Office-Based Surgery Frequently Asked Questions for Consumers
1. Why must certain physician practices be accredited?
A law passed in 2007 requires that physicians, physician assistants and specialist assistants, who perform or assist in Office-Based Surgery ("OBS"), must practice in an accredited setting. "OBS" is defined as invasive or surgical procedures, using more than minimal sedation.
On July 14, 2009, any physician performing "office-based surgery" ("OBS") must do so either in a Article 28 licensed hospital, ambulatory surgery center, diagnostic and treatment center; or in a private physician's office that is accredited. Article 28 facilities must post their operating certificates in an accessible location. Accredited "OBS" offices must post their accreditation certificates.
2. Who accredits "OBS" physician practices?
Offices may be accredited by any one of the following three organizations designated by the Commissioner of Health:
- The Joint Commission (TJC)
- Accreditation Association for Ambulatory Health Care (AAAHC)
- American Association for Accreditation of Ambulatory Surgery Facilities (AAAASF)
3. What are examples of procedures that might be covered by this law?
- All invasive procedures done under moderate sedation, deep sedation or general anesthesia
- Gastrointestinal procedures:
- Plastic surgery:
- Nasal reconstruction
- Breast reduction/augmentation
- Some obstetric and gynecologic procedures
- Gastrointestinal procedures:
- Liposuction of greater than 500 ml
4. What are examples of procedures that are not covered by this law?
- Most, but not all, botulinum toxin injections and minor dermatologic procedures can be performed in offices that do not require accreditation because they generally do not require more than minimal sedation.
- Generally, Magnetic Resonance Imaging (MRI) procedures are not subject to this law. However, MRIs that are performed with contrast are invasive, and these procedures must be performed in an accredited office if done under moderate or deeper levels of sedation.
- It is important to note that many offices perform invasive procedures using local anesthesia and/or mild sedation where the patient remains awake, aware, responds normally to verbal command, is breathing, and where other body functions are unaffected. In this case, no accreditation is required. However, if the physician's office practice performs other surgical or invasive procedures using more than minimal sedation, the practice must be accredited.
5. How can I find out if my physician's office is accredited?
- Prior to July 14, 2009, you can call the practice and ask directly if they are accredited, by which agency, and under what name. Once you get this information, you can visit the accrediting agency's Web site and search for the practice's name.
- After July 14, 2009, a list of accredited practices, including the practice name, address and county, will be posted on the "OBS" Web page on the Department of Health's Web site (www.nyhealth.gov).
- Please note that a physician may practice at more than one location, each of which must be separately accredited if "OBS" is practiced there.
6. What if I don't find the physician practice name I am looking for on the Web site?
If you do not find the name of the practice you are looking for on the DOH Web site or on the Web site of any of the accrediting agencies, then the physician's practice is most likely not accredited. But not all physician practices that perform procedures must be accredited. Offices performing invasive/surgical procedures using only local anesthesia and/or mild sedation do not need to become accredited.
7. I need to have a colonoscopy done and my doctor's office is not accredited. What should I do?
You always have the choice as to whether to have surgery or an invasive procedure done at a physician practice/location or at a NYS licensed Article 28 facility. Whether or not the practice needs to be accredited is based on whether moderate or deeper sedation is administered to patients during the procedure.
- Discuss with your physician what sedation options you have for this procedure. (Most physicians recommend, and over 90 percent of patients choose, moderate or deeper sedation for a colonoscopy.) It is your decision as to the level of sedation you want during the colonoscopy. If you and your physician agree that your colonoscopy will be done with minimal or no sedation, and the practice does not perform any other procedures using moderate or deeper sedation/anesthesia, then the practice would not have to be accredited.
- If you want more than minimal sedation, you and your physician may decide that the procedure will be done at another practice site, which is accredited.
- If the physician does not have an accredited practice site and you decide you want moderate or deep sedation, you can ask your physician if he/she can do the colonoscopy in a hospital or ambulatory surgery center.
- You may choose a different physician to perform your colonoscopy in either an accredited "OBS" practice or in a facility with an operating certificate.
8. Where can I go if I want to make a complaint about care in a private physician's office?
- You may file a complaint with the accreditation agency for that practice. The practice must post a telephone number for the accreditation agency.
- You may also file a complaint with the Department of Health's (DOH) Office of Professional Medical Conduct (OPMC) at 1-800-663-6114.
9. What happens to a physician, physician assistant or specialist assistant that performs office-based surgery in an unaccredited location?
Any violation of the Office-Based Surgery law falls within the definition of professional misconduct. Any of those providers may be subject to disciplinary action by OPMC.