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Ambulatory Surgical Center

April 11, 2017

The following Op-Ed by Jeff Tieman, VAHHS President and CEO, ran in VT Digger and the Burlington Free Press. 

Next week the Green Mountain Care Board will hold a public hearing to consider a new ambulatory surgical center in Colchester. It is understandable why some support the application because on the surface it sounds good: another option for certain medical procedures, new competition in the health care market and, possibly, lower costs for the patients who go there.

The problem for the proposed surgical center is that health care is not a typical competitive landscape. And Vermont is not a typical health care market.

On behalf of our state’s not-for-profit hospitals, the association I lead opposes the surgical center’s application because we want the best care available to all Vermonters in a sustainable, safe and cost-effective way.

Recently ranked by the Commonwealth Fund as the #1 health care system in the country, Vermont takes seriously the business of delivering the best care at the lowest possible cost. Vermont hospitals are more regulated than any state in the union, answering to state and federal regulatory bodies for safety and quality, as well as the Green Mountain Care Board for financial performance and sustainability.

Conversely, the surgical center would be completely unregulated. No state agency would monitor its quality and safety. No federal authority would check to ensure it meets widely accepted clinical and operational standards. No government or other entity would assess its business practices to ensure it is fair to patients.

Without any of the rules that apply to hospitals, the surgical center would operate with virtually no oversight in a state that has chosen the opposite path—a highly regulated market focused on ensuring that the right facilities and services are available to meet the needs of Vermonters every day.

Our state regulators evaluate health care projects like this through what is known as the Certificate of Need (CON) process to ensure there is adequate access to health care services and to contain health care costs. The fact is, there is no real need for this type of new facility. Kaufman Hall, a reputable firm that worked independently to assess Vermont’s health care environment, concluded that existing capacity in our health care system is sufficient to meet the needs of Vermonters for the next 20 years.

Building a new facility means adding unneeded capacity and increasing the fixed costs that support new infrastructure. Meanwhile, the surgical center has the luxury of providing only those patient care services that are highly profitable. This results in cherry picking those cases away from the nearby hospitals, which need the more profitable cases to support the services that operate at a loss.

The surgical center would not have to maintain an emergency room. It would not have to be open 24/7. It would also not have to provide critical but costly services like kidney dialysis and cancer treatment. Instead, complicated cases or surgeries that result in trauma for any reason fall back on the local hospital.   

Unlike Vermont’s community hospitals, the surgical center wouldn’t necessarily accept any patient who wants services there. As a for-profit entity, its best choice might well be to decline patients who are uninsured or on Medicaid, or whose medical status makes their surgery too complex. The applicant has said its surgery center will offer charity care, but without a regulatory apparatus to guarantee or even monitor that, we have no assurance.

The ASC will not be compelled or incentivized in any way to improve the community it serves nor work with partners to meet identified community needs such as increased investment in mental health services and addiction treatment, all which Vermont’s hospitals do every day of the year.

Vermont’s hospitals are non-profit organizations that exist to serve and improve their communities. We are accountable to our patients, to families, to communities and to creating a better, stronger Vermont. We proudly do that work every day—and will continue to do so.