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What to do when your state wants to regulate office-based surgical facilities
Managing Your OR
What to Do When Your State Wants to Regulate Office-based Surgical Facilities State regulation of office-based surgical facilities has been ongoing since 1995, making participation in the legislative and regulatory arenas essential for surgeons who practice in this setting. According to the author, onerous state requirements may be averted if key elements facilitating a proactive plan are in place. He presents guidelines for monitoring and influencing the regulatory process. (Aesthetic Surg J 2002;22:89-90.)
I
f your state legislators and/or regulators have not shown an interest in regulating office-based surgical facilities (OBSFs) yet, be certain that they will. The national movement toward mandatory regulation, which began in California in 1995, has moved across the country. Each year more and more states adopt legislation or regulations that affect how we perform office-based surgery. The current list of states with significant regulations and laws includes Connecticut, Florida, Illinois, Maryland, Nevada, New Jersey, New York, Ohio, Pennsylvania, Rhode Island, and Texas. Many other states have considered, or are considering, new or additional requirements relating to Certificates of Need, regulations for physicians supervising certified registered nurse anesthetists (CRNAs), length of surgery, lipoplasty guidelines, mandatory malpractice insurance, advanced cardiac life support requirements, and other issues. Interest in regulating OBSFs may be provoked by one of these events: a death in an OBSF, a media exposé of the “dangers” of surgery centers, new laws or regulations in an adjoining state, an election involving an ambitious consumer-activist legislator, or a rash of new OBSFs, prompting hospitals to react to potential income loss. Each event may stimulate new rules or consideration of new laws. Once the “ball gets rolling,” it may be hard to stop. Guiding its path to keep it from an undesirable direction may be the best option. That is only possible if the legislative or regulatory process is detected early and intervention is aggressive and persistent.
AESTHETIC
To prepare for such legislation, key elements must be put in place well in advance. State or regional specialty societies should develop a method of monitoring legislative initiatives, such as becoming involved in state Michael F. McGuire, MD, medical society legislative Santa Monica, CA, is a boardcommittees, using one of certified plastic surgeon and an ASAPS member. (©1999 the online monitoring serThomas Neerken. All rights 1 vices (eg, State Watch ), reserved.) developing relationships with state legislators, hiring a part-time legislative advocate (lobbyist), and reading legislative newsletters. The activities of the state medical licensing board should also be monitored because many legislative actions and regulatory changes originate here. Ideally, a plastic surgeon should get appointed to the board both to monitor and guide regulatory activity. Developing relationships with key members of the legislature may require persistence and patience over time and may involve supporting the legislator’s election efforts by attending fund raisers and contributing money. Established friendships make this process much easier. A “key contact” system should be developed in every state to identify plastic surgeons who know legislators or regulators and to support and encourage these ongoing relationships. Trust between legislators and constituents develops over time, but once established, it can be an invaluable asset in influencing the legislative agenda to benefit plastic surgeons. Another element in preparing for legislation regulating OBSFs is anticipation. Watch the media for the following reports: deaths after elective surgery; new laws in other states concerning OBSFs; and legislative or regulatory hearings on lipoplasty safety, supervision of CRNAs, or surgery center Certificates of Need. The sooner you learn about a proposal, the better you can respond to it. A legislative advocate can detect legislative or regulatory activity
SURGERY
JOURNAL
~
JANUARY/FEBRUARY
2002
89
Managing Your OR
early in the process, just as legislators may alert key contacts about new initiatives. Obviously, plastic surgeon members of the legislature or regulatory agency (such as the Medical Board) are in an ideal position to detect or introduce new laws or regulations. They may also be able to modify inappropriate actions or work to defeat them, which sometimes may be as valuable as introducing new concepts. A timely response is essential once new legislation or regulations are introduced because the adoption process may move very quickly, especially if in response to a public outcry or media exposure of a “problem.” This is when preparation pays off. Activate key contact systems, use legislative or regulatory relationships, and mobilize medical society resources to rally support. Prepare a response, develop a plan for presenting your position to the key players, and consider a back-up position if you do not succeed with your initial efforts. Probably it is most important to call for help. It is likely that someone in another state has already dealt with the issue confronting you and can provide expert assistance. Plastic surgeons should call on their specialty societies. The American Society for Aesthetic Plastic Surgery (ASAPS), American Society of Plastic Surgeons (ASPS), and American Association for Accreditation of Ambulatory Surgery Facilities (AAAASF) have resources to help you respond, including expert spokespersons to testify before legislative or regulatory hearings, position papers to provide guidance to legislators and regulators on OBSF-related issues, and
experience in proceeding through the murky legislative or regulatory process. The Task Force on Patient Safety in Office-based Surgery Facilities, which includes representatives from ASAPS, AAAASF, ASPS, and anesthesiologists, has recently developed and approved model legislation. The model incorporates all the desirable legislative and regulatory elements for OBSF-accreditation, while avoiding some of the onerous and inappropriate requirements that some states have included in legislation that has already been passed. In several of these states, surgeons were unaware that the legislation was pending until it became law. Do not let that happen in your state! Advocacy and participation in the legislative and regulatory arenas have become essential activities for surgeons who practice in OBSFs and for those concerned about the other major issues facing us at the state level, such as the performance of aesthetic surgery by practitioners without appropriate training and cosmetic surgery discount plans that compromise quality of care. Get started now to plan for the inevitable, and you will be ready for whatever legislative or regulatory proposals your state capital devises. ■
Reference 1. State Watch. Available at: http://www.statewatch.com. Reprint requests: Michael F. McGuire, MD, 1301 20th Street, Suite 1460, Santa Monica, CA 90404. Copyright © 2002 by The American Society for Aesthetic Plastic Surgery, Inc. 1084-0761/2002/$35.00 + 0 70/1/121671 doi:10.1067/maj.2002.121671
Errata • Leslie Bolton, MD, was incorrectly named as the author of the article, “Insurance Reimbursement for Surgical Facilities” (Volume 21, Number 5, pages 467-468), and Laurence Reich was incorrectly noted as a contributor to the article. In fact, Dr. Reich was the author. He was invited to write the article for “Managing Your OR” by Dr. Bolton, who is chair of the ASAPS Accreditation Task Force. Dr. Reich, an advocate for patients and physicians in obtaining insurance reimbursement, is president of Creative Consultants for Physicians, Beverly Hills, CA; telephone: 310-274-8887; fax: 310-274-7638; Web site: www.ccpmd.com. • In the article by Brian M. Kinney, MD, and Charles E. Hughes III, “Soft Tissue Fillers: An Overview” (Volume 21, Number 5, p. 471), it was stated that SoftForm was withdrawn from the market in 2000. According to McGhan Medical, Santa Barbara, CA, SoftForm is still available. • In the article by Rafael de la Plaza, MD, and Luis de la Cruz, MD, on “The Sliding Fat Pad Technique with Use of the Transconjunctival Approach” (Volume 21, Number 6, pages 487-492), the following statement appeared on page 491: “Although most surgeons do not perform this procedure, we believe it reduces postoperative conjunctival discomfort and fosters prompt scarification of the transected planes, preventing overlapping of their edges.” Because of an editorial error, the last part of this sentence is incorrect. It should read, “…and fosters prompt scarring of the transected planes, preventing overlapping of their edges.”
90
Aesthetic
Surgery
Journal
~
January/February
2002
Volume 22, Number 1
What to Do When Your State Wants to Regulate Office-based Surgical Facilities State regulation of office-based surgical facilities has been ongoing since 1995, making participation in the legislative and regulatory arenas essential for surgeons who practice in this setting. According to the author, onerous state requirements may be averted if key elements facilitating a proactive plan are in place. He presents guidelines for monitoring and influencing the regulatory process. (Aesthetic Surg J 2002;22:89-90.)
I
f your state legislators and/or regulators have not shown an interest in regulating office-based surgical facilities (OBSFs) yet, be certain that they will. The national movement toward mandatory regulation, which began in California in 1995, has moved across the country. Each year more and more states adopt legislation or regulations that affect how we perform office-based surgery. The current list of states with significant regulations and laws includes Connecticut, Florida, Illinois, Maryland, Nevada, New Jersey, New York, Ohio, Pennsylvania, Rhode Island, and Texas. Many other states have considered, or are considering, new or additional requirements relating to Certificates of Need, regulations for physicians supervising certified registered nurse anesthetists (CRNAs), length of surgery, lipoplasty guidelines, mandatory malpractice insurance, advanced cardiac life support requirements, and other issues. Interest in regulating OBSFs may be provoked by one of these events: a death in an OBSF, a media exposé of the “dangers” of surgery centers, new laws or regulations in an adjoining state, an election involving an ambitious consumer-activist legislator, or a rash of new OBSFs, prompting hospitals to react to potential income loss. Each event may stimulate new rules or consideration of new laws. Once the “ball gets rolling,” it may be hard to stop. Guiding its path to keep it from an undesirable direction may be the best option. That is only possible if the legislative or regulatory process is detected early and intervention is aggressive and persistent.
AESTHETIC
To prepare for such legislation, key elements must be put in place well in advance. State or regional specialty societies should develop a method of monitoring legislative initiatives, such as becoming involved in state Michael F. McGuire, MD, medical society legislative Santa Monica, CA, is a boardcommittees, using one of certified plastic surgeon and an ASAPS member. (©1999 the online monitoring serThomas Neerken. All rights 1 vices (eg, State Watch ), reserved.) developing relationships with state legislators, hiring a part-time legislative advocate (lobbyist), and reading legislative newsletters. The activities of the state medical licensing board should also be monitored because many legislative actions and regulatory changes originate here. Ideally, a plastic surgeon should get appointed to the board both to monitor and guide regulatory activity. Developing relationships with key members of the legislature may require persistence and patience over time and may involve supporting the legislator’s election efforts by attending fund raisers and contributing money. Established friendships make this process much easier. A “key contact” system should be developed in every state to identify plastic surgeons who know legislators or regulators and to support and encourage these ongoing relationships. Trust between legislators and constituents develops over time, but once established, it can be an invaluable asset in influencing the legislative agenda to benefit plastic surgeons. Another element in preparing for legislation regulating OBSFs is anticipation. Watch the media for the following reports: deaths after elective surgery; new laws in other states concerning OBSFs; and legislative or regulatory hearings on lipoplasty safety, supervision of CRNAs, or surgery center Certificates of Need. The sooner you learn about a proposal, the better you can respond to it. A legislative advocate can detect legislative or regulatory activity
SURGERY
JOURNAL
~
JANUARY/FEBRUARY
2002
89
Managing Your OR
early in the process, just as legislators may alert key contacts about new initiatives. Obviously, plastic surgeon members of the legislature or regulatory agency (such as the Medical Board) are in an ideal position to detect or introduce new laws or regulations. They may also be able to modify inappropriate actions or work to defeat them, which sometimes may be as valuable as introducing new concepts. A timely response is essential once new legislation or regulations are introduced because the adoption process may move very quickly, especially if in response to a public outcry or media exposure of a “problem.” This is when preparation pays off. Activate key contact systems, use legislative or regulatory relationships, and mobilize medical society resources to rally support. Prepare a response, develop a plan for presenting your position to the key players, and consider a back-up position if you do not succeed with your initial efforts. Probably it is most important to call for help. It is likely that someone in another state has already dealt with the issue confronting you and can provide expert assistance. Plastic surgeons should call on their specialty societies. The American Society for Aesthetic Plastic Surgery (ASAPS), American Society of Plastic Surgeons (ASPS), and American Association for Accreditation of Ambulatory Surgery Facilities (AAAASF) have resources to help you respond, including expert spokespersons to testify before legislative or regulatory hearings, position papers to provide guidance to legislators and regulators on OBSF-related issues, and
experience in proceeding through the murky legislative or regulatory process. The Task Force on Patient Safety in Office-based Surgery Facilities, which includes representatives from ASAPS, AAAASF, ASPS, and anesthesiologists, has recently developed and approved model legislation. The model incorporates all the desirable legislative and regulatory elements for OBSF-accreditation, while avoiding some of the onerous and inappropriate requirements that some states have included in legislation that has already been passed. In several of these states, surgeons were unaware that the legislation was pending until it became law. Do not let that happen in your state! Advocacy and participation in the legislative and regulatory arenas have become essential activities for surgeons who practice in OBSFs and for those concerned about the other major issues facing us at the state level, such as the performance of aesthetic surgery by practitioners without appropriate training and cosmetic surgery discount plans that compromise quality of care. Get started now to plan for the inevitable, and you will be ready for whatever legislative or regulatory proposals your state capital devises. ■
Reference 1. State Watch. Available at: http://www.statewatch.com. Reprint requests: Michael F. McGuire, MD, 1301 20th Street, Suite 1460, Santa Monica, CA 90404. Copyright © 2002 by The American Society for Aesthetic Plastic Surgery, Inc. 1084-0761/2002/$35.00 + 0 70/1/121671 doi:10.1067/maj.2002.121671
Errata • Leslie Bolton, MD, was incorrectly named as the author of the article, “Insurance Reimbursement for Surgical Facilities” (Volume 21, Number 5, pages 467-468), and Laurence Reich was incorrectly noted as a contributor to the article. In fact, Dr. Reich was the author. He was invited to write the article for “Managing Your OR” by Dr. Bolton, who is chair of the ASAPS Accreditation Task Force. Dr. Reich, an advocate for patients and physicians in obtaining insurance reimbursement, is president of Creative Consultants for Physicians, Beverly Hills, CA; telephone: 310-274-8887; fax: 310-274-7638; Web site: www.ccpmd.com. • In the article by Brian M. Kinney, MD, and Charles E. Hughes III, “Soft Tissue Fillers: An Overview” (Volume 21, Number 5, p. 471), it was stated that SoftForm was withdrawn from the market in 2000. According to McGhan Medical, Santa Barbara, CA, SoftForm is still available. • In the article by Rafael de la Plaza, MD, and Luis de la Cruz, MD, on “The Sliding Fat Pad Technique with Use of the Transconjunctival Approach” (Volume 21, Number 6, pages 487-492), the following statement appeared on page 491: “Although most surgeons do not perform this procedure, we believe it reduces postoperative conjunctival discomfort and fosters prompt scarification of the transected planes, preventing overlapping of their edges.” Because of an editorial error, the last part of this sentence is incorrect. It should read, “…and fosters prompt scarring of the transected planes, preventing overlapping of their edges.”
90
Aesthetic
Surgery
Journal
~
January/February
2002
Volume 22, Number 1