Welcome to Asheville Eye Surgery Center (AESC) Surgery Day

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AESC: Dedicated to Quality AESC promotes care and compassion. We respect your rights as a patient and want you to know about these rights. We also want you to know the things you can do to help us provide quality care.

AESC Values The surgeons and staff at Asheville Eye Surgery Center (AESC) are dedicated to providing you with the highest quality medical care. We welcome your comments about the care you receive and appreciate you selecting AESC. Getting Ready for Your Eye Surgery Eyedrops: Remember to use your eyedrops if the doctor prescribed them for you. Do not bring ANY drops with you on the day of surgery. However, please DO take them with you to your post-operative checkup at the Asheville Eye Associates office. Smoking/Alcohol Do not drink alcoholic beverages or smoke for at least 24 hours prior to your surgery. Your Health If a change in your physical condition develops prior to surgery, such as a cold, persistent cough, fever or other noticeable symptoms, please call your surgeon.

Medications If you take medication, take your normal morning medication as usual with a small amount of water, as per instructions given to you by your surgeon or anesthesia provider. Blood thinner: If you take blood thinner such as Coumadin, Plavix or Aspirin, it is important to discuss this with your surgeon. *DO NOT TAKE INSULIN OR ORAL DIABETIC MEDICATION ON SURGERY MORNING. PLEASE CHECK YOUR BLOOD SUGAR THE DAY OF SURGERY AND BRING THE READING WITH YOU.*

Anesthesia PriorThe day to yourbefore scheduled your scheduled surgery, surgery, an anesthesia an anesthesia care provider care provider will contact will callyou youby telephonefrom this telephoneto discuss yournumber medical (828-398-5224) history and to the discuss type ofyour anesthesia medical historyyou will and receive. the type On ofthe anesthesia day of surgery, you will please receive. let theOn anesthesiathe day of surgery, staff member please letknow the if anesthesia you have staffever memberhad any knowproblems if you with have anesthesia, ever had any including problems nausea with afteranesthesia, surgery, including or any other nausea co ncernsafter surgery, regarding or anesthesiaany other concerns you may regardinghave. anesthesia you may have. Notice: Anesthesia services for Asheville Eye Surgery Center (AESC) are provided by an independent contractor. Bathing Prior to your arrival at the AESC, take a bath or shower and wash your hair (do not use hairspray on surgery day). What to Wear Wear flat shoes. Wear a warm button down OR loose fitting shirt. A V-neck shirt is ideal if a button down is not available.

2 Cosmetics Please do not wear cosmetics, cologne, perfume, lotion, hair spray or other scented products on surgery day (deodorant is OK).

Jewelry, Glasses, Hearing Aids, Dental Wear Leave all jewelry at home on your surgery day. Do bring a case for your glasses or contact lenses. Hearing aids and dentures may be worn; hearing aids will be removed from surgical side prior to surgery. Leave at Home Do not bring personal items or valuables, except a photo ID and insurance card for veriﬁcation purposes, and a form of payment, if you have a balance due. AESC is not responsible for any personal items.

Homecare after Surgery You should arrange for a family member, friend or caregiver to stay with you the ﬁrst 24 hours after surgery.

DRIVER REQUIREMENTS It is important to have someone drive you to your surgery as you will not be allowed to drive yourself home. Please instruct this person that they must remain in the waiting room throughout your stay. Surgery cannot be performed unless you have a responsible caregiver present. A printed copy of your discharge instructions will be given to you to take home.

Cell Phones If you choose to bring your cell phone to the AESC, please turn phone to “OFF” position prior to surgery. Please limit cell phone use to outside the facility. Use of cell phones in patient care areas is not allowed. Photography and video recording while at the surgery center is prohibited.

WI-FI Service Free wireless internet access service is available for use in waiting areas. You can access our public network by selecting ‘AEA Public.’

Surgery Day Instructions

Directions/Parking/Arrival From Interstate 40, take Exit #51 to Sweeten Creek Road. Turn left at the traffic light at the bottom of the exit ramp, heading south on Sweeten Creek Road (Highway 25A). Take first right onto Medical Park Drive – the entrance to Regional Medical Park. Turn left into Asheville Eye Associates’ second driveway at the sign for Asheville Eye Surgery Center. What To Expect on Surgery Day The AESC team has prepared a brief, informational video that walks you through what you can expect on surgery day from start to finish. We highly recommend that each patient watch this video before arriving to the AESC. You may view it by typing in this web address: https://vimeo.com/183607143 Questions If you have any questions once you are home, call the AESC at (828) 210-2020 or Asheville Eye Associates at (828) 258-1586. If you are calling during non-operational hours, our answering service will contact the surgeon on call to assist you. If you have an emergency, call 911 or go to the closest emergency room. 3

Please call if any of these occur: -Increased or severe eye pain -Heavy or increased eye drainage -Increased redness around your eye -Sudden loss of vision -Fever over 101 degrees

*Dr. Goldstein’s patients: please call if you have any of the following: -Sudden extreme lid swelling or bruising, pressure that is causing the eyelid to swell shut -Vision loss -Pain that is not relieved by Tylenol -Persistent nausea or vomiting

Follow-Up Appointments It is very important to keep your follow-up appointments after your surgery.

Insurance and Financial Arrangements • AESC participates with most insurance programs, including Medicare and Medicaid. Insurance companies may require a “pre-admission authorization” or prior approval of your need for surgery. We will contact your insurance provider for benefits prior to your scheduled surgery and send a notification letter to you detailing your expected financial obligation for the facility fee prior to your surgery at the Asheville Eye Surgery Center. Each patient will receive an itemized billing statement after surgery. • Surgeon fees are not included in your AESC bill. The surgeon’s professional fees will be billed directly to you by your surgeon. In addition to your surgeon you may receive a bill from the Anesthesiologist, Pathologist, Cardiologist, or Radiologist if their services are required. • Charges not covered by your insurance plan are your responsibility. Any outstanding balance will be due prior to your date of surgery. AESC will file insurance claims for you as a courtesy. If you have questions, please call our billing department at (828)258-1586 (extension 3700).

Billing Information Deductibles, co-insurance payments, and any other charges not covered by your insurance will be collected prior to your admission to the AESC. If you have no medical insurance, you will be asked to pay your balance in full prior to admission. We accept cash, checks and all major credit cards. If needed, we will assist you in evaluating the availability of financial assistance. Please contact our patient billing services department at (828) 258-1586, ext 3700, Monday through Friday, 8:00am to 5:00pm with any questions about paying for your surgery, or if you have any questions regarding pre-certification or insurance coverage.

Cosmetic Surgery Fees for cosmetic surgery are not covered by insurance. You will be provided with a detailed cosmetic surgical quote for the proposed surgery following your initial consultation. All financial obligations are due prior to service.

Patient Rights and Responsibilities

Asheville Eye Surgery Center promotes care and compassion. We respect your rights as a patient and want you to know about these rights. We also want you to know the things you can do to help us provide quality care.

We pledge to do all we can to: • Provide reasonable access to the care you need; • Show respect for your dignity and privacy as care is given; • Provide skilled, well-trained staff to care for you; • Respect your values and beliefs, and support you in your beliefs as long as they do not hinder the well-being of others or your planned course of care; • Keep your medical records private and secure; • Treat you and all patients without regard to race, gender, color, religion, national origin, disability, age, veteran status, or sexual orientation; • Listen to, review and address your concerns; • Inform the person of your choice if you are admitted to the hospital; • Tell you the names and roles of people caring for you; • Tell you about your illness, treatments and likely outcomes; • Help you take part in planning your care and having an active role in that plan of care. You may request or refuse treatment at any time. You and your physician will discuss the best care for you; • Take into account your Advance Directives, and inform you of AESC’s Policy on Advance Directives, such as a Living will or Healthcare Power of Attorney, and answer any of your questions; • Protect you from any form of abuse or harassment by anyone while you are a patient; • Help you present your concerns, get spiritual care, get advice about ethics, discharge planning, and financial matters; • Help you get protection from abuse; • If requested provide your itemized bill and answer any questions regarding your statement; • Let someone you choose act for you and support your rights, if you ever cannot do so. You cannot be denied the right of access to the person or agency that has been given the right to act on your behalf; • Provide emergency care when needed; • Provide you quality health care; • Get someone to translate for you if you do not speak English or if you have trouble reading, speaking or hearing; • Provide information by the physician concerning diagnosis, planned course of treatment, alternatives, risks and prognosis; • Transfer you in a safe and prompt manner to another place for care if medically appropriate care cannot be provided, or if laws do not allow the care requested, or if you request a transfer; • Provide your treatment in such a way that you will not suffer needless physical or mental distress. Help you describe your pain and provide treatment for your pain; 5 • Let you obtain a copy of your medical record with appropriate request; • Let you request restrictions on how your information will be used and disclosed. We may not be able to honor all your requests; • Let you request a change to your medical record once authenticated. We may not be able to honor all requests; • Tell you how to register a complaint about any concerns you have about how your medical information was used; • Freely voice complaints and recommend changes without being subject to coercion, discrimination or reasonable interruption of care, treatment and services; • Respond to your complaints promptly. You may report your complaints to any Asheville Eye Surgery Center staff member or ask for a copy of the patient grievance procedure process. You may report your complaints to the Administrator at (828) 258-1586 (extension 2360); • Listen to, review and try to resolve your concerns. If your concerns cannot be resolved or you do not wish to use our grievance process, you may report your concerns to:

Division of Facilities Services 20711 Mail Service Center Raleigh, NC 27699-20711 (800) 624-3004

Accreditation Association for Ambulatory Health Care 5250 Old Orchard Road Suite 200 Skokie, IL 60077 (847) 853-6060

Web site for the Office of the Medicare Beneficiary Ombudsman: http://www.cms.hhs.gov/center/ombudsman.asp

AS A PATIENT, YOU ARE RESPONSIBLE FOR: • Providing the healthcare provider, to the best of your knowledge, accurate and complete information about present complaints, past illnesses, hospitalizations, Advance Directives, medications, including over the counter and dietary supplements, allergies and sensitivities and other matters relating to your health; • Let the Surgery Center staff or your doctor know if you do not understand the plan for your care or your role in that plan; • Follow the treatment plan prepared by the doctor and staff; • Acknowledging when you do not understand a contemplated treatment course or treatment plan; • Understand the fact that you may cause your health to become worse if you refuse treatment or do not follow your plan of care; • Reporting changes in your health; • Tell us if you have any concerns about your safety;

6 • Keeping your appointments and, when you are unable to do so for any reason, for notifying the physician or the AESC as soon as possible; • Following the Center rules and regulations affecting patient care and conduct; • Providing Advance Directives (Living Will or Healthcare Power of Attorney) if you have one; • Respecting the property of others and of the AESC; • Providing a responsible adult to transport you home from facility and remaining with you for 24 hours, if needed; • Taking into account the needs and feelings of other patients and the AESC staff; • Assuring your financial obligations of healthcare are fulfilled as promptly as possible.

AS A PATIENT YOU CAN: Ask questions about anything regarding your care. We want you to be involved.

You can: • Remind healthcare providers to check your armband for identification; • Ask your healthcare provider to wash their hands before providing care; • Ask what medications your healthcare provider has given and why; • Tell your healthcare provider if you have pain; • Report your concerns directly to the person rendering your care or ask to speak with your physician or the departments director/administrator; • If you have any safety concerns, please tell your healthcare provider and action will be taken to address your concern.

AESC Ownership Interest

The Asheville Eye Surgery Center, a Medicare certified facility for outpatient eye surgery, is a physician- owned facility. The following physicians have ownership interest: Thomas L. Beardsley, MD; James D. Crandall, MD, Jeffrey B. Goldstein, MD; William L. Haynes, MD; Edward K. Isbey, III, MD; Damien C. Macaluso, MD; Brian E. Smith, MD; Robert E. Wiggins, Jr., MD.

There are other providers of outpatient ophthalmic surgical services in Western North Carolina and you have the freedom to choose another facility for services to be provided.