An ambulatory surgical center in Lodi, Calif., temporarily shut down last week as the Centers for Medicare and Medicaid Services continued to flex its regulatory muscles in the San Joaquin Valley.

The Lodi Outpatient Surgical Center voluntarily closed for 2 days last week after CMS concluded during a sample validation survey that "there were some issues that they considered, in their interpretation, to be not in accordance with the new Conditions for Coverage," says Marklin Brown, administrator of the physician-owned, multispecialty facility.

The center had earned 3-year accreditation and Medicare deemed status from the Accreditation Association for Ambulatory Health Care after an October survey, but later received notice that it had been chosen at random to undergo a validation survey by CMS within 60 days of its accreditation, according to Mr. Brown, who says he was "surprised" by the notice. A spokesman for CMS says sample validation surveys are conducted for every provider type eligible for deemed status and are a means of getting "feedback and assessing the surveys conducted by the accrediting organizations."

When state inspectors found the alleged violations of Medicare conditions for coverage at Lodi last week, they gave the facility the option to "fix those overnight or cancel cases voluntarily until those things were fixed," says Mr. Brown. Although he says the facility didn't agree with the surveyors' conclusions, "we had to follow their protocol."

The alleged issues were related to GI procedures and infection control; in some cases, they were a matter of not having the proper documentation, according to Mr. Brown. For example, he says the while the "autoclave was being cleaned on a regular basis, it was not being documented on employee turnover, so [the surveyors] considered it not done."

Ralph Montano, a spokesman for the California Department of Public Health, which handles CMS surveys in the state, says the situation at the Lodi center is an "ongoing investigation" and therefore the department "can't comment on anything specific about that."

Lodi's temporary closure comes on the heels of CMS' termination notice sent to St. Joseph's Surgery Center in nearby Stockton, Calif., on Nov. 30. That notice, based on alleged deficiencies noted during a recent survey of the part hospital-owned ASC, was later rescinded, allowing the center to remain open as it worked on a plan of correction.

"Quite frankly, some folks think they are trying to give outpatient surgery centers a wake-up call," says Mr. Brown, who describes the Medicare survey as a "grueling, intense and stressful process."

Mr. Montano says the state is not engaged in a purposeful crackdown on ASCs, but he notes that there has been a lot of news coverage of surgery center practices in the Los Angeles Times and other local media over the past year, which may be drawing more attention to the issue.

Irene Tsikitas

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