NMC Commentary

What Happened to the Legislation on Regulating Ambulatory Surgery Centers?

The bill got voted down in committee.  As I described in a February column and in a letter to our local legislative delegation, there are strong reasons that Vermont should extend the same level of licensing, quality, and financial regulation to for-profit Ambulatory Surgery Centers (ASCs) that it places upon Vermont’s not-for-profit hospitals.  Unfortunately, soon thereafter, the Vermont Senate Health and Welfare Committee voted down bill S.278 which would have begun to put those provisions in place. Hospitals are at a disadvantage with being highly regulated and the soon to be built ambulatory surgery center in Colchester will not be held to the same regulations.  This is damaging to hospitals without a level playing field.

Fortunately, the concern with the proposed legislation has been described by a key legislator as one of timing rather than fully policy direction. The Vermont Digger story on the vote said, “Sen. Claire Ayer, D-Addison and the committee’s chairwoman, had been a strong supporter of regulating surgical centers. But Ayer said it became clear that any decisions made this session would be premature. ‘I think we’ve come to a place where we’re all not sure that we’re ready to move forward with anything,’ Ayer said. ‘It’s too fast. There are too many open issues.’” It is good to see that some of the leaders within the Vermont Legislature understand the importance of this regulation.  Discussions must and will continue and action must be taken.

In the Certificate of Need process, the Green Mountain Care Board placed numerous conditions on the proposed Ambulatory Surgery Center in an effort to ensure that facilities like that carried some of the same expectations that are placed on Vermont’s not-for-profit hospitals. If Vermont is to have this type of facility, such conditions are crucial.  It is now important that Legislators act to preserve those conditions in statute and extend the provider tax and other fees/expenses that hospitals must pay to these new competitors who tout having lower prices.  At NMC, we are fully prepared to compete for patients if that is what is required – all we ask for is a level playing field. Will all the pressures on hospitals to fund the future of the healthcare transformation in addition to the already cap on hospital revenues, I am not sure folks understand that services offered at hospitals will be impacted.  Hospitals are leading the way in reducing their costs and we will be presenting the collective impact of these reductions and innovations to the Green Mountain Board this week.

It is ironic and particularly disappointing that in a year when the State is searching for budget cuts within promising programs and pressuring hospitals for even greater efficiency and cost reductions beyond what we have already achieved, that there is hesitation to extend the 6% provider tax (which hospitals must pay) to the new Ambulatory Surgery Center.  If hospital based surgery centers have to pay that tax to help the Vermont State budget, I believe non-hospital surgery centers should also have to pay that same tax. Again, voices in the legislature agree.  In that same media article, Rep. David Yacovone of Morrisville is described as “still in favor of regulating ambulatory surgery centers” and quoted as saying, “ “These issues don’t go away … We ask (medical) providers to pay the provider tax. Why we wouldn’t ask these folks to is beyond me. It’s called a level playing field.”

Similarly, I strongly believe that if an organization wants to duplicate the services of a hospital, they should be held to the same licensing and quality standards which hospitals carry.  Yes, it represents added cost for the new competitors, but it is cost that carries reason and value.  I was struck by the CBS News coverage of the recent joint investigation by Kaiser Health News and USA Today Network into conditions at ambulatory surgery centers.  While proponents say such centers may “make for cheaper, faster and more convenient service than in a hospital” the news of the investigation reports that “when something goes wrong during surgery, the hospital may be the safer option.”  That story about the “potential dangers” is available online at https://www.cbsnews.com/news/surgery-centers-report-highlights-risks/.  It is time to take this seriously and fairly. We are moving to capitation and we all need to be working together in a system of care.

At NMC, we have a long history of dedication to ‘the triple aim’ from the Institute of Healthcare Improvement: improving the patient experience, improving the health of populations, and reducing the per capita cost of healthcare.  In this Fiscal Year alone, the NMC team has used their creativity and expertise to achieve more than $700,000 in cost reductions while maintaining our quality and continuing our investment in primary prevention. We are true to driving cost reductions.  Thank you for your continued support of local healthcare and please join me in continuing to push for a level playing field at a  time of immense pressure to lead in healthcare transformation.

— Jill Berry Bowen, NMC’s Chief Executive Officer