In 1996 California Assembly Bill AB 596 was introduced, which prohibited outpatient surgery, unless the facility was accredited by an approved accrediting agency or Medicare-certified as an ambulatory surgery center. This evolved further in 2007, when private bodies (AAAHC, AAAASF, etc.) received re-approval from the Medical Board of California as recognized accrediting agencies. These events mandated the adherence to a set of several levels of standards for the physical setup for all ambulatory surgery facilities in the State, new and existing.
Generally, private outpatient surgery centers now fall into two categories; basic office-based settings; and Medicare licensed facilities. Both are regulated for full-anesthesia cases. However the former are normally just a part of a clinical office, and associated with elective, non-reimbursed surgeries with lower levels of anesthesia. Medicare licensed ambulatory surgery centers (ASC’s) are stand-alone facilities for surgery only, and are held to much higher standards. They are required for all insurance or Medicare reimbursed procedures. At this point we see very different approaches to design for the physical environment of each type.
Interestingly, the building codes don’t properly address office-based surgery facilities. This creates a bit of a dilemma when it comes to designing an appropriately scaled facility, since the requirements for operating rooms are quite different from those applicable to a physician’s medical office. Architects charged with creating a medical office which incorporates an operating room, should carefully advise their clients on the differences. And they’ll need to be highly conversant with all the building code limitations.
The design of Medicare-licensed ambulatory surgery centers is actually more black and white. California Building Code (CBC) Section 1226 deals with specialty clinics in great detail, although this is not the whole story, since NFPA-99 also comes into play, and Medicare has its own set of parallel standards too. You may also have heard of OSHPD (Office of Statewide Health Planning and Development) – where do they fit in? As you can see, Architects need to be on top of all these factors, in addition to being experienced in medical design; the needs, layouts and flow and so on. Great care must be taken, not just in preparing designs for the functional facility, but in also the selection of the site and the building an ASC will be housed in.
In the next part of this blog, we’ll look in more detail at the design considerations for various types of surgery facility.