What is an Outpatient Surgery Setting or an Outpatient Ambulatory Surgery Setting?
It’s any facility, clinic, center, office or other setting that is not part of a
general acute care facility, where anesthesia, except local anesthesia or peripheral
nerve blocks, or both, is used in compliance with the community standard of practice
in doses that, when administered have the probability of placing a patient at risk
for loss of the patient’s life-preserving protective reflexes.
Who can own an Outpatient Surgery Setting?
An Outpatient Surgery Setting can be owned by an association, corporation, firm,
partnership, or individual person.
Who can practice in an Outpatient Surgery Setting?
Licensed physicians and other medical staff who are professionally qualified and
appropriately credentialed can be granted privileges. Such privileges shall be periodically
reappraised by the Outpatient Surgery Setting and Accrediting Agency.
What kinds of procedures are done in Outpatient Surgery Settings?
Any type of outpatient surgery whereby the patient care is less than 24 hours.
Does an Outpatient Surgery Setting need to be licensed or accredited?
Anytime a medical procedure is performed under anesthesia that places patients at
risk of losing their life-preserving protective reflexes, the medical procedure
must be done in a licensed, certified, or accredited setting.
What is the difference between being licensed and/or accredited?
An Outpatient Surgery Setting that is owned and operated by a physician must be
accredited through one of four agencies approved by the Medical Board of California.
Non-physician owned Outpatient Surgery Centers can be licensed by the California
Department of Public Health or accredited by one of the Board approved Accreditation
What is the Medical Board of California responsible for?
The Board approves the Accrediting Agencies that accredit Outpatient Surgery Settings
What is not considered an Outpatient Surgery Setting for purposes of accreditation?
When an Outpatient Setting does not administer or use anxiolytics and analgesics,
in compliance with the community standard or practice, in doses that place the patient
at risk for loss of life-preserving protective reflexes it does not have to be accredited.
In addition, the following settings are exempt from accreditation: ambulatory surgical
centers certified pursuant to the Centers for Medicare Medicaid Services (CMS) requirements
for Medicare; any clinic directly conducted, maintained and operated by the Federal
Government; licensed acute care hospitals; and Outpatient Surgery Settings licensed
by the California Department of Public Health.
What are the minimum standards for accreditation of an Outpatient Surgery Setting?
Health and Safety Code Section 1248.15 defines minimum standards for accreditation
of Outpatient Surgery Settings and approving Accreditation Agencies. The following
are some of the accreditation standards:
- Outpatient setting allied health staff shall be licensed or certified
- Outpatient settings shall have a system for facility safety and emergency training
- Onsite equipment, medication, and trained personnel to handle services sought or
provided and to facilitate handling of any medical emergency
- Have a written transfer agreement with a local accredited or licensed acute care
- Permit surgery only by a licensee who has admitting privileges at a local accredited
or licensed acute care hospital, with the exception that licensees who may be precluded
from having admitting privileges by their professional classification
- Submit for approval by an accrediting agency a detailed procedural plan for handling
- Submit for approval by an accrediting agency a detailed plan, standardized procedures,
and protocols to be followed in the event of serious complications
- The procedural plan for handling medical emergencies shall include at a minimum:
- Notify individual designated by the patient in case of an emergency
that the mode of transfer is consistent with the patient’s medical condition
Ensure all relevant clinical information is documented and accompanies the patient
Continue to provide appropriate care to the patient until the transfer is effectuated
- All physicians and surgeons transferring patients from an outpatient setting shall
agree to cooperate with medical staff peer review process on the transfer case
- Outpatient setting shall permit surgery by a dentist, physician and surgeon, an
osteopathic physician and surgeon or podiatrist acting within their scope of
- Outpatient setting may, in its discretion, permit anesthesia service by a certified
registered nurse anesthetist acting within their scope of practice
- Outpatient setting shall have a system for:
- Maintaining clinical records
- Patient care and monitoring procedures
- Members of medical staff and other practitioners who are granted clinical privileges
shall be professionally qualified and appropriately credentialed
- Outpatient setting shall grant privileges in accordance with recommendations from
qualified health professionals, and credentialing standards established by the outpatient
- Clinical privileges shall be periodically reappraised
- Outpatient settings that have multiple service locations shall have all of the sites
inspected by the Accrediting Agency
- Outpatient settings shall post the certificate of accreditation in a location readily
visible to patients
- Outpatient settings shall post the name and telephone number of the accrediting
agency with instructions on submission of complaints in a location readily visible
- Outpatient settings shall have a written discharge criteria
- Outpatient settings shall have a minimum of two staff persons on the premises, one
of whom shall either be a licensed physician and surgeon or a licensed health care
professional with current certification in advanced cardiac life support (ACLS)
- Transfer to an unlicensed setting of a patient who does not meet the written discharge
criteria shall constitute unprofessional conduct
- An accreditation agency may include additional standards in its determination to
accredit outpatient settings
- No accreditation standard adopted or approved by the board, and no standard included
in any certification program of any accreditation agency approved by the board,
shall serve to limit the ability of any allied health care practitioner to provide
services within their full scope of practice
- Notwithstanding this or any other provision of law, each outpatient setting may
limit the privileges, or determine the privileges, within the appropriate scope
of practice, that will be afforded to physicians and allied health care practitioners
who practice at the facility
- Privileges may not be arbitrarily restricted based on category of licensure
- The Board shall adopt regulations that it deems necessary for outpatient settings
that offer in vitro fertilization
- The Board may adopt regulations it deems necessary to specify procedures that should
be performed in an accredited outpatient setting for facilities or clinics that
are outside the definition of outpatient setting
- As part of the accreditation process, the accrediting agency shall conduct a reasonable
investigation of the prior history of the outpatient setting, including all licensed
physicians and surgeons who have an ownership interest therein, to determine whether
there have been any adverse accreditation decisions rendered against them
- An outpatient setting shall be subject to the reporting requirements in Section
1279.1 and the penalties for failure to report specified in Section 1280.4
Who inspects and insures the safety of the Outpatient Surgery Setting?
The accrediting agency is responsible for inspecting and making sure the Outpatient
Surgery Setting is in compliance with the minimum requirements for accreditation.
These inspections will be conducted no less than once every three years by the accrediting
agency. In addition, the Board may also inspect Outpatient Surgery Settings.
What types of information must be posted inside the Outpatient Surgery Setting?
The Outpatient Surgery Setting’s certificate of accreditation must be posted along
with the name and telephone number of that accrediting agency with instructions
on submission of complaints in a location that is readily visible to patients.
How do I know the Outpatient Surgery Setting is licensed or accredited?
Search for an Outpatient Surgery Setting
on the Board’s website. You can also ask the Outpatient Surgery Setting staff regarding
the facility’s accreditation. Also, check for the Outpatient Surgery Setting’s accreditation
certificate that should be in a visible place at the Outpatient Setting.
What Accreditation Agencies are approved by the Board?
The Board has approved four accreditation agencies:
What is the Outpatient Surgery Setting’s responsibility to the patient?
Maintaining the Outpatient Setting in continual compliance with the minimum requirements
for accreditation pursuant to California Health and Safety Code Section 1248.15
and any other additional requirements of the Accreditation Agency that accredited
What types of problems can cause an Outpatient Surgery Center to have its accreditation
denied, suspended, or revoked?
Violating the requirements pursuant to California Health and Safety Code Section
1248.15 and/or violating the additional requirements of the specific Accreditation
Agency that accredited the Outpatient Surgery Setting. If accreditation is denied
by the Accrediting Agency it shall provide notification of the denial to the Outpatient
Surgery Setting, as well as the Board.
Can an Outpatient Surgery Setting be closed down, and if so who can do it?
Yes, once the Medical Board of California has completed its investigation that substantiates
the allegations of an illegally operating Outpatient Surgery Setting. The Board
may submit an investigative report to the local District Attorney’s Office or the
Office of the Attorney General to request an injunction through the court system.
Who chooses the surgery center?
Usually your physician will determine the Outpatient Surgery Setting. The physician
should have privileges to perform the specific procedure, at that specific Outpatient
Surgery Setting. You can Search for an Outpatient Surgery Setting
as well as who owns it, on the Board’s website. Also, the accreditation should be posted in plain view at the setting.
What safety measures should be in place in case of an emergency at an Outpatient
The Outpatient Surgery Setting is required to have a detailed procedural plan to
follow in case of a medical emergency. There must be a physician or another licensed
health care professional with current certification in advanced cardiac life support
on site. In addition, there must be a detailed plan and standardized procedures
and protocols to be followed in case of serious complications. The Outpatient Surgery
Setting must also have access to a licensed acute care hospital as well as a transport
agreement. Feel free to ask the Outpatient Surgery Setting staff about the Outpatient
Surgery Setting’s emergency protocol.
How do I file a complaint?
What if I can’t find the outpatient surgery setting on the Board’s list?
Not all outpatient surgery settings are required to appear on the Board’s list.
For example, Medicare/Medicaid certified outpatient settings that are regulated
by the Federal Government’s Center for Medicare/Medicaid Services (CMS) and surgical
clinics licensed by the California Department of Public Health’s Licensing and Certification
Program are not required to be accredited by one of the Board’s approved accreditation
agencies. For a complete list of surgery settings exempted from having to be accredited,
click on this link:
Types of Settings Not Required to Appear On List.
If you can’t find the surgery setting on the Board’s list, please contact CMS or
the California Department of Public Health to determine if the setting is CMS certified
If you cannot find the outpatient surgery setting after checking the Board’s list,
and contacting CMS and the California Department of Public Health, and
the outpatient surgery setting is performing surgery using anesthesia in doses that
have the probability of placing a patient at risk for loss of life-preserving reflexes,
please file a complaint with the Medical Board using the
Consumer Complaint Form.