Ambulatory Surgery Centers (ASCs) offer a cost-effective alternative to hospital-based surgical care (1). ASCs create a comfortable environment for patients who do not require hospitalization after surgery. They have experienced rapid growth in the US in recent years as more procedures and surgeries move out of inpatient settings. However, before a new ASC can begin operations, it must undergo certifications and inspections to ensure compliance with federal, state, and accreditation standards (2).
To open a new ASC, one must first obtain a state license. Each state has specific regulatory requirements governing ASCs, and it is therefore important to familiarize oneself with local laws. Many states require ASCs to meet certificate-of-need (CON) laws to ensure the new facility is necessary in the community (3). Some states may have specific laws outlining operational rules, age regulations, population restrictions, quality reporting requirements, and more (2). The licensing process for a new ASC typically involves submitting an application to the state, which may in itself require certifications from the department of public safety, occupancy certifications, and the fulfillment of other state health department regulations (4).
Most ASCs will be interested in participating in the Federal ASC Program, which will allow them to receive facility fees from government payers such as Medicare and Medicaid. In order to do so, they must contract with the Centers for Medicare and Medicaid Services (CMS), which involves meeting the regulations outlined in the Conditions for Coverage (CfCs) (5). The current list of CfCs includes items such as compliance with state licensure law, quality assessment and performance improvement, patient rights, and infection control, among others.
Though not legally required, accreditation by national independent organizations bolsters an ASC’s credibility. Private insurers may also require these further accreditations before contracting with providers.
One accreditation organization is The Joint Commission (TJC), which accredits and certifies around 24,000 healthcare organizations and programs in the United States. They conduct inspections of healthcare facilities with the aim of improving the quality and safety of healthcare. They have been working with ASCs for 45 years (6).
Another organization is the Accreditation Association for Ambulatory Health Care (AAAHC). Obtaining its accreditation is a three-year process to ensure the ASC meets the organization’s guidelines, which focus on ongoing performance improvement strategies to promote quality and infrastructure that promotes excellence (7).
Finally, the Accreditation Commission for Health Care (ACHC), formerly HFAP, which partners with CMS for deeming authority, offers the benefits of ensuring ASCs are meeting regulatory requirements and are striving for quality improvement (8). Unlike other accreditations, they offer a fast-track program so that ASCs are able to begin receiving reimbursements from CMS much faster.
Navigating certifications and inspections for a new ASC can be complex. By staying informed on regulatory state and federal requirements, as well as striving to achieve further accreditations, anesthesiologists can contribute to a high-quality, legally compliant, and financially sustainable surgical facility.
References
- Monk, S. H., Hani, U., Pfortmiller, D., Smith, M. D., Kim, P. K., Bohl, M. A., Coric, D., Adamson, T. E., Holland, C. M., & McGirt, M. J. (2022). Anterior Cervical discectomy and Fusion in the ambulatory Surgery Center versus inpatient setting: One-Year Cost-Utility Analysis. Spine, 48(3), 155–163. https://doi.org/10.1097/brs.0000000000004500
- Ikpot, I. Z., Smolyak, G., & Kreso, M. (2024). Establishing and managing an Ambulatory Surgery Center: planning, launching, operating, and sustaining success. International Anesthesiology Clinics, 63(1), 1–13. https://doi.org/10.1097/aia.0000000000000465
- Stratmann, T., Bjoerkheim, M., & Koopman, C. (2024). CON and Ambulatory Surgical Centers. CATO. https://www.cato.org/regulation/fall-2024/con-ambulatory-surgical-centers
- Commonwealth of Massachusetts. (n.d.). Health care facility initial licensure and change of ownership. Mass.gov. https://www.mass.gov/how-to/health-care-facility-initial-licensure-and-change-of-ownership
- Ambulatory Surgical Centers | CMS. (n.d.). https://www.cms.gov/medicare/health-safety-standards/guidance-for-laws-regulations/ambulatory-surgery-centers/ambulatory-surgery-centers
- Ambulatory health care accreditation. (n.d.). The Joint Commission. https://www.jointcommission.org/what-we-offer/accreditation/health-care-settings/ambulatory-health-care
- AAAHC. (2024, December 4). Ambulatory Accreditation | AAAHC. https://www.aaahc.org/accelerated-readiness/program-overview/ambulatory-accreditation/
- Chothani, J. (2025, January 31). About accreditation – ACHC. ACHC. https://www.achc.org/about-accreditation/