Memorandum to NYSAASC Members

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Peggy Alteri, President and Executive Director

On March 23, 2006, I was invited to present to a subcommittee of the NYS Public Health Council and the State Hospital Review and Planning Council.  These two agencies have long been at odds regarding the matter of ambulatory surgery centers and whether or not they should proceed with approving new centers.  Chris Delkar, from the NYSDOH will be scheduled to present info regarding the growth of ASC’s in NYS at the NYSAASC meeting scheduled for April 24 and 25, 2006 in Saratoga. This is an opportunity that I have requested for the past several years as I have listened to these Councils misrepresent what the ASC industry is and our impact on the health care system and hospitals, specifically.

The PHC and SHRPC are very divided on the issue of ASC’s with some of them strongly pro-competition and some of them strongly pro hospital protectionism.

I thanked them for the opportunity to tell them who and what we are, and what we do and do not do.

What We Are:

I discussed the need to revisit the lifting of the moratorium and the changes in the regulations that date back to 1998.  At the time the intent of the changes in the regulations had a stated intention of “enhancing competition” and improving quality and cost.  I pointed out that we had in fact reached that objective through the growth of ASC’s throughout the state. 

Providers:

I stated that we are providers of high-quality , efficient, cost-effective ambulatory surgical care, and that we would stand on our record in terms of quality, efficiency, cost, infection and complication rates, and patient and surgeon satisfaction. I reminded them that our organization had actually insisted on the accreditation requirement for all new and existing ASC’s when the regulations changed to allow for the approval of new ASC’s.  

Choice:

In being responsive to patient, surgeon and payor demand, we provide choice to the community for their health care decisions.

Contributors:

We have been attacked as impinging on the hospitals’ ability to provide charity care and emergency room services.  I reminded the panels (who seemed to be totally unaware) that we contribute 8.95% of our gross receipts to the bad debt and charity pool for HOSPITAL care, that there is an 8.18 % surcharge on services to offset charity care, and that free-standing surgery centers pay sales tax, income tax and real estate taxes.  These all contribute in a positive way to the communities which we serve.

Medicaid and Charity Care Providers:

Furthermore, the ASC’s in NYS provide care on a Medicaid and charity care basis.  We had developed charity care policies long before the hospitals were required to do so, and surgeons still contact our facilities for charity care for their patients when the hospitals fail to cooperate with these requests. 

Highly Regulated and Controlled:

The ASC’s in NYS are not only licensed and reviewed by the DOH, we are required, at our own insistence, to be accredited on at last a 3 year cycle by either JCAHO or AAAHC.  Most of the facilities are Medicare approved, and therefore also need to meet the Medicare Conditions of Participation.  Our own accrediting agencies require that we participate in some time of benchmarking, and we are unable to benchmark against the hospital outpatient surgery departments as they do not perform benchmarking. 

Competition:

We are in fact competition to the hospitals, and in some instances, to each other in the provision of ambulatory surgical services.  We are all better providers and more efficient providers as a result of the competition presented over the past several years.

Colleagues:

We are colleagues in the provision of health care services and our interest in the welfare of the community.  Our clinical staffs are wise enough to know enough to share equipment, ideas and policies and procedures to positively impact patient care.

What We Are Not:

Providers of Acute Care:

ASC’s are not providers of acute care.  We screen our patients carefully to assure that the free-standing setting is appropriate for our patients.  We do not consider this “cherry-picking”, but rather, good medicine. The same parties who accuse the ASC’s of cherry-picking would have much more reason to attack us if we were to be caring for patients who are too sick for our facilities.  Sick patients belong, and need to be, in a hospital.  Healthy patients do not.

Substandard Providers:

The Hospital Associations have made allegations and innuendo regarding the quality of care in the free-standing ASC’s.  I reiterated all of the quality issues and suggested that the councils request the information from the DOH regarding the quality of care in the ASC’s as it would demonstrate that there are very few problems with the ASC’s.

Office-Based Surgery

ASC’s in NYS continue to be thrown into the basket of office-based surgery by many parties in NY.  We are separate and distinct from these entities in that we a specifically licensed for ambulatory surgery, we are regulated, controlled and accredited.  We must meet many quality standards in order to maintain our licensure and Medicare status.

There is a section of the NYS Health Code that requires that offices or practices that use the term “center” or “clinic” in their names seek licensure as an Article 28 facility in NYS.  I reminded the committees that when I attended the committee established by the Commissioner of Health to look at office based surgery there were a number of physicians names posted on the wall.  All of them had been investigated and sanctioned in some way by the Office of Professional Misconduct, and many of them identified their practices as “surgery centers” with no intervention from the Department of Health.  There is a center is Syracuse that identifies itself as “A&E and NYS Surgery Center” that is a hair restoration center!

Patients are being harmed in these practices and some are even dying, and there is no accountability, except through OPMC.

Threat to Hospitals

Hospitals have not closed in NYS due to the growth of ASC’s.  One ASC has closed as a result of hospital activity.  Hospitals become more efficient and more user-friendly through the competition provided by the ASC’s.  This was the exact intent of the changes to the regulations and should be fostered rather than stifled. 

I used the example of Syracuse:

Prior to 1998:

2 hospitals had off campus ASC’s and 2 provided those services in their regular OR’s.  Harrison Center had 1 free-standing ASC.

After 1998:

There is a new single specialty eye center, there is a new single specialty orthopedic center, Harrison added another center in Camillus, St. Joseph’s added another center in Fayetteville, and all of the original centers and facilities continue to exist.

Three of the hospitals in town currently have major building programs underway, all of the hospitals have added major (costly) services, and Upstate has urged its surgical staff to relocate the ambulatory surgery to the Harrison facility.  Syracuse is not a large community, yet all parties co-exist.

Summary:

It is my belief that the Councils need to give serious and thoughtful consideration to the issue of independent ASC’s.  Only 2 ASC projects have been approved since 2004 and they were both joint ventures.  Recently, an independent Long Island Hand Surgery application was denied, with no reason given.  I suggested that this is dangerous territory, in that Councils comprised of primarily hospital representatives, and with no ASC representation whatsoever, are making decisions on whether or not competitive ventures will be approved.  The concept and intent of the regulations that they approved in 1998 is very clear on the pro-competitive intent of the regulations.