1. Office Or Outpatient Centers Are The Best Place To Perform Most Arterial And Venous Interventional Treatments: Precautions And Current Status Of Their Accreditation And Reimbursement
Krishna Jain MD, FACS
Clinical Professor of Surgery
Western Michigan University, Homer Stryker MD School of Medicine

2. Conflict Of Interest
President and CEO National Office Endovascular Labs LLC
CEO and Medical director National Surgical Ventures

4. Lessons Learnt Do not push the envelop You can do more than you think
Follow Medicare guidelines and avoid audits
Cost containment is mandatory
Follow protocols

5. Lessons Learnt Mentor new associates
Communication between the team members is essential
Use conscious sedation judiciously
Be prepared to handle all emergencies
Know your data

6. Optimum site of Service
Hospital Inpatient
Hospital Outpatient
ASC
OBL
Patient convenience
Poor
Good
Excellent
Patient satisfaction
Mediocre
Patient Safety
satisfactory
Cost
Expensive
Cost effective
Cost Effective
Physician satisfaction
Acceptable

7. Need for Accreditation
Provide safe environment
Policies and Procedures
Credentialing
Radiation safety
Maintain quality
Board certification
Provide appropriate care
Measure patient satisfaction

8. Comparison Year Facilities accredited Surveyors Emphasis
Recertification
AAAASF
1992
ASC and OBS
Surveyed by surgeons
Physical layout and environment
Peer review, board certification
Yearly self evaluation
On site every 3 years
AAAHC
1979
ASC, OBS ,pain management clinics CHC etc.
Physician, nurses and others trained by AAAHC
Patient rights, administration, governance, Quality, medical records, facility and environment
Every 3 year on site visit
The Joint Commission
1951
Hospitals, ASC Home care Clinical labs etc.
Physician, nurses and others governed by 28 member board
Safety and Quality ,Staff competence, Leadership
Every 3 years on site visit

9. SVS/OEIS Certification
In development
Indication and outcome based
Participation in a registry
Depends on phase of care
Surgical preoperative evaluation and preparation phase of care
Immediate preoperative readiness phase of care
Intraoperative phase of care
Postoperative phase of care
Post discharge phase of care

10. Reimbursement Proposed 2019 Final 2019 Net Improvement/Loss
Proposed 2019
Final 2019
Net Improvement/Loss
Peripheral IVUS
-9%
-6%
+3%
ATK Interventions
-7%
+4%
+11%
BTK Interventions
+9%
+16%
Venous Interventions
-13%
-14%
-1%
Dialysis Circuit Interventions
-2%
-0.8%
+1.2%

11. Reimbursement
The 2019 Physician fee schedule conversion factor is $36.04, as compared to conversion factor of $35.99.
Peripheral venous procedure payments declined while arterial procedures increased.   
Lower Limb arterial procedures in the OBL
Iliac stenting payments decrease by 7.5%
Fem/Pop payments increase 11.8% for atherectomy and 18.6% for stenting
BTK procedures increase , stent 26.4%, atherectomy 13.4% and stent + atherectomy 12%.