When planning surgery at an ambulatory facility, you should ask if the facility is accredited. Accreditation can be an indication of the quality of the facility operation. It requires that the facility has passed strict guidelines for equipment, staff, hospital access and anesthesia administration. It also requires that the doctors performing surgery at the facility have privileges to perform the same procedures at an accredited hospital.

You can find out if a facility is accredited by asking your surgeon. The doctor will welcome questions about the facility and will be pleased that you are concerned enough to ask.

An accreditation certificate will usually be prominently displayed in the facility. The following are some of the groups that accredit facilities:

• The American Association for Accreditation of Ambulatory Plastic Surgery Facilities (AAAAPSF)
  1202 Allanson Road
  Mundelein, Illinois 60060
  (847) 949-6058

• The Joint Commission on Accreditation of Healthcare Organizations (JCAHO)
  One Renaissance Boulevard
  Oakbrook Terrace, Illinois 60181
  (847) 916-5600

• The Accreditation Association for Ambulatory Health Care (AAAHC)
  9933 Lawler Avenue
  Skokie, Illinois 60077
  (847) 676-9610

All of these groups have programs to provide accreditation and inspection of outpatient surgical facilities.

A patient can also check if a plastic surgeon's facility is accredited by calling the American Society of Plastic Surgeons (ASPS) at 1-800-635-0635. ASPS is a national medical specialty society in which certification by the American Board of Plastic Surgery is a membership requirement.

Inspection and Classification

The American Association for Accreditation of Ambulatory Plastic Surgery Facilities (AAAAPSF) is a not-for-profit association devoted to a voluntary inspection and accreditation program for qualifying ambulatory plastic surgery facilities. Accreditation by the AAAAPSF certifies a facility has met the rigorous standards developed by the AAAAPSF for patient care, quality and safety.

The AAAAPSF inspects only ambulatory plastic surgery facilities owned or directed by surgeons certified by the American Board of Plastic Surgery (ABPS). Certification by the ABPS means that the surgeon has graduated from an accredited medical school and completed at least five years of additional residency training - usually three years of general surgery (or its equivalent) and two years of plastic surgery. To be certified by the ABPS, a doctor must also practice plastic surgery for two years and pass comprehensive written and oral exams.

AAAPSF classifies ambulatory surgery facilities as A, B or C facilities. Re-certification of facilities occurs every three years. Plastic surgery procedures are performed under local anesthesia in class A facilities. Medication to relieve tension may be given before local anesthesia is administered. A sedative and local anesthetic allow you to be comfortable during surgery.

Most plastic surgery procedures are performed in class B or C facilities. The standards vary just slightly between B and C facilities. Both have life-support equipment just as a hospital operating room.

• In the class B facility intravenous sedation may be administered.
• General anesthesia, which will allow you to sleep through the entire operation, may be administered only in class C facilities.

Insurance

An ambulatory facility usually charges set amounts based on the procedure(s) performed at the facility. Therefore, you will have a good estimate of what costs will be for your surgery in an ambulatory facility. Generally, costs for ambulatory facilities are less than similar services provided in a hospital.

While most insurance plans do not cover facility fees for elective surgery, facility fees for reconstructive procedures may be covered. Your doctor or your doctor's office staff may be able to help you with questions about your insurance coverage. Reimbursement of facility fees may be expedited when the facility carries recognized accreditation, as accreditation assures that the facility meets generally recognized standards of quality. The cost-saving benefits of ambulatory facilities have also been favorably viewed by state and federal health agencies, including Medicare.

Other Considerations

Ambulatory surgery is not appropriate for everyone. Each case must be evaluated individually. Your medical history must be reviewed and only your doctor and you can best decide if you are a good candidate for surgery in an ambulatory setting.

As an additional precaution, after surgery in an ambulatory facility, a responsible adult must be available to drive you home and remain with you for 24 to 48 hours post-operatively - or as your doctor recommends. If this is not possible, your physician may transfer you to a post-operative recovery facility until you are able to safely care for yourself.