Three ophthalmology groups are asking the Centers for Medicare and Medicaid Services to broaden the conditions under which ambulatory surgery centers are permitted to treat patients on the same day they are referred for surgery.

A new condition for coverage enacted last spring that requires ASCs to notify patients of their rights and the center's ownership before the day of surgery has "been disruptive to the delivery of optimal patient care," write the American Academy of Ophthalmology, American Society of Cataract and Refractive Surgery and the Outpatient Ophthalmic Surgery Society in a letter to CMS this week.

On April 23, 2010, CMS published a proposed rule solidifying an exception it announced last May for cases "when the procedure must, to safeguard the health of the patient, be performed on the same day as the physicians' referral." The eye groups, submitting their letter on the last day of the comment period, argue that this exception to the same-day notice rule does not go far enough.

"Medical necessity is but one of several factors that might legitimately result in the scheduling of services on the same day," they write, arguing that the current policy "causes unnecessary inconvenience and economic hardship to many ophthalmic patients throughout the country."

To remedy this problem, AAO, ASCRS and OOSS recommend that CMS either return to the pre-2009 patient rights language in its conditions for coverage; hold ASCs to the same notice standards for same-day surgery as hospitals; or allow patients for whom a delay in surgery would pose a "significant inconvenience or financial hardship" to sign a waiver permitting the ASC to perform surgery on the same day of patient rights notification.

Irene Tsikitas

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