Despite the fact that ambulatory surgery centers across the United States are handling increasingly complex procedures and now outnumber hospitals, 17 states don’t have any laws on the books that require these facilities to report patient deaths.

They operate under an uneven mix of rules that make it difficult for government officials and potential patients to track safety performance, according to a joint investigation by USA Today Network and Kaiser Health News. Of equal concern, these gaps in oversight allow surgery centers to keep operating even after they’ve been hit with federal regulators’ toughest sanctions.

“It’s disgraceful that there’s so little information” about what happens in surgery centers, said Leah Binder, chief executive of the Leapfrog Group, a non-profit that surveys more than 2,000 hospitals a year and rates healthcare providers.

The leading accreditation body for hospitals, The Joint Commission, recommends members report unexpected deaths so lessons from one tragedy might prevent another. The top surgery center accreditation body has no similar guideline.

Even Medicare rules differ for surgery centers compared to hospitals. Consider this: Medicare allows surgery centers to report data for as little as half its Medicare patients, which excludes patients under age 65 who do not yet qualify for Medicare. This rule essentially allows surgery centers to artificially reduce the number of hospital transfers they report, unless half of their patients leave by ambulance. But a potential patient examining the Medicare data would only see that the transfer rate is less than half the rate reported in most medical research.

While ASC Quality Collaboration, a group of surgery center leaders, urged Medicare to collect reports on every patient transfer to expand transparency and accountability, in July, Medicare actually proposed to stop collecting surgery center-to-hospital transfer data and seven other measures of quality.

Bill Prentice, executive director of the Ambulatory Surgery Center Association, supports giving patients access to data that could compare surgery centers with hospital outpatient departments. “We shouldn’t have a patchwork system, where one state asks for one thing and others ask for others,” he contends. “What consumers want is consistency.”

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