For Surgery Facilities


INSPECTION FEES: $500 for *New Facility (*New Facility refers to a brand new location where no cases have been performed, this inspection is required in Florida, California and New York for all facilities that currently do not hold state licensure or other accreditation at the time of
application.), as well as $2000 inspection fee for regular, procedural, or oral maxillofacial.

MEDICARE INSPECTION FEES
Small Facilities (1-5 specialists) = $3,000
Medium Facilities (6-9 specialists) = $4,000
Large Facilities (10 or more specialists) = $4,500
(Please Note: A separate fee will be charged for the Life & Safety Code inspection, call the AAAASF office with questions)

Facility must pay inspection fees in addition to annual fees: Accreditation Fee Schedule
** A surcharge will be assessed on all facilities in a re-inspection cycle (in addition to the inspection fees) that does not complete the required paperwork 90 days prior to their accreditation expiration date.
**Facilities in remote locations will be assessed a surcharge (in addition to the inspection fees) if an AAAASF inspector is not available within a 50 mile radius of the facility to be inspected.
A surcharge is assessed to cover all extraordinary expenses including but not limited to travel, lodging, meals and additional staff time required to complete the inspection. Whenever possible, the facility will be advised in advance of the inspection date that a surcharge will be assessed.

Timeline for Accreditation Process
Designed to ensure verifiable quality care with specific requirements, the AAAASF standards that every facility must meet include:

- General Environment
- Operating Room Environment, Policy & Procedures
- Recovery Room Environment, Policy & Procedures
- General Safety in the Facility
- Blood and Medications
- Medical Records
- Quality Assessment/Quality Improvement
- Personnel
- Governance
- Anesthesia


The Accreditation Program

The American Association for Accreditation of Ambulatory Surgery Facilities, Inc. (AAAASF) conducts an accreditation program that certifies that an accredited facility meets nationally recognized standards. The accreditation program is conducted by physicians, podiatrists and oral and maxillofacial surgeons who determine the standards under the direction of a Board of Directors. The AAAASF strives for the highest standards of excellence for its facilities by regularly revising and updating its requirements for patient safety and quality of care.

Basic Mandates

Surgical procedures should be of a duration and degree to permit safe recovery and discharge from the facility.

Patients receiving anesthetic agents other than topical or local anesthesia should be supervised in the immediate post discharge period by a responsible adult for at least 12-24 hours, depending on the operation and anesthesia used. -Changes in facility ownership must be reported to the AAAASF Office within thirty (30) days.

Any death occurring in an accredited facility, or any death occurring within thirty (30) days of a surgical procedure performed in an accredited facility, must be reported to the AAAASF office within five (5) business days after the facility is notified or otherwise becomes aware of that death. In addition to this notification, the death must also be reported as an unanticipated operative sequelae in the biannual Peer Review report. In the event of a death occurring within thirty (30) days of an operation done in an AAAASF accredited facility, an unannounced inspection will be done by a senior inspector.

The medical director must have an M.D. or D.O. degree.

All individuals using the facility must meet one of the following criteria:

- A Doctor of Medicine certified or eligible for certification by one of the member boards of the American Board of Medical Specialties (ABMS medical or surgical specialty).
- A Doctor of Osteopathy certified or eligible for certification by the American Osteopathic Association Bureau of Osteopathic Specialists (AOABS).
- A podiatrist certified or eligible for certification by the American Board of Podiatric Surgery (ABPS).
- An oral and maxillofacial surgeon certified or eligible for certification by the American Board of Oral and Maxillofacial Surgery (ABOMS).
Every physician, podiatrist, and oral and maxillofacial surgeon operating in an AAAASF accredited facility, must hold, or must demonstrate that they have held, unrestricted hospital privileges in their specialty at an accredited and/or licensed acute care hospital within thirty (30) minutes of the accredited facility for all operations that they perform within the facility. Only surgical procedures included in those hospital privileges may be performed within the AAAASF accredited facility. A physician must be present when anesthesia other than strictly local is being administered in Class B, Class C-M, and C accredited facilities.

Inspection

A facility is inspected every three years. The facility inspector will review any deficiencies with the facility director and forward the Standards and Checklist answer sheet to the AAAASF Central Office. To be accredited by AAAASF, a facility must meet every standard for its Class (A, B, C-M or C).

Self-Evaluation

A facility is evaluated by the facility director each year between inspections and the Standards and Checklist answer sheet is sent to the AAAASF Office. A facility's AAAASF accreditation remains valid if it continues to meet every standard for its Class (A, B, C-M or C). Otherwise, accreditation is revoked.

Denial or Loss of Accreditation

The AAAASF may deny or revoke accreditation of a facility if the facility fails to satisfy every standard for its Class (A, B, C-M, or C), or if any surgeon operating at the facility;

- has had their privileges to perform surgery restricted or limited by any hospital at which the surgeon has privileges , related to lack of clinical competence, ethical issues, or professional problems other than economic competition.

- has been found to be in violation of the Code of Ethics of any professional medical, podiatric or oral and maxillofacial surgical society or association of which they are a member.

- has had their right to practice medicine, podiatry or oral and maxillofacial surgery limited, suspended, terminated or otherwise affected by any state, province, or country, or if they have been disciplined by any medical licensing authority.

- non-reporting of any of the above to the AAAASF.

Hearing

Any facility whose accreditation has been revoked or denied by the AAAASF has the right to a Hearing at which it may present such information as it deems advisable to show that it has satisfied the requirements for accreditation. The Hearing process is described in the AAAASF Bylaws available from the AAAASF Office.

Emergency Suspension or Emergency Probation

The AAAASF may place a facility on Emergency Suspension or Emergency Probation status upon receiving information that a state medical, podiatric or oral and maxillofacial surgery board has taken action, or begun formal proceedings which may result in it taking action against a license held by a surgeon, podiatrist or oral and maxillofacial surgeon operating at the facility, or the Board of Directors determining that the facility may no longer meet AAAASF standards for accreditation. A facility that has been placed on Emergency Suspension or Emergency Probation status will remain in such status pending an expedited investigation and possible Hearing conducted in accordance with AAAASF procedures available from the AAAASF Office.

Definitions of Facility Classes

Class A:

In a Class A Facility, all surgical, endoscopic and/or pain management procedures may be performed under the following anesthesia:
1. topical anesthesia
2. local anesthesia

Class A facilities must meet all Class A standards.

Class B:

In a Class B facility, all surgical, endoscopic and/or pain management procedures may be performed under the following anesthesia:

- topical anesthesia

- local anesthesia

- parenteral sedation

- regional anesthesia

- dissociative drugs ( excluding propofol )

Agents 3 thru 5 may be administered by a physician; a Certified Registered Nurse Anesthetist (CRNA) under physician supervision if required by state or federal law, or by policy adopted by the facility; an anesthesia assistant (as certified by the National Commission for the Certification of Anesthesiologist Assistants under direct supervision of an anesthesiologist); or by a registered nurse under the supervision of a qualified physician.

The use of propofol, endotracheal intubation anesthesia, laryngeal mask airway anesthesia, and/or inhalation general anesthesia (including nitrous oxide) is prohibited in a Class B facility.

Class B facilities must meet all Class A and Class B standards.

Class C-M:

In a Class C-M facility, all surgical, endoscopic and/or pain management procedures may be performed under the following anesthesia:

- topical anesthesia

- local anesthesia

- parenteral sedation

- regional anesthesia

- dissociative drugs including propofol

- spinal anesthesia

- epidural anesthesia
Agents 3 thru 4 may be administered by either a physician; a Certified Registered Nurse Anesthetist (CRNA) under physician supervision if required by state or federal law, or by policy adopted by the facility; or an anesthesia assistant (as certified by the National Commission for the Certification of Anesthesiologist Assistants under direct supervision of an anesthesiologist). Propofol, spinal anesthesia and epidural anesthesia may be administered only by a CRNA or an anesthesiologist.

The use of endotracheal intubation anesthesia, laryngeal mask airway anesthesia, and/or inhalation general anesthesia (including nitrous oxide) is prohibited in a Class C-M facility.

Class C-M facilities must meet all Class A, Class B, and Class C-M standards.

Class C:

In a Class C facility all surgical, endoscopic, and/or pain management procedures may be performed under the following anesthesia:

- topical anesthesia

- local anesthesia

- parenteral sedation

- regional anesthesia

- dissociative drugs, including propofol

- epidural anesthesia

- spinal anesthesia

- general anesthesia
with or without endotracheal intubation or laryngeal mask airway anesthesia

Propofol and agents 6 through 8 may be administered only by an anesthesiologist, a Certified Registered Nurse Anesthetist (CRNA) under physician supervision if required by state or federal law or by policy adopted by the facility; or an anesthesia assistant (as certified by the National Commission for the Certification of Anesthesiologist Assistants under direct supervision of an anesthesiologist).

Class C facilities must meet all Class A, Class B, Class C-M, and Class C standards.

Important Notice -

Maximal patient safety has always been our guiding concern. We are proud that our Standards may be considered the strongest of any agency that accredits ambulatory surgery facilities, and that many consider them to be the Gold Standard . We recognize, however, that they need to be part of a living document, and we continually re-evaluate and revise these Standards in the light of medical advances and changing legislative guidelines.

The AAAASF Accreditation Program requires 100% compliance with each Standard to become and remain accredited. There are no exceptions. However, when a Standard refers to appropriate or proper or adequate, reasonable flexibility and room for individual consideration by the inspector is permitted as long as patient and staff safety remain uncompromised.

REGULAR ACCREDITATION ANNUAL FEES
 

Class

Specialists
# of Specialties
A
B/C-M/C

1 - 2

Less than 2
$750
$1,105

3 - 5

Less than 2
$1,045
$1,545

3 - 5

3 or more
$1,325
$1,820

6 - 9

Less than 2
$3,390
$4,100

6 - 9

3 or more
$3,655
$4,360

10 plus

Less than 2
$4,785
$6,045

10 plus

3 or more
$5,045
$6,885
MEDICARE ACCREDITATION ANNUAL FEES
 

Facility Class

 
Specialists
# of Specialties
A,B,C-M,C
INSPECTION FEE

1 - 2

Less than 2
$1,655
$3,000

3 - 5

Less than 2
$2,095
$3,000

3 - 5

3 or more
$2,370
$3,000

6 - 9

Less than 2
$4,625
$4,000

6 - 9

3 or more
$4,885
$4,000

10 plus

Less than 2
$6,570
$4,500

10 plus

3 or more
$7,410
$4,500
(Please Note: A separate fee will be charged for the Life & Safety Code inspection, call the AAAASF office with questions)

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