You must make arrangements to be driven home by a responsible adult. If you are unable to make arrangements for a responsible adult to drive you please let your physician know.

If you have any special needs for your day of surgery, please inform your physician.

A member of the nursing staff from East Bay Surgery Center will call 1-2 days prior to surgery between the hours of 8:00am and 5:00pm. If you have any questions,  please call us at 508-324-1171.

The call will take about 5 – 10 minutes and it is helpful to have a pen and paper available to write down the instructions the nursing staff gives you. They will give you your preoperative instructions and they will have some questions regarding your medical history. Specific instructions for certain medications will be given at this time, if applicable. PLEASE LEAVE ANY VALUABLES AT HOME.

Do not eat or drink anything after midnight, unless otherwise instructed. Shower or bathe the night before or the morning of surgery.

Please take all your prescription medication, as directed, in the morning with a small sip of water. NO MORE THAN 16 ounces of water (clear liquids) up to 2 hours prior to arrival time.

Wear comfortable clothing. Remove all jewelry, including body piercings, and do not use any cosmetics, make-up, hair spray, perfume or after-shave. You may use deodorant.

DO NOT REMOVE your hearing aids. We will do that prior to you entering the surgical room. It will be stored under your stretcher. Again, please leave any valuables at home and empty your pockets of keys, nail clippers, pocket knives, scissors and anything that can be considered a weapon.

This facility does not provide implementation of advanced directives, however, the following protocol is in place:

• This facility will post information in the waiting room regarding our policy on advanced directives.
• All patients will be asked if they have advanced directives.
• All patients are offered information regarding EBSC advanced directives.
• All patients will be informed that this facility does not honor advanced directives.
• All patients who present with advance directive (DNR order) will be asked to sign a waiver stating, “while at EBSC the DNR order will not be honored”.
• A copy of the advanced directive, if applicable, will be placed in the patients chart.
• All patients in life threatening situations will have life sustained at this facility and be transferred to the hospital via ambulance.

A copy of the chart (to include the advanced directive waiver, if applicable) will be transferred to the hospital via ambulance.

AFTER YOU HAVE RETURNED HOME

Re-read the discharge instructions and follow your doctor’s orders regarding surgical site care, rest, medication, diet, and activity.

Follow any specific diet and/or fluid restrictions. A healthy diet and drinking water helps heal your body.

Follow specific instructions given by your doctor regarding incision and bandage care to aid in healing and preventing infection. Wash your hands before and after touching your bandage and incision.

In the event of an emergency such as extreme pain in the operative eye, sudden loss of vision and/or signs of infection; (redness, discharge, fever), please call your surgeons office immediately.

NOTE: IF THIS IS A MEDICAL EMERGENCY PLEASE CALL “911” IMMEDIATELY**

East Bay Surgery Center, LLC has established this Patient’s Bill of Rights as a policy with the expectation that observance of these rights will contribute to more effective patient care and greater satisfaction for the patient, his physician, and the group organization. It is recognized that a personal relationship between the physician and the patient is essential for the provision of proper medical care. The traditional physician-patient relationship takes on a new dimension when care is rendered within an organized structure. Legal precedent has established that the facility itself also has a responsibility to the patient. It is in recognition of these factors that these rights are affirmed.

Photographs, Cell Phone Use and Video Taping

The facility takes patient privacy seriously.  The use of cell phones or the taking of pictures or recording of any patient or staff member in the facility including the waiting area, is prohibited.  Any patient or visitor that is found taking pictures, or videotaping patients or staff via cell phone or other device will be asked to delete the recording(s) and refrain from further recording/photography/videography.

As a Patient, You Have the Right to:

• Considerate, respectful care at all times and under all circumstances with recognition of your personal dignity.
• Personal and informational privacy.
• Confidentiality of records and disclosures. Except when required by law, you have the right to approve or refuse the release of records.
• Information concerning your diagnosis, treatment, and prognosis, to the degree known.
• The opportunity to participate in decisions involving your healthcare.
• Competent, caring healthcare providers who act as your advocates.
• Know the identity and professional status of individuals providing service. And have the right to change providers if other qualified providers are available.
• Adequate education regarding self-care at home translated in language you can understand.
• Make decisions about medical care, including the right to accept or refuse medical or surgical treatment
• Impartial access to treatment regardless of race, color, sex, gender identity, national origin, religion, handicap, disability.
• To be free from all forms of abuse or harassment.
• To exercise his/her rights without being subject to discrimination or reprisal.
• Receive an itemized bill for all services.
• Report any comments concerning the quality of services provided to you during the time spent at the facility and receive follow-up on your comments.
• Know about any business relationships among the facility, healthcare providers, and others that might influence your care or treatment.
• To change providers if you are not satisfied with your current provider.

As a Patient, You Are Responsible for:

• Providing, to the best of your knowledge, accurate and complete information about your present health status and past medical history and reporting any unexpected changes to the appropriate physician(s).
• Following the treatment plan recommended by the primary physician involved in your case.
• Providing an adult to transport you home after surgery and an adult to be responsible for you at home for the first 24 hours after surgery, if required by his/her provider.
• Indicating whether you clearly understand a contemplated course of action and what is expected of you and ask questions when you need further information.
• Behave respectfully toward all the healthcare professionals and staff, as well as other patients.
• Your actions if you refuse treatment, leave the facility against the advice of the physician, and/or do not follow the physician’s instructions relating to your care.
• Ensuring that the financial obligations of your healthcare are fulfilled as expediently as possible, for any charges not covered by his/her insurance.
• Providing information about and/or copies of any living will, power of attorney, or other directive that you desire us to know about.

No catalog of rights can guarantee the patient the kind of treatment he has a right to expect.

This facility has many functions to perform, including the prevention and treatment of disease, the education of both health professionals and patients. All these activities must be conducted with an overriding concern for the patient, and, above all, the recognition of his dignity as a human being. Success in achieving this recognition assures success in the defense of the rights of the patient.

 

Any complaints regarding this policy should be addressed to either;

Joanne Swift, RN/Clinical Director or Administrator at

508-324-1171

or you may file a grievance with the;

State of Massachusetts
Health and Human Services
Complaints Unit

1-617-753-8150

or

AAAHC

1-847- 324-7745

 

Centers for Medicare & Medicaid

www.cms.hhs.gov/center/ombudsman.asp

Notice of Privacy Practices

Online Notice of Privacy Practices

Notice of Privacy Practices Summary

Notice of Privacy Practices Summary

Your Rights and Protections Against Surprise Medical Bills

Rights and Protections – Surprise Medical Billing

The Commonwealth of MA – “Patients First”

Comm of MA – Patients First

This notice is effective November 1, 2022.
As a state licensed outpatient surgery center and in accordance with State and Federal regulations, the East Bay Surgery Center, LLC (“Center”) ensures that all patients are properly informed about the following information prior to their scheduled surgical procedure.
*Patient Rights and Responsibilities* * Grievance Procedures Advance Directives* *Anti-Discrimination Policy* *HIPAA Privacy Practices* *Physician Ownership

Patients have the right to:
• Considerate, dignified, and respectful care in a safe,
comfortable environment.
• Personal privacy and confidentiality.
• Be free from all forms of abuse or harassment.
• Know the names of the health care providers furnishing care to you and their role in your care and the right to change providers if other qualified providers are available.
• Treatment by compassionate, skilled, qualified health
professionals.
• Be informed about and participate in your care and treatment planning.
• Make informed decisions about your medical care, including the right to accept or refuse medical or surgical treatment.
• Timely information regarding Center policy that may limit its ability to implement a legally valid advance directive.
• Be free from discrimination or reprisal.
• Evaluation, service and/or referral as indicated by the urgency of the case.
• To be transferred to another healthcare facility when medically necessary with explanation concerning this need, its risks and alternatives, as well as acceptance by the receiving institution in advance of such transfer.
• Consent or decline to participate in proposed research studies or human experimentation affecting care or treatment.
• Review and obtain copies of your medical records.
• Receive treatment in an environment that is sensitive to your beliefs, values and culture.
• Be informed about the care you will need after discharge.
• The right to know your physician may have ownership in the Center.
• The right to file a verbal and/or written grievance as
outlined in the Grievance Policy.
• To be fully informed about your treatment and the expected outcomes and potential risks of your procedure.
• If a patient is adjudged incompetent by a under applicable state law, the rights of the patient are exercised by the person appointed under state law to act on that patient’s behalf, or if a state court has not adjudged a patient incompetent, any legal representative or surrogate designated by the patient in accordance with state law may exercise the patient’s rights to the extent allowed by state law.

Patients have the responsibility to:
• Give us complete and accurate information about your medical history, including all prescription and nonprescription medications you are taking.
• Tell us what you need. If you do not understand your care plan, ask questions.
• Be part of your care.
• To arrange for a responsible adult to provide transportation home and to remain with you for 24 hours after your procedure.
• To follow up on your doctor’s instruction, take medication when prescribed, to make and keep follow-up appointments as directed, and ask questions concerning your own health care as necessary.
• To fully participate in decisions involving your own health care and to accept the consequences of these decisions if complications occur.
• If you are not satisfied with your care,
please tell us how we can improve.
• Be respectful and considerate of the rights of other patients, families, and Center personnel.
• Give us any insurance information we need to help get your bill paid and fulfill financial obligations to the Center. Any verification of benefits, if provided, has been provided as a
courtesy to you. This is not a guarantee of payment. Insurance benefits can sometimes be quoted incorrectly. We strongly recommend that you contact your health plan to verify your insurance information and benefits.

Please contact the following with any concerns or complaints related to your experience at the
Center. Complaints are reviewed and acted upon as they are received.
Administrator:
440 Swansea Mall Dr.
Swansea, Mass. 02777

The patient, family member, and visitor to the Center may contact the following if not satisfied with the outcome of their complaint:

Massachusetts Department of Public Health
250 Washington St
Boston, Ma 02108
617-624-6000
Medicare Ombudsman
1-800-633-42273
www.medicare.gov/claims-and-appeals/index.html
Accreditation Association for Ambulatory Health Care
Phone: 847-853-6060 • Email: info@aaahc.org

The Center will always attempt to resuscitate a patient and will transfer that patient to a hospital in the event their condition deteriorates. The Center will make every reasonable attempt to obtain and file in the patient’s medical record copies of the following existing documents:
• Appointment of a Health Care Representative
• Living Will and Health Care Instructions
• Documentation of Anatomical Gift
• Conservator of the Person for My Future Incapacity
If an emergency transfer occurs, all pertinent chart information will be copied and sent with the patient to the hospital, including the patient’s information regarding Advance Directives, if given to the facility by the patient on admission.

The Center does not discriminate, exclude people or treat them differently on the basis of race, religion, color, national origin, age, disability, marital status, gender identity, or sex.

The Center provides free aids and services for disabilities as follows:
• Qualified sign language interpreters
• Written information in other formats (such as large print or electronic formats)

The Center provides free language services to people whose primary language is not English, such as:
• Qualified interpreters
• Information written in other languages
ATTENTION: Language assistance services, free of charge, are available to you.
Call 508-324-1171.
ATENCIÓN: Si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística.
Llame al 508-324-1171.
ATENÇÃO: Se fala português, encontram-se disponíveis serviços linguísticos, grátis. Ligue par a 508-324-1171.

Patients who believe that the Center has failed to provide these services may file a complaint either in person or by mail, fax, or email. The complaint should be filed with the Center Administrator,
whose contact information is listed in the Grievance Procedure Section.
Patients can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights.
U.S. Department of Health and Human Services
200 Independence Avenue, SW Room 509F, HHH Building Washington, D.C. 20201
1-800-368-1019, 800-537-7697 (TDD)
Complaint forms are available at
http://www.hhs.gov/ocr/office/file/index.html

The Center has adopted a Patient Privacy Plan to comply with the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”), as amended, including by the Health Information Technology for Economic and Clinical Health Act, and applicable security and privacy regulations, as well as our
duty to protect the confidentiality, appropriate accessibility, and integrity of confidential medical information as required by law, professional ethics, and accreditation requirements. This policy applies to all personnel of the Center.
If you feel that your privacy or access protections have been violated, you may submit a written complaint with the Center or with the Department of Health and Human Services, Office of Civil Rights. (See Grievance Procedure Section for contact information.) See posted Notice of Privacy Practices.
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU
CAN GET ACCESS TO THIS INFORMATION PLEASE REVIEW CAREFULLY

The Center and its employees are dedicated to maintaining the privacy of your personal health information (“PHI”), as required by applicable federal and state laws. These laws require us to provide you with this Notice of Privacy Practices, and to inform you of your rights and our obligations concerning Protected Health Information, or PHI, which is information that identifies you and that relates to your physical or mental health condition.
Permitted Disclosures of PHI. We may disclose your PHI for the following reasons:
1. Treatment We may disclose your PHI to a physician or other health care provider providing treatment to you.
2. Payment We may disclose your PHI to bill and collect payment for the services we provide to you. We may need to disclose this information to insurance companies to establish insurance eligibility benefits for you. We may also provide
your PHI to our business associates, such as billing companies, claims processing companies and others that process our health care claims.
3. Health Care Operations We may disclose your PHI in connection with our health care operations. Health care operations include quality assessment activities, reviewing the competence or qualifications of health care
professionals, evaluating provider performance, and other business operations. For example, we may use your PHI to evaluate the performance of the health care services you received and how we can improve our services.
4. Emergency Treatment We may disclose your PHI if you require emergency treatment or are unable to communicate with us.
5. Family and Friends We may disclose your PHI to a family member, friend or any other person who you identify as being involved with your care or payment for care, unless you object.
6. Required by Law We may disclose your PHI for law enforcement purposes and as required by state or federal law. For example, the law may require us to report instances of abuse, neglect, or domestic violence; to report certain injuries such as gunshot wounds; or to disclose PHI to assist law enforcement in locating a suspect, fugitive, material witness or missing person.
We will inform you or your representative if we disclose your PHI because we believe you are a victim of abuse, neglect, or domestic violence, unless we determine that informing you or
your representative would place you at risk. In addition, we must provide PHI to comply with an order in a legal or administrative proceeding.
Finally, we may be required to provide PHI in response to a subpoena discovery request or other lawful process, but only if efforts have been made, by us or the requesting party, to contact you about the request or to obtain an order to protect the requested PHI.
7. Serious Threat to Health or Safety We may disclose your PHI if we believe it is necessary to avoid a serious threat to the health and safety of you or the public.
8. Public Health We may disclose your PHI to public health or other authorities charged with preventing or controlling disease, injury, or disability, or charged with collecting public health data.
9. Health Oversight Activities We may disclose your PHI to a health oversight agency for activities authorized by law. These activities include audits; civil, administrative, or criminal investigations or proceedings; inspections; licensure or disciplinary actions; or other activities necessary for oversight of the health care system, government programs and compliance with civil rights laws. We may also de-identify health information in accordance with applicable law. After the information is de- identified, it is no longer subject to this notice and it may be used for any lawful purposes.
10. Research We may disclose your PHI for certain research purposes, but only if we have protections and protocols in place to ensure the privacy of your PHI.
11. Workers’ Compensation We may disclose your PHI to comply with laws relating to workers’ compensation or other similar programs.
12. Specialized Government Activities If you are active military or a veteran, we may disclose your PHI as required by military command authorities. We may also be required to disclose PHI to authorized federal officials for the conduct of intelligence or other national security activities.
13. Organ Donation If you are an organ donor, or have not indicated that you do not wish to be a donor, we may disclose your PHI to organ
procurement organizations to facilitate organ, eye or tissue donation and transplantation.
14. Coroners, Medical Examiners, Funeral Directors We may disclose your PHI to coroners or medical examiners for the purposes of identifying a deceased person or determining the cause of death, and to funeral directors as necessary to carry out their duties.
15. Disaster Relief Unless you object, we may disclose your PHI to a governmental agency or private entity (such as FEMA or Red Cross) assisting with disaster relief efforts.

YOUR RIGHTS WITH RESPECT TO YOUR PHI
1. Right to Receive a Paper Copy of This Notice. You have the right to receive a paper copy of this Notice upon request.
2. Right to Access PHI. You have the right to inspect and copy your PHI for as long as we maintain your medical record. You must make a written request for access to the Privacy Officer at the address listed at the end of this Notice. We may charge you a reasonable fee for the processing of your request and the copying of your medical record pursuant to Virginia state law. In certain circumstances we may deny your request to access your PHI, and you may request that we reconsider our denial. Depending on the reason for the denial, another licensed health care
professional chosen by us may review your request and the denial.

3. Right to Request Restrictions. You have the right to request a restriction on the use or disclosure of your PHI for the purpose of treatment, payment, or health care operations, except for in the case of an emergency. You also have the right to request a restriction on the information we disclose to a family member or friend who is involved with your care or the payment of your care. However, we are not legally required to agree to such a restriction.
4. Right to Restrict Disclosure for Services Paid by You in Full. You have the right to restrict the disclosure of your PHI to a health plan if the PHI pertains to health care services for which you paid in full directly to us.
5. Right to Request Amendment. You have the right to request that we amend your PHI if you believe it is incorrect or incomplete, for as long as we maintain your medical record.
We may deny your request to amend if (a) we did not create the PHI, (b) is not information that we maintain, (c) is not information that you are permitted to inspect or copy (such as
psychotherapy notes), or (d) we determine that the PHI is accurate and complete.
6. Right to an Accounting of Disclosures. You have the right to request an accounting of disclosures of PHI made by us (other than those made for treatment, payment, or health care operations purposes) during the 6 years prior to the date of your request. You must make a written request for an accounting, specifying the time period for the accounting, to the Privacy Officer at the address listed at the end of this Notice.
7. Right to Confidential Communications. You
8. have the right to request that we communicate with you about your PHI by certain means or at certain locations. For example, you may specify that we call you only at your home phone number, and not at your work number. You must make a written request, specifying how and where we may contact you, to the Privacy
9. Officer listed at the address listed at the end of this Notice.
10. Right to Notice of Breach. You have the right to be notified if we or one of our business associates become aware of a breach of your unsecured PHI.
11. Changes to this Notice. We reserve the right to change this Notice at any time in accordance with applicable law. Prior to a substantial change to this Notice related to the uses or disclosures of your PHI, your rights, or our duties, we will revise and distribute this Notice.
ACKNOWLEDGMENT OF RECEIPT OF NOTICE
We will ask you to sign an acknowledgment that you received this Notice.

QUESTIONS AND COMPLAINTS
If you would like more information about our privacy practices or have questions or concerns, please contact us. If you are concerned that we may have violated your privacy rights, or you disagree with a decision we made regarding the use, disclosure,
or access to you PHI, you may complain to us by contacting the Privacy/Compliance Officer at the address and phone number at the end of this Notice. You also may submit a written complaint to the U.S. Department of Health and Human Services. We will provide you with the address to file such a complaint upon request.
We support your right to the privacy of your PHI. We will not retaliate in any way if you choose to file a complaint with us or with the U.S. Department of Health and Human Services.
Please direct any of your questions or complaints to:
Privacy Officer:
440 Swansea Mall Dr.
Swansea, Mass 02777

PHYSICIAN OWNERSHIP
WILLIAM ANDREONI, M.D.
CHARLES COLLINS, M.D.
EZRA GALLER, M.D.
CHRIS NEWTON, M.D.
WILLIAM VARR, M.D.
DOMINICK ZANGARI, M.D.
JOSEPH LEVY, M.D.
JEFFREY HOFMANN, M.D.
TOM LANG, M.D.
ELIOT PERLMAN, M.D.
ROBERT KELLY, M.D.
GREGORY HOFELDT, M.D.
DURGA LARKIN, M.D.
KEEGAN JOHNSON, M.D.
PAUL BEADE, M.D.
SARAH ANIS, MD
GAURA GUPTA, MD
JORGE RIVERA, MD

Your Rights and Protections Against Surprise Medical Bills

What is “balance billing” (sometimes called “surprise billing”)?

When you see a doctor or other health care provider, you may owe certain out-of-pocket costs, like a copayment, coinsurance, or deductible. You may have additional costs or have to pay the entire bill if you see a provider or visit a health care facility that isn’t in your health plan’s network.

“Out-of-network” means providers and facilities that haven’t signed a contract with your health plan to provide services. Out-of-network providers may be allowed to bill you for the difference between what your plan pays and the full amount charged for a service. This is called “balance billing.” This amount is likely more than in-network costs for the same service and might not count toward your plan’s deductible or annual out-of-pocket limit.

“Surprise billing” is an unexpected balance bill. This can happen when you can’t control who is involved in your care—like when you have an emergency or when you schedule a visit at an in- network facility but are unexpectedly treated by an out-of-network provider. Surprise medical bills could cost thousands of dollars depending on the procedure or service.

You’re protected from balance billing for:

Emergency services
If you have an emergency medical condition and get emergency services from an out-of- network provider or facility, the most they can bill you is your plan’s in-network cost-sharing amount (such as copayments, coinsurance, and deductibles). You can’t be balance billed for these emergency services. This includes services you may get after you’re in stable condition, unless you give written consent and give up your protections not to be balanced billed for these post-stabilization services.

Certain services at an in-network hospital or ambulatory surgical center
When you get services from an in-network hospital or ambulatory surgical center, certain providers there may be out-of-network. In these cases, the most those providers can bill you is your plan’s in-network cost-sharing amount. This applies to emergency medicine, anesthesia,

pathology, radiology, laboratory, neonatology, assistant surgeon, hospitalist, or intensivist services. These providers can’t balance bill you and may not ask you to give up your protections not to be balance billed.

If you get other types of services at these in-network facilities, out-of-network providers can’t
balance bill you, unless you give written consent and give up your protections.

You’re never required to give up your protections from balance billing. You also aren’t required to get out-of-network care. You can choose a provider or facility in your plan’s network.

Under state law, in certain circumstances when you receive services from an out-of-network provider at an in-network facility, you may be required to pay only the applicable co-insurance, copayment, deductible or other out-of-pocket expense that would be imposed for such health care services if such services were rendered by an in-network provider.

When balance billing isn’t allowed, you also have these protections:

• You’re only responsible for paying your share of the cost (like the copayments, coinsurance, and deductible that you would pay if the provider or facility was in-network). Your health plan will pay any additional costs to out-of-network providers and facilities directly.

• Generally, your health plan must:
o Cover emergency services without requiring you to get approval for services in advance (also known as “prior authorization”).
o Cover emergency services by out-of-network providers.
o Base what you owe the provider or facility (cost-sharing) on what it would pay an in-network provider or facility and show that amount in your explanation of benefits.
o Count any amount you pay for emergency services or out-of-network services toward your in-network deductible and out-of-pocket limit.

If you think you’ve been wrongly billed you may contact the Massachusetts Division of Insurance Toll Free (877) 563-4467. https://www.mass.gov/orgs/division-of-insurance
Visit www.hhs.gov for more information about your rights under federal law.

Good Faith Estimate Notice

The facility does not discriminate, exclude people, or treat them differently on the basis of race, color, national origin, age, disability, or sex.

The facility provides free aids and services for disabilities as follows:

• Qualified sign language interpreters
• Written information in other formats (large print, electronic formats, etc)

The Center provides free language services to people whose primary language is not English, such as:

• Qualified interpreters
• Information written in other languages

Patients who believe that the facility has failed to provide these services may file a complaint with the either in person or by mail, fax or email.  (See Grievance Procedure Link Below)

Patients can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights.

U.S. Department of Health and Human Services

200 Independence Avenue, SW

Room 509F, HHH Building

Washington, D.C. 20201

1-800-368-1019, 800-537-7697 (TDD)

Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html

GRIEVANCE PROCEDURE

Please contact the following with any concerns or complaints related to your experience at the surgery center. Complaints are reviewed and acted upon as they are received.

Administrator:

Claudia Bussiere, RN, BSN

440 Swansea Mall Drive

Swansea, MA 02777

1.508.324.1171

The patient, family member, and visitor to the facility may contact the following if not satisfied with the outcome of their complaint:

Massachusetts Department of Public Health

250 Washington Street

Boston, MA 02108

1.617.624.6000

TTY 617.624.6001

Medicare Ombudsman

1-800-243-4636

www.medicare.gov/claims-and-appeals/index.html

AAAHC 847-853-6060