Current through Register Vol. 24-18, September 15, 2024
(1) To receive
approval, an ambulatory surgical facility must meet the following standards in
addition to applicable review criteria in WAC
246-310-210,
246-310-220,
246-310-230, and
246-310-240.
(2) The area to be used to plan for operating
rooms and ambulatory surgical facilities is the secondary health services
planning area.
(3) Secondary health
services planning areas are: San Juan, Whatcom, East Skagit, Whidbey-Fidalgo,
Western North Olympic, East Clallam, East Jefferson, North Snohomish, Central
Snohomish, East Snohomish, Southwest Snohomish, Kitsap, North King, East King,
Central King, Southwest King, Southeast King, Central Pierce, West Pierce, East
Pierce, Mason, West Grays Harbor, Southeast Grays Harbor, Thurston, North
Pacific, South Pacific, West Lewis, East Lewis, Cowlitz-Wahkiakum-Skamania,
Clark, West Klickitat, East Klickitat, Okanogan, Chelan-Douglas, Grant,
Kittitas, Yakima, Benton-Franklin, Ferry, North Stevens, North Pend Oreille,
South Stevens, South Pend Oreille, Southwest Lincoln, Central Lincoln, Spokane,
Southwest Adams, Central Adams, Central Whitman, East Whitman, Walla Walla,
Columbia, Garfield, and Asotin.
(4)
Outpatient operating rooms should ordinarily not be approved in planning areas
where the total number of operating rooms available for both inpatient and
outpatient surgery exceeds the area need.
(5) When a need exists in planning areas for
additional outpatient operating room capacity, preference shall be given to
dedicated outpatient operating rooms.
(6) An ambulatory surgical facility shall
have a minimum of two operating rooms.
(7) Ambulatory surgical facilities shall
document and provide assurances of implementation of policies to provide access
to individuals unable to pay consistent with charity care levels provided by
hospitals affected by the proposed ambulatory surgical facility. The amount of
an ambulatory surgical facility's annual revenue utilized to finance charity
care shall be at least equal to or greater than the average percentage of total
patient revenue, other than medicare or medicaid, that affected hospitals in
the planning area utilized to provide charity care in the last available
reporting year.
(8) The need for
operating rooms will be determined using the method identified in subsection
(9) of this section.
(9) Operating
room need in a planning area shall be determined using the following method:
(a) Existing capacity.
(i) Assume the annual capacity of one
operating room located in a hospital and not dedicated to outpatient surgery is
ninety-four thousand two hundred fifty minutes. This is derived from scheduling
forty-four hours per week, fifty-one weeks per year (allowing for five weekday
holidays), a fifteen percent loss for preparation and clean-up time, and
fifteen percent time loss to allow schedule flexibility. The resulting seventy
percent productive time is comparable to the previously operating hospital
commission's last definition of "billing minutes" which is the time lapse from
administration of anesthesia until surgery is completed.
(ii) Assume the annual capacity of one
operating room dedicated to ambulatory surgery is sixty-eight thousand eight
hundred fifty minutes. The derivation is the same as (a)(i) of this subsection
except for twenty-five percent loss for prep/clean-up time and scheduling is
for a thirty-seven and one-half hour week. Divide the capacity minutes by the
average minutes per outpatient surgery (see (a)(vii) of this subsection). Where
survey data are unavailable, assume fifty minutes per outpatient surgery,
resulting in a capacity for one thousand three hundred seventy-seven outpatient
surgeries per room per year.
(iii)
Calculate the total annual capacity (in number of surgeries) of all dedicated
outpatient operating rooms in the area.
(iv) Calculate the total annual capacity (in
number of minutes) of the remaining inpatient and outpatient operating rooms in
the area, including dedicated specialized rooms except for twenty-four hour
dedicated emergency rooms. When dedicated emergency operating rooms are
excluded, emergency or minutes should also be excluded when calculating the
need in an area. Exclude cystoscopic and other special purpose rooms (e.g.,
open heart surgery) and delivery rooms.
(b) Future need.
(i) Project number of inpatient and
outpatient surgeries performed within the hospital planning area for the third
year of operation. This shall be based on the current number of surgeries
adjusted for forecasted growth in the population served and may be adjusted for
trends in surgeries per capita.
(ii) Subtract the capacity of dedicated
outpatient operating rooms from the forecasted number of outpatient surgeries.
The difference continues into the calculation of (b)(iv) of this
subsection.
(iii) Determine the
average time per inpatient and outpatient surgery in the planning area. Where
data are unavailable, assume one hundred minutes per inpatient and fifty
minutes per outpatient surgery. This excludes preparation and cleanup time and
is comparable to "billing minutes."
(iv) Calculate the sum of inpatient and
remaining outpatient (from (b)(ii) of this subsection) operating room time
needed in the third year of operation.
(c) Net need.
(i) If (b)(iv) of this subsection is less
than (a)(iv) of this subsection, divide their difference by ninety-four
thousand two hundred fifty minutes to obtain the area's surplus of operating
rooms used for both inpatient and outpatient surgery.
(ii) If (b)(iv) of this subsection is greater
than (a)(iv) of this subsection, subtract (a)(iv) of this subsection from the
inpatient component of (b)(iv) of this subsection and divide by ninety-four
thousand two hundred fifty minutes to obtain the area's shortage of inpatient
operating rooms. Divide the outpatient component of (b)(iv) of this subsection
by sixty-eight thousand eight hundred fifty to obtain the area's shortage of
dedicated outpatient operating rooms.
Statutory Authority: RCW 70.38.135 and 70.38.919. 92-02-018
(Order 224), § 246-310-270, filed 12/23/91, effective 1/23/92. Statutory
Authority:
RCW
43.70.040. 91-02-049 (Order 121), recodified
as § 246-310-270, filed 12/27/90, effective 1/31/91. Statutory Authority:
RCW
70.38.919. 90-16-058 (Order 073), §
248-19-700, filed 7/27/90, effective
8/27/90.
