While 43 states require ASD to be granted, only 30 require them to consider the possibility of outpatient emergency care. Fifteen of them are demanding that they have a hospital transfer agreement. The others require either an agreement or hospital admission privileges for CSA surgeons. (See the “Situation” sidebar. Some states require that the hospital with which the CSA arranges transfers be within a certain csa travel time limit. For example, Illinois and Mississippi indicate 15 minutes, while Oklahoma indicates 20 minutes and Florida 30 minutes. 15 states require a hospital transfer agreement:AlabamaAlaska ArcansasConnecticutIllinoisKentuckyMississippiNevadaNew YorkNorth CarolinaOhioSouth DakotaTennesseeWashingtonWyoming Each CSA treating Medicare recipients must be certified by the Medicare program and meet federal government requirements for ASCs. One of these requirements requires CSOs to have a written transfer agreement with a local Medicare participating hospital or a non-participating hospital that meets Medicare program requirements for emergency payments. If the CSA does not have a transfer agreement, any physician who performs an operation in the CSA must have privileges to be admitted to a designated CMS-compliant hospital. For more information on this topic, contact Albert R. Riviezzo at 610.458.4949 or [email protected]. The active terms of a hospital transfer agreement vary from case to case and must be set out in the written document. A transfer contract may have an expiry date or indicate that it remains in effect until a party terminates the contract.

A hospital transfer agreement should address the circumstances in which an emergency transfer is to take place, indicate who is empowered to make the decision to transfer a patient, and list the documentation that must accompany the patient to the hospital. The agreement should describe the procedure for implementing the transfer, including the assignment of roles and responsibilities to the staff of the surgical organization and prior agreements regarding the method of transport by which patients are hospitalized. transfer agreements should clearly define the respective responsibilities of the CSA and the hospital in a number of areas, including the provision of patient information; the provision of means of transport; sharing of services, equipment and personnel; the provision of care with regard to the establishment and capacity of the Agency; and confidentiality of medical records. The Ohio regulations are representative of the first group and state that a CSA “must have a written transfer agreement with a hospital for the transfer of patients in the event of medical complications, emergencies, and other needs in the event of an occurrence.” In contrast, according to the Texas Executive Order, a CSA must “have a written transfer agreement with a hospital or all physicians performing a CSA operation must have omission privileges at a local hospital.” In addition, the Directive should include provisions on emergency care and stabilising treatments in the CFS, within the limits of the possibilities offered by CSA staff until the patient is transferred. Staff should be trained to implement this Directive in the event of a medical emergency, so that regular training sessions and mock exercises can be useful in times of crisis. Finally, that emergency directive should provide for a compensation clause allowing each party to claim reimbursement from the other party in order to cover all liabilities, claims, actions, losses, costs, damages or expenses resulting from any of its acts or omissions in the performance of the agreement. . . .