Understanding the Regulations and Guidelines of Ambulatory Surgery Centers

Until the 1970s, it was practically unheard of to have a surgical procedure outside of a hospital. However, health care facilities that offer patients a more convenient, affordable method of care grew in popularity in the form of Ambulatory Surgery Centers (ASCs). Each year, more than 23 million procedures are performed by physicians in these facilities, known for providing same-day surgical care.[1] At ASCs, patients typically have a shorter wait time for surgery, physicians have more professional autonomy, and care is more cost-effective, saving the government, third party payers, and patients money.[2] However, as independent entities, ASCs have their own set of laws and regulations to abide by. In order to increase awareness of these regulations and assist legal advisors to patients and physicians at ASCs, here’s an overview of ASC admission, pre-surgical, and anesthetic policies. The following information is provided by the Department of Health and Human Services and the American Society of Anesthesiologists:[3]


Admission and Pre-Surgical Assessment

  • Each patient admitted to an ASC must have a comprehensive medical history and physical assessment (H&P) completed by a physician no more than 30 days before the date of the scheduled surgery, regardless of the type of procedure.
  • The H&P should specify that the patient is cleared for surgery in an ambulatory setting.
  • If a patient is scheduled for two surgeries at an ASC within a short period of time, the same H&P may be used as long as it is completed no more than 30 days before either surgery.
  • Same-day referrals still require an H&P, but can be performed by the referring physician if permitted by the ASC. The H&P can also be completed on the same day as the surgical procedure.
  • Upon admission, each patient must have a pre-surgical assessment completed, including an updated medical record and documentation of any drug or biological allergies.
  • Post-admission pre-surgical assessment is designed to identify any changes to a patient’s health status after the H&P. However, if no changes are found, this should be indicated.



  • The American Society of Anesthesiologists (ASA) endorses and supports the concept of Ambulatory Anesthesia and Surgery, and encourages anesthesiologists to play a leadership role in ASCs and participate in facility accreditation to standardize and improve quality of patient care.
  • A physician must examine a patient immediately before surgery to evaluate the risks of anesthesia and of the procedure to be performed.
  • The assessment must be specific to each patient; for instance, it is not acceptable for an ASC to assume that coverage of a specific procedure by Medicare in an ASC setting is a sufficient basis to conclude that the risks of the anesthesia and surgery are acceptable generically for every ASC patient.
  • ASCs must have approved policies and procedures to assure that the assessment of anesthesia-related risks is completed just prior to every surgical procedure
  • It is necessary for an anesthesia plan to be developed by an anesthesiologist, discussed with an accepted by the patient, and documented before a surgical procedure.
  • Anesthesia must be administered by an anesthesiologist, other qualified physician, or nonphysician anesthesia personnel medically directed by an anesthesiologist


With a complicated, consistently changing medical scene, Ambulatory Surgery Centers can provide the ease and service many Americans desire. As ASCs’ popularity increases, it is important to be informed of their regulations, and know what expectations patients, physicians, and legal advisors should have when working with them.

[1] Rechtoris, Mary, “50 things to know about the ambulatory surgery center industry,” Becker’s ASC, July 22, 2015, http://www.beckersasc.com/asc-turnarounds-ideas-to-improve-performance/50-things-to-know-about-the-ambulatory-surgery-center-industry.html

[2] “ASCs: A Positive Trend in Health Care,” Ambulatory Surgery Center Association, n.d., http://www.ascassociation.org/advancingsurgicalcare/aboutascs/industryoverview/apositivetrendinhealthcare

[3] “CMS Manual System; Pub. 100-07 State Operations,” Department of Health & Human Services, May 13, 2011, www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/…; “Guidelines for Ambulatory Anesthesia and Surgery,” American Society of Anesthesiologists, Oct. 22, 2008, www.asahq.org/…/guidelines-for-ambulatory-anesthesia-and-surgery.pdf