Regulation

Ruling Places Burden on ASCs for More H&Ps.

Will the value of physicians' assistants increase?

Jerry Helzner, senior editor

The recent enforcement of a 2009 CMS Medicare ruling has caused some consternation for ophthalmology practices that perform a high volume of surgeries.

The ruling requires ASC patients to have a comprehensive pre-surgical medical history and physical (H&P) assessment completed not more than 30 days before the date of surgery, including touch ups and therapeutic lasers that are performed at the facility.

One consultant who specializes in the development and operation of ambulatory surgery centers (ASCs) has asserted, “The ASC world was rocked by this ruling. The new H&P standard created a bigger burden and came with increased regulatory surveillance.”

An example of how this ruling has impacted practices can be seen at Barnet Dulaney Perkins, a large statewide practice in Arizona that operates eight ASCs. The practice performs about 3,500 YAG capsulotomies a year and almost 15,000 surgical procedures overall.

Prior to the ruling, patients undergoing a simple YAG procedure following cataract surgery did not require a complete H&P. This has resulted in 3500 additional H&Ps each year. Access to scheduling these exams has been difficult.

Under the Medicare ruling, the H&P must be performed by a “physician or other qualified practitioner in accordance with state law.” In most states, the only other qualified practitioners, in addition to physicians, are physician assistants (PAs) and nurse practitioners (NPs). It is worth noting optometrists cannot perform H&P assessments.

After consulting with Arizona regulatory authorities and learning the H&Ps must be conducted by a member of the medical staff, Barnet Dulaney Perkins decided that it would be prudent to credential PAs, whose initial responsibilities were to perform the H&Ps. The practice eventually hired four Physician Assistants. Because PAs are considered “physician extenders” and able to perform many surgical tasks under the supervision of a physician, their value to the practice is expected to increase as they undergo further training.

It is important that any practice dealing with the requirement to perform an increasing number of H&Ps and seeking to hire personnel for these tasks should first consult with state regulatory authorities.