A comprehensive medical history and physical assessment (H&P) may be conducted prior to surgery at an ambulatory surgery center (ASC) but regulatory updates stipulate that an H&P is no longer required for all patients before their surgical procedure.

ASCs now must have a written policy that identifies which patient populations are required to have an H&P and/or which types of procedures require an H&P based on the determination of acceptable risk for a procedure. ACHC recommends that your policy contains both, says Michelle Nolander, a Clinical Review Specialist with ACHC, who stresses that reviewing both criteria is a good practice to follow.

The purpose of conducting an H&P for ASC patients is to determine whether there is anything in the patient’s overall current condition that would affect the planned surgery, such as a medication allergy or a new or existing condition that requires additional interventions or intentional consideration to reduce risk to the patient. H&Ps, when required, are completed no more than 30 days before the procedure.

The H&P also weighs whether an ASC is the appropriate setting for the patient’s surgery, since an ASC does not provide services to patients requiring hospitalization, Nolander says.

Another regulatory update specifies that when an H&P is required by an ASC’s policy, it may be performed on the same day as the surgical procedure as long as the H&P meets the following criteria:

• It is conducted by qualified personnel (as defined by standards and the ASC’s policy).
• It is comprehensive.
• It is performed and documented prior to a patient being prepped for a surgical procedure.

The H&P, if required, is conducted in addition to mandatory presurgical and pre-anesthesia patient risk assessments. All are important to enhancing an ASC’s efforts to protect patients and improve outcomes.