By Donna Pleis

With an impressive reputation for cost savings and quality outcomes, ambulatory surgery centers (ASCs) have been providing millions of people with a safe and convenient option for out-patient surgeries. As technology and medical innovation progresses, so will the demand for exceptional surgery centers. As every ASC will attest, their standards of care and concern for patient safety are of prime importance.  But, even with notable patient care and satisfaction records, every ASC needs to recognize that they are vulnerable to malpractice risks.  However, there are ways to reduce and prevent the risk.

Policy and Procedure Manuals

The core of any risk prevention program is a good policy and procedure manual.  All areas of the operation need to be addressed, and when the guideline content is evidence based, and developed and led by the physicians, implementation is usually more successful.

Infection prevention is a key component of the policy manual, as well as anesthesia protocols and equipment maintenance. Regardless of whether a procedure is routine and executed by everyone frequently throughout the day, or one that is considered inconsequential, it still requires written documentation.

Training, Updates and Communication

While development of a manual is essential, it is even more important that all staff and doctors are thoroughly trained on all of the documented guidelines. There is no risk protection if a manual is written and then sits on a shelf gathering dust. The manual becomes the standard of care for the ASC, and in a legal situation the center will be held to that standard of care — whether or not the guideline is a mandated regulation or just a policy of the ASC. Whatever is in the manual should be carried out explicitly at all times.

With ever-changing technology in medicine and the necessity of new guidelines due to process improvement efforts, regular updates to the center’s manual is crucial. The next step is good communication and training all staff on any changes.

Independent Contractors

It is not uncommon for the ASC to deal with independent contractors, whether they are physicians or other professionals, and to prevent malpractice risk with contractors there a couple of points to remember. First, the ASC needs to make sure that patients understand that the contractor is not an employee of the facility. Without giving this notification, the ASC could be held liable under the legal theory of “apparent authority.”

Failing to check credentials properly can also expose the ASC to liability if the physician causes harm to a patient while performing a procedure for which he or she was not qualified. Therefore, it is extremely important to develop a process for authenticating credentials and a procedure for informing the patients that the physician is an independent contractor.

Management Companies

By working with management companies, ASCs get valuable expertise to help the center stay compliant with state and federal laws, especially in the areas of billing and coding. But even when ASCs are following the advice of a management company, they can be held accountable if the management company does not follow the law. It is important when contracting for services to make sure that the ASC is indemnified for any negligence or malfeasance of the management company. Also, the ASC can reduce risk by conducting careful and regular audits of their management company.

HIPAA Compliance

Protecting a patient’s healthcare information is the law, and a breach of the rules, whether the HIPAA Privacy Rules or the Security Rules, carries significant penalties that can be financially and professionally damaging to an ASC.  To avoid the risk of a HIPAA breach and to ensure that patient information is protected, an ASC must see that all physicians and staff stay current with HIPAA, train new employees as they come on board, and carry out all HIPAA protocols consistently.

Strive for Excellence

While there will always be malpractice risks within any healthcare environment, there are also many ways to reduce the chance of liability. Hiring qualified physicians, experienced managers and administrators are central to a well-governed ASC. When a facility is totally committed to patient safety and providing quality care, protocols that are implemented to achieve the goal of excellence will ultimately lessen the risks and protect the ASC against malpractice.


Donna Pleis graduated from the University of Pittsburgh’s Dental Hygiene Program and worked 18 years as a clinical hygienist. After obtaining a business degree, she worked in management within the insurance industry and wrote freelance articles for “The Doctor’s Press.”



abeo Management Corporation (abeo) serves as a leading source of revenue cycle management and practice management with a specialization in anesthesia. The company leverages its people, processes, and software to serve independent practices, surgery centers, hospitals and healthcare systems with a scope of services that include billing, coding, transcription, practice management, and business consulting.

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