By Senator Rob O’Leary
Currently physicians are allowed to open and operate free-standing surgical centers without going through the same licensing process as hospital-owned surgical centers; known as a Determination of Need (DoN).
While these physician-exempted surgical centers provide additional access to services, they often compete with our community hospitals for patients and leave these hospitals to deal with the more complex and expensive cases. This can cause financial hardships for hospitals that depend on revenue from more basic surgical procedures to subsidize other critical public services, such as emergency rooms.
That is why I have filed legislation to apply the same state licensure, national accreditation and quality of care standards that apply to acute care hospitals providing the same level of surgical service to these physician-owned single or multi-specialty facilities. It does not involve imaging centers and other similar operations.
This legislation concerns Ambulatory Surgical Centers (ASCs), which are facilities that perform outpatient surgical procedures not requiring an overnight hospital stay.
Currently, only free-standing ASCs—those not owned and operated by physicians and covered by their licenses—are required to meet similar state regulatory criteria.
Only the physician-owned clinics and offices may provide surgical procedures without direct oversight or review by the Department of Public Health.
My bill establishes a level playing field without creating administrative burdens.
The DoN law is designed to ensure equitable access to health care services; to help maintain standards of quality; and to contain overall health care costs by eliminating expensive duplication of technologies, facilities and services.
All hospital-associated ASCs must be operated under a hospital facility license and are subject to DoN review on the same basis as other hospital facilities and services.
In contrast, a DoN review is not required for a physician-owned ASC that relies upon the physician office exemption.
The DoN process also was designed to limit the growth of health care costs by requiring health care providers proposing to build new facilities to demonstrate they were filling an unmet need.
Applying the DoN standard to all centers will slow the growth of so-called “niche” providers.
These “niche” providers are typically physician-owned ASCs that remove certain profitable procedures out of the hospital setting and into a for-profit business. This legislation still allows the creation of ambulatory surgical centers, but only if a clear need is established.
The increase in ASCs has the potential for increased costs to the private and MassHealth market. This is related to duplication of services in a given geographic area, the impact on the current health delivery infrastructure and the ability of hospitals, particularly community hospitals, to maintain their crucial role in the equation, particularly their emergency departments.
Most community hospitals, including those on Cape Cod, have suffered many years of poor profitability as a result of the current absence of this public oversight.
(Senator O’Leary, D-Cummaquid, represents the Mid and Lower Cape and Islands and is a member of the Legislature’s Joint Public Health Committee.)
(EDITOR’S NOTE: As he filed this report, Senator O’Leary told TYGH that he has agreed to meet with the physicians affected by his bill to hear their concerns.)
A Long-Standing Issue
At last winter’s meeting of the Advisory Board of To Your Good Health, A Health Care Newsletter, Cape Cod Healthcare President/CEO Steve Abbott warned of an increasing “impact on community hospitals of so-called niche players like surgery and imaging centers who don’t have to cross-subsidize those other services that don’t really pay so well and often are the most needed,” such as emergency rooms.
In a recent interview with TYGH concerning his impending retirement, Mr. Abbott reiterated that one of the reasons the hospital system faced a continuing challenge “to remain financially viable” was the growing “competitive factor of new outpatient services, those free-standing centers for [such as] surgery and imaging.”
By Senate President Therese Murray
In 2006, Massachusetts became the first state in the nation to make health care coverage mandatory for its residents. The legislation blazed a trail of shared responsibility that put the expectation of coverage on the shoulders of government, businesses, insurers and individuals alike. Since the passage of this bill, we have seen more than half of the uninsured in Massachusetts sign up for coverage–far exceeding our expectations.
As with anything that is done for the first time, we recognized from the beginning that adjustments would have to be made along the way to ensure the continued success and sustainability of health care reform. Now is the time to put some changes into effect.
First, it is critical to achieve more public information and transparency regarding increases in coverage premiums. Given the double digit percentage increases for health care coverage, I believe it is important for providers and insurers to release more information about preventable costs, administrative costs, marketing costs and reserves.
I am currently drafting legislation to address this issue and set up a public process to document the need for premium increases above 7 percent annually.
Additionally, it is necessary that we simplify the penalties for those who have chosen not to sign up for insurance so that they are uniform and easy to understand.
For the 2007 tax year, the penalty is straightforward. If you do not have insurance, you will lose the $219 personal exemption on your state income taxes.
After 2007, as the law is written, the penalties get more complicated. Currently, after 2007, uninsured individuals will be required to pay up to one half of the lowest cost premium available to that person. This translates up to 27 different penalties that could be imposed upon those ineligible for subsidized coverage. It also would be based on age and residence, with older individuals paying higher fines.
To comply, people must understand the consequences of being uninsured. We must work on simplifying the penalties so they are equitable and easy for consumers to understand while still creating an incentive for compliance.
In addition to these adjustments, we still face a shortage of nurses and primary care physicians. In order to increase this workforce and improve access to care, we must create initiatives such as partnering with medical schools and hospitals to create loan forgiveness programs for doctors who commit to practice primary care in the state.
We also can increase slots at our state medical school for physicians who commit to stay in-state for a set period of time practicing primary care. We also should realign payment structures so primary care doctors are compensated at or near the rate of specialists.
Another option to increase accessibility is to create a larger role for nurse practitioners by allowing patients to choose them as primary care providers and to support the development of limited-service clinics.
We were able to draft and pass health care reform because we were successful in bringing everyone to the table to craft the best solution. We understood, however, that as we implemented this groundbreaking reform there would be a need for updates, changes and adjustments to continue down the path of success.
That knowledge fueled a willingness to improve upon the bill legislatively and provide the necessary flexibility to make the plan work.
As we continue to see the implementation of health care reform, issues and challenges like these will continue to arise. But, if we maintain our willingness to adapt, health care reform will continue to be a success.
(Senator Murray, D-Plymouth/Upper Cape, is the first female President of the Senate in Massachusetts history.)
By Representative Cleon H. Turner
The Legislature’s Joint Committee on Public Health has heard testimony on a bill that would ban all use of all mercury-based preservatives in vaccines.
In the past 20 years, the United States has seen a rise in autism in children. It’s a frustrating and insidious malady and many researchers, physicians, and parents have sought to discover the source of this spike in numbers.
Some say it’s genetics, others believe substances ingested by the pregnant mother may be at fault. One of the more prevalent theories over the past decade has been that autism is caused by the mercury contained in childhood vaccines. The Joint Committee on Public Health recently learned about one such ingredient in vaccines containing mercury, called Thimerosal, a preservative which used to be used in various multi-dose vaccines and the influenza vaccine.
In 1997, Congress passed the Food and Drug Administration Modernization Act requiring the study of all types of mercury in vaccines and food. Thimerosal was removed from all childhood vaccines after a review by the American Academy of Pediatrics and federal agencies concluded that it was better to be safe than sorry.
The FDA and other public health agencies have conflicting views on whether Thimerosal was one of the mercury agents that could be linked to childhood autism. The strongest case to date suggesting a link (Geier & Geier–2003) has been disputed by those who claim the study was not adequately performed.
Bottom line, for some the jury is still out on Thimerosal and other mercury-containing agents. The federal government in the meantime has taken wise precautionary measures to remove them from vaccines. Parents still concerned should review studies on the other sources of mercury including food such as fish, which has been known to contain mercury.
Pregnant mothers choosing to play it safe should become nutrition-wise.
(Representative Turner, D-Dennis, is a member of the Legislature’s Joint Public Health Committee.