The United States has approximately 5,400 ambulatory surgery centers (ASCs), representing roughly 35% of all surgeries performed nationwide. These facilities commonly focus on gastrointestinal, ophthalmology, pain management, orthopedic, and genitourinary procedures. ASCs provide advantages including enhanced patient access, dependable scheduling, customized surgical spaces, efficient teams, shorter stays, reduced expenses, and diminished hospital-acquired infection exposure. To address potential limitations, outpatient facilities typically establish transfer agreements with hospitals for emergency situations.
"Transfer agreements between outpatient facilities and hospitals serve as an essential safety net, ensuring that patients receive appropriate care in the event of an emergency." Prior to 2019, federal regulations required ASCs to maintain written transfer agreements with local hospitals or ensure all surgeons had hospital admitting privileges. In November 2019, the Centers for Medicare and Medicaid Services (CMS) modified these requirements, eliminating the mandate for written transfer agreements. Instead, ASCs were directed to periodically notify local hospitals about their operations and patient demographics. Only Alaska and Delaware have removed this state-level requirement since 2019.
Transfer agreements provide structured processes ensuring patients receive suitable care levels, as ASCs may lack resources for complex emergencies. Hospitals offer specialized equipment and personnel necessary for advanced care. These agreements facilitate smoother care transitions when inpatient admissions become necessary and can improve patient outcomes overall.
State-by-state requirement variations create challenges for multi-state ASCs. Negotiating agreements consumes considerable time and resources for smaller facilities. CMS estimated $843 million in first-year savings when proposing guidance eliminating transfer agreement requirements. Currently, CMS encourages collaborative relationships between outpatient facilities and hospitals while prioritizing patient safety and respecting varying state regulations.