Blog Post August 14, 2019 Florida HB 843: Extending Recovery Time in the ASC Authors Naomi Fisher On June 25, the Florida State Legislature passed the healthcare-related House Bill (HB) 843, which contained two provisions that will have a direct impact on Ambulatory Surgery Centers (ASCs) in the state. The first provision pertains to pediatric patient care in ASCs and according to the bill summary will require “the Agency for Health Care Administration to adopt rules that establish standards related to the delivery of surgical care to children in [an] ambulatory surgical center.” The second provision is of immediate significance as it changes the existing Florida state healthcare statute 395.002. As described in the bill summary it changes Florida state healthcare statute 395.002 to “allow a patient to stay in an ASC for up to 24 hours and deletes the current-law requirement that a patient be admitted and discharged on the same working day without staying overnight.” What does Florida’s HB 843 mean for Florida ASCs? As of July 1, Florida ASCs are now allowed to hold a patient overnight for observation as long as they are discharged within 24 hours of admission. This rule change gives ASCs and surgeons the opportunity to perform higher-acuity procedures that have historically remained in hospital settings due to the required recovery time. In particular, the number of ASC-based spine surgeries and total joint replacements has the potential to grow after this rule change. In addition to increasing the surgeons’ access to case volume, HB 843 will benefit patients and payers by expanding access to the ASC place of service as an alternative to hospital outpatient surgery, which in most cases is significantly more costly than surgery performed in an ASC. Furthermore, HB 843 aligns Florida ASC length of stay regulations with CMS conditions for coverage: CMS does not place limits on admittance and discharge, and instead requires only that the expected duration of services not exceed 24 hours following an admission. While the impact of HB 843 on Florida ASCs is clear, what are the broader implications for the future of ASCs across the country? With HB 843, Florida joins a growing list of states enacting extended recovery stay laws. In March 2018, Oregon passed a bill that allows patients to stay in ASCs for up to 48 hours, where previously they were required to be discharged within 24 hours. That same month, a law took effect in Pennsylvania redefining the duration of ASC “services” to be 24 hours, rather than 4 hours for a procedure and 4 for supervised recovery. Many other states have extended recovery care legislation, including Colorado, Illinois, Nevada, and New Hampshire. Extended recovery legislation is a possible contributor to surgical patients migrating from hospitals to ASCs at a time when growth in outpatient surgery continues to outpace that of inpatient surgery. Surgeons with access to ASCs that are equipped for extended recovery will have the opportunity to perform higher-acuity cases that may otherwise have been handled in a hospital. At the same time, the ability of these surgeons to shift higher-acuity cases to ASCs will depend on the ASC negotiating with commercial payers to establish reimbursement rates that enable this case migration. All in all, cost savings will be provided to both the payer and patient. HB 843 is an important milestone for Florida—with potentially a broader impact. This bill could provide momentum for future legislation, including 72-hour extended recovery care centers, an initiative Florida ASCs advocated for but that ultimately failed in the Senate in 2017. The push to allow extended recovery in ASCs is further supported by the July 29 CMS release of the proposed Hospital Outpatient Prospective Payment System rule, which includes a provision for adding total knee arthroplasty to the Medicare ASC list in 2020. Such legislation will be encouraging to both surgeons and payers, as many surgeons are comfortable moving higher-acuity cases to the ASC setting and payers continually work with providers to reduce healthcare costs.