The Alabama Board of Medical Examiners has proposed significant updates to its rules governing office-based surgery (OBS), with the goal of strengthening patient safety and modernizing outdated standards. If adopted, these changes will directly affect physicians who perform procedures outside of hospitals or licensed ambulatory surgery centers. See below for proposed rule.
What’s Changing?
The proposed rule would repeal and replace Chapter 540-X-10 of the state’s administrative code, creating new requirements for office-based procedures. Key updates include:
Registration Requirements – Physicians performing Level II or Level III office-based surgeries (involving moderate sedation, deep sedation, general anesthesia, major nerve blocks, or procedures using Propofol or tumescent liposuction) must register with the Alabama Board before performing these services.
Accreditation & Quality Assurance – All Level II and III procedures must be performed in offices that are not only registered but also accredited or certified by a Board-approved accrediting entity. Practices will also be required to implement a quality assurance program, including annual reviews of complications, emergency transfers, patient satisfaction, and outcomes.
Patient Selection & Safety Standards – New restrictions define who is an appropriate candidate for office-based surgery. For example, patients with an ASA classification of IV or higher, frail patients over age 70 without proper screening, and most patients over 85 would not be eligible without special Board approval.
Emergency Preparedness – Physician offices must maintain robust emergency plans including resuscitation equipment, transfer protocols, and ACLS-trained staff.
Timeline for Compliance – The Board will notify all licensed physicians by January 1, 2026, and full compliance will be required beginning January 1, 2027.
Why This Matters
Office-based surgery has grown rapidly in scope and complexity, but without consistent oversight, patient safety risks increase. These proposed rules emphasize accreditation, structured oversight, and clear patient safety guidelines—bringing office-based practices in line with hospital and ambulatory surgery center standards.
What Practices Should Do Now
Stay informed: Submit comments to the Board by November 4, 2025, if you wish to weigh in on the proposal.
Begin evaluating accreditation options if you perform Level II or III procedures.
Review your patient selection, anesthesia protocols, and emergency plans to ensure they align with the proposed standards.
Citation: Alabama Board of Medical Examiners. Notice of Intended Action: Repeal and Replace Chapter 540-X-10 – Office-Based Surgery. August 27, 2025.