In recent years, the economic realities of health care reimbursement and a growing consumer demand have lead to a dramatic shift in the way health care is delivered: from in-hospital O.R. settings, to remote interventional settings outside of the O.R., to outpatient facilities, and to physicians’ offices.

Significant safety issues related to the ambulatory procedural and surgical setting have been identified, including patient and procedure selection, perioperative care, management of complications and patient recovery. Other non-patient-related issues recently highlighted in both academic and popular literature include unqualified proceduralists performing procedures outside of their scope of practice, substandard facilities and lack of qualified personnel. These deficiencies have gradually attracted the attention of the Centers for Medicare & Medicaid Services (CMS), state health departments, medical boards, commercial health insurers and accreditation agencies. The Department of Health and Human Services (HHS), in...

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