Revised ASC Conditions of Coverage & Advance Directives

May 18, 2009

Effective today, ASCs are required by the revised CMS Conditions of Coverage (42 CFR § 416.50) to inquire with all patients about advance directives and to provide patients with information about their policies on advance directives and information on applicable state law. Furthermore, ASCs must provide patients with official state advance directives forms, if requested.

Although state laws vary, advance directives typically come in two forms:

  • Designation of an agent (or “proxy” or “surrogate” or “durable power of attorney for healthcare”) to specific a decision-maker at any time a patient cannot speak for himself/herself.
  • “Living will” to specify the patient’s healthcare wishes in the event of a terminal condition.

In addition to the above advance directives, many patients have “Do Not Resuscitate” (or “Allow Natural Death”) orders that set forth the type of care wanted in the event of cardiac and/or respiratory arrest. In some states, DNR orders are considered to be advance directives.

Although the procedures performed in ASC typically do not create situations in which advance directives or DNRs will be an issue, CMS has recognized that discussions about advance directives are becoming a standard practice and are important in those rare circumstances in which complications arise. Furthermore, honoring advance directives is required by the AAAHC accreditation standards (Rights of Patients Standard F.8), and both the American College of Surgeons and the American Society for Anesthesiologists have professional standards indicating that automatic suspension or revocation of DNRs for surgery is inappropriate.

In light of the new rules, ASCs should reexamine any existing advance directives policies and/or create new ones; document, in a prominent part of the patient’s record, whether the patient has an advance directive; ensure that their professional and support staff are educated on the topic; and ensure that they have up to date information and forms available for their patients that are consistent with applicable state law.

For more information on advance directives, including free forms for every state, please consider the materials available on the National Healthcare Decisions Day website. Note: this nation-wide advance directives educational event was founded and is chaired by Nathan Kottkamp.

For assistance with advance directives issues, including development of policies and staff education, or any other questions about the revised ASC Conditions of Coverage, please contact the authors.