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Is my in-office surgical suite considered an “outpatient surgical facility” for underwriting or coverage purposes?

For underwriting purposes, an “outpatient surgical facility” is broadly defined not only as any ambulatory surgery center but also as any laser refractive center or any surgical facility, including an in-office surgical suite or in-office laser equipment utilized by physicians other than the owners and employees of the practice. Outpatient surgical facilities must complete an OSF Application and comply with OMIC’s underwriting requirements pertaining to patient selection, type of anesthesia/sedation, pre- and post-operative assessments and monitoring, and emergency response and equipment. Depending upon the ownership, usage, and limits of liability carried, an additional premium may apply.

Exclusive Use Facilities

In-office surgical suites used exclusively by members of an insured’s practice are generally viewed as extensions of the physician’s medical practice. There usually are no credentialing exposures or vicarious liability exposures other than those which would otherwise exist within the group practice. The liability would generally fall primarily on the surgeon and the surgeon’s judgment in selecting the surgical setting. For these reasons, in-office surgical suites used exclusively by the practice are not considered by OMIC to be “outpatient surgical facilities,” and no special underwriting is required. To assist insureds in promoting patient safety and reducing their risk, OMIC has developed voluntary guidelines for office-based surgery.

Open Access Facilities

When a physician allows surgeons outside his or her practice to use the surgical suite or laser equipment, the practice assumes additional responsibilities that increase the liability exposures beyond those directly associated with the surgeon’s performance of the procedure. Besides the vicarious liability exposure arising from services rendered by the other surgeons, non-physician personnel and anesthesia providers, the facility has direct liability exposures related to its duties to properly credential all health care providers to ensure they are appropriately trained, skilled, and qualified to perform the services rendered there; conduct peer review services; establish appropriate protocols for monitoring and discharging patients; and otherwise ensure that all activities are performed in a reasonable, responsible, and safe manner.

Leased Facilities

In some situations, a physician may contractually lease his or her office space, including an in-office surgical suite, to another provider as opposed to simply permitting “open access” to the facility. It is OMIC’s belief that a physician who formally leases office space to another provider for use when the owner does not require access to it and acts exclusively in the capacity of landlord would not be held to the same duties and standards as an open access outpatient surgical facility. The physician may, however, assume additional liabilities in his or her capacity as landlord relating to the maintenance of equipment or other contractual services provided. OMIC does not consider such leasing arrangements to be “outpatient surgical facilities,” and no special underwriting is required.

OMIC encourages physicians to seek the advice of private legal counsel when assessing their legal liability and considering whether, and under what arrangements, other physicians in the community should have access to their in-office surgical facilities.

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