgery center in the building. He sought out accreditation early in order to ensure that his facility provided the kind of care he wanted his patients to receive. “At that time, it was my feeling that most office-based surgeons would be required to be accredited at some point,” says Edds. “I wanted to make an effort to provide the quality service that my patients deserved.” After receiving and maintaining AAAHC accreditation for several years, Edds joined the AAAHC’s board in 1997, representing the American Academy of Facial Plastic and Reconstructive Surgery. He served on and chaired multiple committees, and was elected president of AAAHC in 2003.

In addition to the organization’s ongoing efforts, work is being done on its office-based surgery accreditation program. “Currently there are nine states that require accreditation of office-based surgical facilities, but the Federation of State Medical Boards has issued a policy of recommending that all office-based surgery centers be accredited,” Edds explains. “There is an increasing percentage of procedures being done in office-based settings and in the absence of either accreditation or state oversight; basically that entire segment of healthcare provision is unregulated.”

Edds points out that the organization also remains committed to providing the core services that so many ASCs have come to rely on. “We’re certainly filling a huge niche and we intend to keep doing so.”

The American Association of Ambulatory Surgery Centers (AAASC) began in 1978 as the Society for Office Based Surgery (SOBS). The organization’s initial mission was to provide surgeons and anesthesiologists with resources and information to help them in developing their own facilities. While the industry has changed and evolved over the years, AAASC has continued to be a physician-led voice for the advancement of ASCs.

There are plenty of issues to keep the organization busy going forward. Federal advocacy efforts are ongoing to address physician ownership, Medicare payment and expansion of the Medicare procedures list as the top priorities. AAASC keeps a close watch on state regulations as well. “Advocacy at the state level happens through our cooperative working relationships that we have with many state associations,” says Craig Jeffries, executive director of AAASC. “We are working with state associations on specific issues and then we are trying to set up and nurture better state associations in a few states.”

While physician ownership is an ongoing concern, AAASC has had past success in promoting the merits of this vital ASC element. “We’ve done a very good job of convincing policymakers in Washington and creating tools for our members to use in their states for their communications to further understanding of the value of physician ownership in ASCs,” says Jeffries. “The other part is that we’ve worked hard to develop some Congressional champions who will stand up for our interests.”

Providing education and useful information to members is also a constant focus at AAASC. “We want to help our members operate more cost-effectively in an environment where we’re seeing a lot of change and reduction in payment,” says Jeffries. “The goal is to help them be smarter and operate more cost effectively.”

David Shapiro, MD, president of AAASC, reinforces the idea of educating members. “AAASC continues to expand educational offerings to our members,” he says. “These programs provide opportunities for professional development of ASC staff. The 2005 AAASC annual meeting builds on the successes of previous programs while giving attention to new and emerging needs of our members.”

For 30 years, the Federated Ambulatory Surgery Association (FASA) has been a vocal champion for the ASC industry. As 2005 approaches, FASA continues to be steadfast in promoting the many benefits of ambulatory surgery and in providing education and advocacy where it is needed.

“FASA’s mission is to be the premier source of information on ambulatory surgery and to advocate appropriate policies and reimbursement for ASCs to assure that patients have access to ASCs for care,” says president Jack Egnatinsky, MD. Egnatinsky has been actively involved in the ambulatory surgery arena since 1974, when the Syracuse, N.Y.-based community hospital where he worked began plans to develop an ambulatory surgery center in a nearby medical office building. He later worked with the state health department to develop criteria for free-standing ASCs under the state certificate of need (CON) laws. These efforts led Egnatinsky to FASA and its resources, and he remained involved through the years. He was elected to the FASA board of directors in 1995 and served as program chair for the 1999 annual meeting.

Egnatinsky assumed the role of president of FASA in May 2004 and now contributes his considerable knowledge and experience directly to the organization’s efforts. “I see my role as similar to that of a director in a theatre production,” he says. “The board of directors gives me my script, often modified by unexpected actions by CMS, MedPAC, state actions, Congress, etc., which is acted upon by our extremely dedicated and skilled staff led by Kathy Bryant, Sarah Silberstein and Amy Carle.” Egnatinsky sees his time at FASA as a unique opportunity to make a difference. “As a physician, being able to be involved at this critical time for physician ownership is a real honor and responsibility.”

In addition to physician ownership, FASA has several other issues on which to focus its attention. “The development of a new payment system for ASCs under the Medicare program will be a key focus of activity for the next few years,” says Egnatinsky. Adding procedures to the Medicare ASC list is also on the agenda. “Although FASA believes that ASCs should be approved to do all procedures done in hospital outpatient departments, until that is the case we will work aggressively to ensure the inclusion of appropriate procedures at appropriate levels of reimbursement,” Egnatinsky continues. Finally, FASA will continue to assist states in which legislation and provisions are introduced that are harmful to ASCs and may limit access of proper patient care.

“SAMBA is very involved and interested in education and research, because that is how you advance clinical care,” says association president Kathryn McGoldrick, MD, FABA, professor and chairman, department of anesthesiology, New York Medical College. “We want to be loud and clear that our mission is to advance the highest quality of science, education and patient care in the outpatient arena.”

To that end, the association has renewed its pledge to keep all practitioners up-to-speed and very contemporary in their knowledge. McGoldrick says two hot topics will be in focus during the coming year: managing the morbidly obese with sleep apnea, and geriatric patients and the issue of postoperative cognitive dysfunction.

SAMBA is actively supporting research. The first SAMBA outcomes research award was granted to Dr. Lee Fleisher several years ago, and yielded important data about safety related to location of care. At the most recent annual meeting, an award of $150,000 was granted to Dr. Karen Nielsen of Duke University for work on postoperative cognitive function — the deteriorization of intellectual function presenting as impaired memory or concentration.

“This is a hot-button area, because most of the studies that have looked at the incidence of post-operative cognitive dysfunction have found at least a 25 percent incidence in the elderly one week post-operatively when they do psychometric testing,” says McGoldrick. “Many studies have actually shown higher than that. We have many more questions than answers in this area. I think that in the next decade that’s really where a lot of time, effort and money are going to be directed.”

President-elect Lucinda L. Everett, MD, of the department of anesthesiology at Children’s Hospital and Regional Medical Center, Seattle, says SAMBA will continue to work for their membership, currently at 5,000. “Ten to 15 years ago, ambulatory surgery was a very novel concept,” she says. “Now it is a mainstay of most practices. SAMBA needs to continue to evolve with the specialty to provide fresh and relevant services to our members. We are exploring how this might be accomplished — including such ideas as benchmarking projects, practice guidelines, and alternative CME products such as mini-meetings or web-based educational modules.

We rely heavily on input from and participation of our members in tailoring the organization’s agenda. We also try to provide a voice for critical review of practices and having appropriate data regarding safety. SAMBA board members and past presidents have participated in the development of guidelines for ambulatory surgery and for office-based anesthesia.”

Over the last two years, the SAMBA leadership has had to deal with changes in the economy, trying to ensure financial stability while still providing good value to its membership. “Through close scrutiny and careful management, the financial picture has stabilized, and we have been able to support programs such as an outcomes research grant,” says Everett. “We continue to consider our educational programs a mainstay of SAMBA’s services and work to try to meet the needs of the membership at a reasonable cost.”

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