NC should open a path to more same-day surgery centers

March 18, 2013 

The New York Post headline summed up the complex issue with typical barbed brevity: “Mini-clinics give hospitals profit-ectomy.”

Now the same profit-ectomy is being proposed in North Carolina, and hospitals are howling like someone forgot the anesthesia. Our sense is that the process won’t hurt a bit and may even make a lot of wallets feel better.

At issue is House Bill 177. The legislation sponsored by three Republicans would make it easier to open same-day surgery centers, where patients can have procedures that can be done on an out-patient basis, such as tonsillectomies and cataract surgeries.

As The Charlotte Observer’s Ames Alexander reported last week, the proposed expansion is modeled on 2005 legislation that made it easier for gastroenterologists to perform colonoscopies and endoscopies in their offices. That change appears to have worked well for doctors and patients alike. Doctors serve more patients without the hospital overhead; patients and insurance providers save money.

The centers are growing in number around the country but have lagged in North Carolina mostly because of the state’s stringent standards for receiving a Certificate of Need, essentially a license to open a new medical facility or to purchase expensive medical equipment. HB 177 would exempt diagnostic centers from CON review and make it easier to win approval of same-day surgery centers.

The CON was intended to keep hospitals from building unnecessary facilities and buying expensive equipment they couldn’t fully employ. But hospitals now use the certificate requirements to fend off upstart competitors and protect their local monopolies on certain services.

The need for hospitals to protect that advantage is essentially the N.C. Hospital Association’s argument against HB 177. The association says relaxing CON standards would allow surgeons to open facilities outside of a hospital setting and take away the profitable services that keep hospitals viable. Losing those patients, the hospitals argue, would leave them mostly with indigent and high-risk surgery patients, and many hospitals, particularly those in rural areas, could not stay open with that patient base alone.

The association’s objections have merit, but they don’t trump the case for HB 177. The proposed law has provisions to protect vulnerable hospitals in under-served areas, and it has provisions to protect patients, too.

The proposed change would allow more patients to undergo surgery in settings that are often more pleasant and convenient than a large hospital. This is the direction medicine must go in the 21st century. Technology has made many surgeries safer, easier and less invasive. There’s no reason policies should stand in the way of their also becoming less expensive.

And, ultimately, as Alexander also reported in a series on hospitals’ inflated charges, hospitals sometimes use their control of facilities to gouge insured patients.

After that rich and excessive diet, hospitals can hardly complain now about having to undergo a profit-ectomy.

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