More than $250,000 and 200 hours later, Dr. Cap Lesesne's office-based plastic surgery center, International Cosmetic Surgery on New York's Park Avenue, is accredited. Knowing how much money (most of it went toward a new floor and other capital improvements) and time (he spent one day a week for eight months preparing) accreditation would cost, he had put it off for years.

The procrastination ended last July when the American Society of Plastic Surgeons required its members who perform plastic surgery involving anesthesia other than topical or oral anesthetics be accredited by a nationally or state recognized accrediting agency, be Medicare certified or licensed by the state.

"You can't go through the accreditation process without improving the quality of your facility," says Dr. Lesesne, whose office has been accredited for 10 months now. "Having a trained third party examine your policies and procedures can only help your center."

More than 90 percent of office-based centers are not accredited, according to accreditation agency estimates. If you're among them, you may wonder whether accreditation is worth it. Read on for insights into the benefits that accreditation can bring to your office-based surgery center.

Accreditation authenticates the quality of care
While most office-based surgeons already provide safe, excellent care, accreditation validates the quality. "A surgeon can meet and even exceed accreditation standards on his own, but without accreditation he has nothing to show for it," says Lawrence Reed, MD, a surgeon at the Reed Center in New York City, whose facility has been accredited for nearly 20 years. "A person could study on his own, learn medicine and be a better surgeon than an MD, but I wouldn't want him performing on me.

"Accreditation standards require you to have policies in place for all conceivable emergencies," adds Dr. Reed. "Such as if the anesthesiologist or surgeon becomes incapacitated, what would you do? Accreditation forces you to think about these kinds of questions and come up with a policy that works your center."

Surgeons say that meeting the standards of the three accrediting bodies, the American Association for Accreditation of Ambulatory Surgery Facilities (AAAASF), Accreditation Association for Ambulatory Health Care, Inc. (AAAHC) and Joint Commission on Accreditation of Healthcare Organizations (JCAHO), resulted in better emergency preparedness, better infection control policies and better business practices.

"In preparing for your survey, you find out a lot about your practice. You may be doing something one way, thinking that it is the right way or the only way of doing it," says Andrew Shatz, MD, a surgeon at the Akstein Eye Center in Riverdale, Ga. To his surprise, Dr. Shatz had to remove locks from the doors of the operating suite to pass inspection because the accrediting agency considered them a fire hazard.

Accreditation is a requirement for reimbursement
The Akstein Eye Center opened a year and a half ago and found that most insurance companies wouldn't pay for procedures unless the facility became accredited. Dr. Shatz says his facility had no choice but to become accredited.

"Most office-based facility owners don't get reimbursed for surgeon's fees and even less are collecting facility fees," says Jack Anderson, vice president of business development with Validare.com, an online accreditation consulting business specializing in office-based surgery centers.

The good news is numbers are on the rise. Mr. Anderson believes that as more centers become accredited and begin demanding facility fees, insurance companies will comply. "Many insurers reject claims that look unfamiliar. When that happens, you may have to prove that you deserve it," says Mr. Anderson. But it pays to be persistent. Facility fees can add $20,000 in revenue a month.

Accreditation may be state mandated
Only three states, Connecticut, Pennsylvania and Rhode Island, mandate accreditation of office-based surgery centers, but four more states, Alabama, Georgia, Ohio and Tennessee, are considering doing so as well, according to data complied by AAAHC (see "State Regulations Regarding Office-based Surgery" on page 86). The Ohio medical board, for example, has proposed that offices using higher levels of anesthesia be accredited. With the rise in office-based surgery, state-required accreditation is inevitable, says AAAASF Executive Director Ed Stygar.

Even if your state does not mandate accreditation, you may be able to waive your state inspection if your facility is accredited, says JCAHO Executive Director Michael Kulczycki.

Medical societies require accreditation
Many cosmetic surgeons had their office-based centers accredited last year when the American Society of Plastic Surgeons and American Society of Aesthetic Plastic Surgeons required members to become accredited. And more professional societies may follow suit.

The American Medical Association (AMA) and the American College of Surgeons (ACS) are working together to create patient safety guidelines for office-based facilities. "Physicians who perform office-based surgery with moderate sedation/analgesia, deep sedation/analgesia or general anesthesia should have their facilities accredited by JCAHO, AAAASF, AAAHC, AOA or a state-recognized entity," according to the guidelines, available at www.facs.org/ahp/pubs/pubs.html. The AMA and the ACS expect to ratify the guidelines later this month and would like to see state governments use the guidelines as a model for state legislation.

Patients may ask about accreditation
With reports about safety issues in office-based surgery settings making headlines, patients are asking more questions than ever. "Patients ask about accreditation," says Dr. Reed. "They are also more aware of their rights and more critical of healthcare providers."

"Accreditation makes a statement to patients. It says you're dedicated to quality and meeting nationally recognized standards," says AAAHC Executive Director John Burke, PhD.

Accreditation boosts morale
Surgeons say they are more comfortable and confident in their facilities as a result of their accreditation and view the experience as also a morale booster for the staff. Dr. Burke recommends having your staff get involved with accreditation. This will help make the process more manageable and staff members can share in the pride of their accomplishment.

"Many facilities use their accreditation as a way to recruit staff. It shows that the company is a quality organization," says Dr. Burke.

Accreditation is a learning experience
Although the survey process can be very intimidating, it is also a chance to learn from an industry expert. "Many inspectors are leaders in the industry and have seen many facilities and are willing to share their best practices with you," says Dr. Lesesne. "Our inspector offered 60 suggestions of ways we could improve our facility above and beyond just meeting the accreditation standards."

One example: Because the center's recovery room curtains could came in contact with patients, the surveyor recommended they be washed on a regular basis.

"My advice," says Dr. Lesesne, "is to approach your inspection as an educational experience.