AMBULATORY SURGICAL CARE
CON STANDARDS MEETING
10/23/2008 – 2:00 pm EST
Conference ID # 137202
Ms. Sonia Chambers:
My name is Sonia Chambers. I’m
Chair of the board of the West Virginia Healthcare Authority and I want to
welcome everybody to the fifth or sixth in our series of meetings. The purpose
of these meetings is to review the various services that are subject to Certificate
of Need review and allow interested parties to comment on whether those
services should continue to be reviewed under Certificate of Need or not. As
you may or may not know, the legislature has been examining the issue of Certificate
of Need during its interim process and I guess that will continue through the
next legislative session and we have had discussions with them and agreed to
hold these meetings to get input from everybody. We will be passing all of that
input on to the Legislative Interim Committee looking at the issue, so we
welcome your verbal comments today and invite you to submit any additional
comments you might want to in writing and we would ask that you could do that
within 30 days of this meeting, so what I’d like to do is start with those that
are on the phone. If you would identify yourself and then we’ll go around the room
here in
Dr. Mark Mayle:
My name is Dr. Mark Mayle. I’m
with Regional Eye Associates and Surgical Eye Center of Morgantown.
Ms. Marilyn White:
Marilyn White with the
Healthcare Authority.
Ms. [??] [??]: This is
Ms. Sonia Chambers:
Do we have anybody else on the
phone? I’m guessing somebody just joined us.
Ms. Nancy Tonkin:
Yes, this is Nancy Tonkin with
the West Virginia Academy of Ophthalmology.
Ms. Sonia Chambers:
Hi
Ms. Nancy Tonkin:
Hi everybody.
Ms. Nancy Best:
Also Nancy Best from
Ms. Angela Slagger:
And Angela Slagger from West
Virginia University Hospitals, also.
Ms. Sonia Chambers:
Okay, anybody else on the
phone? Is that a no? Okay, why don’t we go around the room here? As I said, I’m
Sonia Chambers.
Ms. Marianne Kapinos:
Marianne Kapinos, Healthcare Authority.
Mr. Dayle Stepp:
Dayle Stepp, CON Director.
Ms. Sheila Kelly:
Sheila Kelly, Certificate of Need
division.
Mr. Tim Adkins:
Tim Adkins, Certificate of Need,
Healthcare Authority.
Mr. Chuck Johnson:
Chuck Johnson, Dinsmore &
Shohl.
Mr. Bill Hicks:
Bill Hicks, also at Dinsmore
& Shohl.
Ms. Nora McQuain:
Ms. Nora McQuain. I’m Director
of Facility Space and Residential Care for the Bureau for Medical Services
Medicaid.
Ms. Stacey Ferguson:
Stacey Ferguson, Tri-State.
Ms. Brenda Grant:
Brenda Grant with CAMC.
Mr. Ed Hamilton:
Ed Hamilton,
Ms. Debbie Hill:
Debbie Hill, Summersville
Memorial.
Ms. Lindsey Darling:
Lindsey Darling, Jackson
Kelly.
Mr. Jim Thomas:
Jim Thomas, Jackson Kelly.
Ms. Jill McDaniel:
Jill McDaniel, Hospital
Association.
Ms. Cindy Dellinger:
Cindy Dellinger of the
Ms. Martha Morris:
Martha Morris, Consumer
Advocate Office.
Mr. Jessie Bond:
Jessie Bond in the Consumers
Advocate’s Office.
Ms. Sonia Chambers:
Okay. What I’d like to do,
start with, is to have Dayle, I guess, briefly go through the standards that we
have and then also we have an inventory of services around the state and for
those of you who are on the phone, this is all available on our website.
Mr. Dayle Stepp:
We don’t have the last two
items on the website yet, but we’ll get them.
Ms. Sonia Chambers:
But they will be? Okay. Also, this meeting is being recorded.
There will be a transcript of the meeting, so if you would identify yourself
before you speak so we can attribute your words to you, that would be helpful
and then the transcripts will be available on the website, as well, so if
anyone wasn’t able to attend in person, they can certainly look at that on the
website. All right, Dayle.
Mr. Dayle Stepp:
Okay the Standards for Ambulatory
Surgery Centers is contained in the Ambulatory Care Center Standards and these
were approved in October 1992. Under the Ambulatory Surgery Center it defines
four types: free standing which means it’s
a total independent and separate facility, hospital-based independent which
means it’s located within a hospital complex, but has a separate, independent
financial and administrative status, outpatient surgery is hospital-based
dependent which means it’s linked to the hospital and then we have private
office practice surgical facilities and this means a facility which is part of
a private office practice but shall be reviewable under CON under the following
circumstances: if there are two or more
operating rooms, if general, epidural, or spinal anesthesia is provided or if
the physician charges an additional fee for the use of the facility or any
ambulatory surgery center subject to the standards if it involves the
acquisition over a two year period of medical equipment with the value in excess
of the threshold which is currently two million dollars. As far as the
methodology, proposals involving new surgery centers expanding or replacing the
existing surgical capacity which might duplicate existing under-utilized
capacity may be denied by the Healthcare Authority. Then it talks about per new
operating suites in existing facilities shall not be added unless all existing
comparable rooms at the facility are utilized 40 hours a week including
billable hours reasonable turnaround. For renovation or replacement of existing
operating suites all existing rooms at facility are utilized an average of 36
weeks and for new operating suites in new freestanding facilities shall not be
added unless all existing comparable operating rooms at other existing facilities
in the area are utilized 40 hours a week. Then there’s the methodology that the
first part of it is calculation of a use rate per 1000 population and you can
use a national surgical use rate, a
Ms. Sonia Chambers:
All right and all of this will
be available on the website for anybody on the phone or….okay great. Thank you
very much, Dayle. That’s a very thorough packet of information. I’m happy to
just open it up and did we have somebody else join us on the phone?
Mr. Gary Murdoch:
Yeah, this is Gary Murdoch up
in
Ms. Sonia Chambers:
Okay
Dr. Mark Mayle:
This is Dr. Mayle on the phone
and I’m again with Regional Eye Associates and do represent the West Virginia
Association of Ambulatory Surgery Centers. Regulation in my opinion should be
geared towards not so much having the public domain protected by numbers of
usage, but more by quality of care and by ease of the patients. It, in national
studies, has always been pre-conclusively shown, beyond a shadow of a doubt,
that ambulatory surgery centers do provide better results and more efficiency
than mandated hospital surgery center rooms and for that reason, I think the
regulations, which sometimes are onerous and burdensome for people to start the
process and accomplish Certificate of Need do, in many instances, discourage
people from even pursuing the process and it is of value and benefit to the
citizens of the state and to the patients that receive care to have high level,
efficient, safe, and up-to-date care provided through ambulatory surgery
centers and I would entertain any questions from anybody regarding those
comments.
Ms. Sonia Chambers:
All right, thank you.
Dr. Mark Mayle:
You’re welcome, thank you.
Ms. Sonia Chambers:
Who’s next?
Ms. Brenda Grant:
Brenda Grant with CAMC. I
would like to take the position that nationally the studies show that with the
fragile bottom lines of hospitals nationwide and especially in
Ms. Sonia Chambers:
Gary or Nancy?
Mr. Gary Murdoch:
Yeah, forgive me, I’m not
quite sure who’s down there, but this is Gary Murdoch up in
Mr. Chuck Johnson:
Hey
Mr. Gary Murdoch:
There is pressure and I’m not
saying that issue doesn’t exist, but a total abandonment of all oversight is
not the answer. I think there could be some…I think there is some middle
ground, but I haven’t really thought that through totally, but a total
abandonment of all CON oversight is, in my mind, we might help a few areas, but
there’s an entire state here to worry about also. Chuck, that is a significant
issue.
Ms. Sonia Chambers:
Nancy Tonkin?
Ms. Nancy Tonkin:
Hi everybody. Dr. Mayle is in
Ms. Sonia Chambers:
Okay. I appreciate that.
Ms. Marilyn White:
Dr. Mayle, do you have a
policy for charity care?
Dr. Mark Mayle:
The question directed to me,
we do have a policy for that that is mandated by the Federal government which
is for us to offer services to anybody at a rate lower than Medicare allowable
which is Medicare fraud, so we do offer charity care. We discount the rate to
Medicare allowable as much as we can and we do set up payment plans for folks
and make it so that any amount of payment that they can make will be sufficient
as long as they’re making progress on that how much it is or how little it is,
but from our standpoint, the regulations as they now stand make it Medicare
fraud if we just somehow bring somebody into the surgery center and do their
surgery for free unless we’re willing to do that for all Medicare patients,
which of course no provider can afford to really do that, so that’s the extent
of the charity care. We do discount our rates to the Medicare allowable and
allow the patient to make payments on that.
Ms. Marilyn White:
Can I ask someone from a
hospital there, does their policy differ from that?
Mr. Gary Murdoch:
Yes, ours does differ from
that. Basically in a nutshell, I don’t have it in front of me, but 200% of
poverty level or less, depending on your family’s situation, so the dollar
threshold of a single person, it used to be 100%, now we have a graduated
scale, I believe up to 200% of poverty level as defined by Federal government
standards which again, I can’t refer to them, but I think you get the idea. If
you demonstrate that and we verify that you are eligible for charity care and
you don’t have to pay your bill basically and our interpretation of the…because
we do that for everybody we believe that’s a compliant position and I believe
most hospitals in the state, whether it’s 100% or 200% of poverty level as
defined by Federal standards, is a fairly common hospital practice, but that’s
not of the issue. There’s a lot of care being given away by critical access or
hospitals and we rely on those paying customers to help make up for that and if
a whole host of profitable services leave the hospitals, that’s what has a host
of financial people terrified across the state, so some safeguards to look into
that is…but back to Chuck’s issue, I think there might need to be some changes,
but wholesale getting rid of this is very scary to some of us.
Ms. Marilyn White:
Thank you.
Ms. Brenda Grant:
Our charity care policy is
very similar to WVUs and it would be the hospital charity care policy that
would apply.
Mr. Gary Murdoch:
Yes. It is worth saying that
only applies to medically necessary treatments. Elective surgeries, plastic
surgeries, cosmetic things, that charity policy does not, but the vast
majority, I would say 95% of what we do, maybe even 99% of what we do, that
policy that I described is accurate.
Ms. Sonia Chambers:
Dr. Mayle, can I follow up on
that. To your knowledge, are ambulatory surgery centers subject to different
rules by Medicare? I notice that you said you thought that under Medicare you
could not charge anybody below Medicare rates, but I would think that you could
have a charity care policy similar to what a hospital does. Are there specific
rules that prohibit that?
Dr. Mark Mayle:
My understanding of that and I
am not a lawyer, I’m a representative, but my understanding of that is that
those rules are applied…any provider…these rules apply to a provider of
Medicare services and my understanding is that these rules do apply to surgery
centers, as well. There’s a host of differing things including reimbursement.
The ambulatory surgery centers get paid at a lower rate of reimbursement from
Federal government and now from the private insurances, as well, and also along
with that, there’s no itemization of services, so it’s the standard rate that
applies regardless of what it would cost you to perform the surgery, but at
least my understanding of the situation is that yes, the rule that applies to
us is that we can only go to Medicare-allowable rates and lower, but I honestly
don’t know if there is a provision someplace that would apply to charity care.
I certainly know of nobody in the state that has an ambulatory surgery center
who is aware of any loophole or any charity care clause, but I don’t know if
that really exists or not to be totally honest with you.
Ms. Sonia Chambers:
Angela, Stacey…
Ms. Stacey Ferguson:
To follow up with what Dr.
Mayle was saying, as far as we know there is no loophole there for the Medicare
rates. We do have to bill at least what Medicare would pay for the procedures
and I think the reason is because for ambulatory surgery centers, we’re doing
mainly elective cases. We’re not doing emergency surgeries or such things like
that. We are doing elective procedures, so I think that’s probably why we have
a different stipulation versus a hospital.
Ms. Sonia Chambers:
We may have to look into that.
I’d be very interested in that. I would think that you could, because I think
physicians’ offices have charity policies, as well. That as long as you have
some policy you apply across the board, you may charge the patient that amount,
but then you would allow them to avail themselves of your charity care policy
and then you would not collect…you would write that off to charity as opposed
to…upfront as opposed to billing them and not getting anything and then writing
it off to bad debt. I would think you could do that, but that’s something I
think I’d be really interested. I would think physicians…I mean physicians’
offices I think…independent physicians’ offices do that, so I don’t know why
ambulatory surgery centers couldn’t have that policy as long as it was applied
across the board based on some income standard or something like that, but I
may be wrong. I’m looking at some of the other learned council in the room to
see if they know the answer to this. Yes, no, not off the top of your head?
Mr. Gary Murdoch:
In a past life I was involved
with the billing of the entire hospital and I’ve worked with the physicians up
here. I think we might be mixing. The charity care policy is one thing, CAMCs
and ours, every organization can have a charity care policy. The Medicare
reg…at least our interpretation of them are we cannot offer discounts. We
cannot have a bill differently depending on the payer and that is true, but
there is a carve-out, if you will, at least our interpretation, and the vast
majority of not-for-profit hospitals in the country, is that charity care is
somewhat of a carve out, that we are sending in the same exact bill that
everybody else gets and it’s consistent with Medicare regs and such like that,
we just have internal policies, that regardless of race, creed, color, it’s all
about your income and if your income is a certain level you don’t have to pay
the bill. In the threshold of that there is no central guidance on that, so a
not-for-profit versus a for-profit versus…our policy has changed in my tenure
here, but I can tell you for a fact that the way our physician group, which is
a separate corporation from our hospital, we have merged those into 200% of
poverty level.
Ms. Sonia Chambers:
Right, so the physician group
has the policy where you would charge them what you would charge everybody else,
but you write it off upfront as charity as opposed to making efforts to collect
and then you don’t and then you do it as bad debt.
Mr. Gary Murdoch:
Correct. You choose your
policies and how you decide to collect and from who and then it becomes an accounting
exercise, what’s written off to charity versus what’s written off to bad debt.
Ms. Sonia Chambers:
That would be my
understanding, so that you could have a charity care policy like that, but you
wouldn’t be charging them differently.
Mr. Gary Murdoch:
Well all I can speak for is
what we do. I don’t know the subtleties of stand-alone ASCs.
Ms. Sonia Chambers:
All right, would you like to
say anything else? No, I didn’t know if you guys had any other…you were next…
Ms. Stacey Ferguson:
Surgical centers do provide a
good service to our area. We have a surgical center that, I guess it’s about
five years old. We provide really good service. Our infection control rates are
less than 1% if I have maybe one post-op infection a year. It’s a great environment
for these smaller elective procedures and in my perspective the hospitals are a
good environment for larger, more urgently needed, more medically critical
patients, so I think these are good. I think surgical centers are good for the
economy of health care. I think it is decreasing the costs and it is improving
outcomes for the smaller, less urgent procedures.
Ms. Sonia Chambers:
Okay.
Dr. Mark Mayle:
I would just like to add onto
that. The footprint of our practice is rather large and we incorporate
basically the entire sort of western, north central portion of
Ms. Sonia Chambers:
Thank you Dr. Mayle. Raymona…
Ms. Raymona Kinneberg:
For all the reasons that have
been discussed by WVU and CAMC, we support continued CON for ambulatory surgery
centers.
Ms. Sonia Chambers:
Debbie…
Ms. Debbie Hill:
We also agree with WVU and
CAMC. We’re a small rural hospital and more and more we are assigned the
responsibility to cover a fairly large geographic area, much of which is a very
poor payer mix. If it were not for some of these procedures we’re able to do in
our facility, we would no longer be able to provide the level of ER services,
perhaps obstetrics, many of the other services, and while I totally agree the
government should not have to support us, I would hate to see these services go
away, that when the patient has a heart attack in the middle of the night, the
nearest hospital is an hour and fifteen minutes or fifty minutes away, so for
those reasons, I think to maintain hospitals throughout the state, we have to
be able to keep that service. I also agree that quality is very important.
However, hospitals should be driven by their own quality measures, by their
relationship with CMS or joint commission or whatever accrediting body they
have, to push those quality factors, but it would be a tremendous problem for
small hospitals, especially Summersville, if we were to lose the volume of the
insurance-paying patients to an ambulatory surgery center.
Ms. Sonia Chambers:
All right. Jim, would you like
to say anything in addition or pass?
Mr. Jim Thomas:
The only thing I was going to
ask was really of the Authority and that is a follow up to Chuck’s question.
What would be the Authority’s position if a
Ms. Sonia Chambers:
We had that issue before us
and I don’t remember…we decided that the [noise
inaudible] funds by that hospital were reviewable, correct? It happened in
Mr. Jim Thomas:
That’s what I thought. I just
wanted to make sure that was still the position.
Ms. Sonia Chambers:
We reviewed the capital
expenditure, didn’t we?
Mr. Dayle Stepp:
It never got to that point.
Mr. Jim Thomas:
Once it’s under two million
it’s just the facility, the healthcare facility.
Ms. Marianne Kapinos:
We have a process, Jim.
Ms. Raymona Kinneberg:
There has been a ruling
previously that facilities out of state, not the capital expenditures, but
facilities out of state are not under the purview of the Healthcare Authority.
There is a [crosstalk inaudible] I
remember.
Ms. Sonia Chambers:
That’s correct, but if an
in-state facility is going to spend more than two million dollars…
Ms. Raymona Kinneberg:
That’s a different issue. That
comes under the…
Ms. Sonia Chambers:
In or out of state, then it
would fall under the capital expenditure. That would be the general position of
the Authority. Of course, anyone who has a specific instance should ask for a
ruling of reviewability in a formal manner if they want to be safe.
Ms. Raymona Kinneberg:
That’s always my advice.
Ms. Sonia Chambers:
Jill…
Ms. Jill McDaniel:
Yes, thank you. This is Jill
McDaniel with the West Virginia Hospital Association. We do have a position
supporting Certificate of Need and recognizing the importance of the Healthcare
Authority in controlling healthcare costs in
Ms. Sonia Chambers:
Mr. Johnson, anything else
from you and your colleague?
Mr. Chuck Johnson:
Well Dayle was very good at
pointing out the re-emergence of that study and that’s very important to the
Healthcare Authority. In ’96 back, there’s a survey of all of the ambulatory
service centers in the whole country, so it wasn’t just a projection, it was
what actually occurred and you could see trends in eye procedures or what’s
going on in the country and I think if we can back on the track that if the
Healthcare Authority is asked to consider exceptions, as was previously
discussed, that that data is going to be very valuable in looking at those
issues.
Ms. Sonia Chambers:
Dr. Mayle, can I ask a question
about something you said?
Dr. Mark Mayle:
Yes ma’am.
Ms. Sonia Chambers:
I’m interested…you said that
you thought the regulations should be geared more towards quality of care. Do
you have any ideas about how exactly, what that would look like?
Dr. Mark Mayle:
Well there are some national
studies that kind of show outcomes and I’m familiar with those related to eye
surgery, since that is my profession. I don’t know if these studies exist, but
I would assume that they also exist for certain otolaryngology, previously
known as ear, nose and throat. I would assume they exist for anesthesia-based
pain control procedures and I would assume they exist for certain orthopedic
procedures which can be done outpatient, but the surveys will…our surveys related
to eye pretty much uniformly show better patient satisfaction and better
patient outcomes based on surgery done in an ASC setting versus a typical
hospital-based outpatient surgery setting and so those are the sorts of
things…now if you’re going to ask me exact benchmarks, I probably can’t provide
that, but I would think based on economy of care, in other words what does it
cost to deliver the care, I think ASCs will consistently come in under those of
the hospital because it’s a much more efficient process just by its nature
because you’re doing one thing and not 50 things. So what does it cost you to
provide the care, what is the starting point of, the baseline measures of
visions or physiologic functions for which surgery is being done, and then some
in-point measures? To my way of thinking, that is a better way of regulating
things, because what most of us want to do is to provide the best level of care
that we can and to do it in the most economical way that is possible and that
equals efficiency and that is our mantra and I know working with other
ophthalmology groups and other ambulatory surgery groups, efficiency is the
mantra and so we tend to think not can we do 500 Lasik procedures to support
looking after some vision surgeries on kids, which is a critically important
service that we provide for kids to do vision monitoring and surgery for
alignment of eyes and whatnot, but it’s not the sort of a thing that is going
to help our bottom line, in fact quite the opposite, but nobody thinks in terms
of how many Lasik do we need to do to offset the kids that we take care of or
how many cataract surgeries do we need to do to offset the diabetics that we
take care of, just to give you some examples. So in that instance, I think the
idea that we need to have something that’s lucrative to offset something that’s
not lucrative is counter intuitive to how we should do things. What we should
say to ourselves is how can we deliver top level quality care, how can we do
that in the most efficient way, and that’s going to be the bottom line,
whatever that is and the process, as it exists right now, I think and I feel
and I believe from the comments that had been made is that let’s use lucrative
procedures to fund care for non-lucrative procedures and to me that’s a
backwards way of thinking. What we should all be thinking is how can we become
more efficient and deliver all of our care cost effective, efficient, and most
importantly top level of quality and then the chips fall where they may and
it’s not always pretty in health care, it’s not for any of us, but in my
opinion I think that’s the way that we should think and operate.
Ms. Sonia Chambers:
I want to pursue this just a
little bit more and Jill McDaniel talked a little about that there ought to be
sort of a level playing field or more transparency and I think the whole push
towards transparency is coming from on all sorts of levels, from the presidents
of CMS to this governor, a lot of people are talking more about that. Do you
think that your association would be supportive of trying to develop ways that
ambulatory surgery centers could provide more transparency on the cost and the
quality side?
Dr. Mark Mayle:
Yes ma’am, absolutely. In
fact, when Governor Manchin recently had a need procedure and then there was an
emphasis to have a web-based device that would give you cost comparisons, I
actually…I’m not well plugged in politically, I must tell you that. I’m just a
guy doing eye surgeries, but I’m not well plugged in politically, but in our
association we tried to make ambulatory surgery center pricing available on
that and I never was able to really get anybody that was willing to consider to
do that. If anybody knows somebody for me to talk to, we would love to do that,
but specifically related to eye surgeries, we get reimbursed at a set rate, so
if you do your standard surgery and everything goes along just fine you get x
amount of dollars. If you have a complicated surgery and we use sutures and
other equipment and other devices and other things, you still get x amount of
dollars. In the hospital setting that billing is all itemized so that if you
use extra equipment, extra sutures, extra things the cost of that surgery
really is going to be more than your standard surgery which was itemized at a
lower rate. We, as an association, want that. We want consumers to be able to
say, to be able to see and to say I’m going to pay x amount of dollars if I
have this surgery done at site A and I’m going to pay x amount of dollars if I
have surgery done at site B and moreover, we would be extraordinarily happy to
provide comparison of outcomes, because I think it will show…every study that I
have see has consistently shown that results are better, in a very general
sense, at ASCs.
Ms. Sonia Chambers:
Dr. Mark Mayle:
Excellent, excellent. Well I
need to get with you then so we can do some work on that, because we did really
try to get involved in that and the people that I had talked with, I was never
able to get any place but a stone wall, so that’s wonderful to know. I will
correspond with you later on this issue.
Ms. Sonia Chambers:
Okay. Well what may have
happened is that we had to get the site up and running and we clearly felt that
we were putting up version 1.0 so that we had to sort of limit what we put up
in 1.0, but I think it’s time to revisit that and maybe one of the things we
can look at is a little more focus around charge and quality, because we want
to begin to start putting some quality measures on that website, so we’d be
happy to work with you guys to do that. I think that would be very informative
for consumers.
Dr. Mark Mayle:
I agree with you, I agree with
you.
Ms. Sonia Chambers:
So and we also are accumulating
more data all the time to make that site better, stronger, all those sorts of
things, so I appreciate your willingness to do that.
Dr. Mark Mayle:
Excellent and as the original
kind of founder and president of our Ambulatory Association and now I’m vice
president, actually, but we would be happy to work with you in any way and
provide whatever information necessary to get that out there. We want that
information out there for folks.
Ms. Sonia Chambers:
Well that will be great. Okay,
anybody else?
Ms. Marilyn White:
Sonia, can I just ask the
doctor a question since we’re on this. Doctor, it’s been a long time since I’ve
had anything to do with billing and is the place of service still involved in
the reimbursement from Medicare?
Dr. Mark Mayle:
Well yes it is. If you’re a
free standing ASC you may not submit itemized billing. There is a set rate of
reimbursement that I believe is 60%, although this number vacillates a bit from
year to year, but I believe currently it’s 60% of hospital reimbursement and
it’s a set rate, so as I mentioned, regardless of what it requires you to use
to get the surgery done, you’re still going to get x amount of dollars, but
yes, as a free standing surgery center a different payment schedule is applied,
number one. And number two is it’s a set rate not available to be itemized or
increased in any way. It’s a set rate and you get what you get regardless of
what it costs you do product the surgery.
Ms. Marilyn White:
Okay, so therefore it’s still
like it used to be for the same, let’s say cataract surgery, take that. If it
is done in a free standing facility, Medicare is going to pay x dollars, but if
the same surgery is done in a hospital setting, they’re going to be reimbursed
more?
Dr. Mark Mayle:
They will be reimbursed…right
now I think x times .4 and then possibly even at a higher rate because again,
itemization of specific things used is available, so it’s a higher baseline
reimbursement plus itemization of any additional supplies that you have
practiced and needed during the surgery can be applied, too, so it’s not a set
number. It’s a set starting number, but the final number could be higher than
that.
Ms. Marilyn White:
Okay, thank you.
Mr. Gary Murdoch:
We’ve done a good bit of
looking at this for a host of other projects and basically it is correct. There
is, depending on what procedure you look at, 25 to 40% premium paid for
hospital-based things. There is a very small number of the CPT codes out there
that might be going to both environments, but there’s actually a slight
advantage for ambulatory care, but that’s because there’s just weird stuff
going on. There is a significant amount…the Federal government does have a
policy on this that by 2011, I believe, they’re trying to normalize all the differences
to between 25 and 30% to that premium.
Ms. Marilyn White:
Oh, okay.
Mr. Gary Murdoch:
So there is some changes going
on and reducements coming on the hospital side and maybe some increases coming
on the ambulatory surgery side, but the studies state by 2011 or 2012 we’ll see
about roughly a 33% premium, if you will, increase, additional reimbursement
for hospital-based versus ambulatory center-based reimbursement from Medicare.
We’ve been trying to evaluate that for our strategic planning. That’s our best
thinking on it, our interpretation right now.
Ms. Brenda Grant:
I have an additional comment.
I’d be concerned leaving here today with the perception that the quality in
ambulatory surgery centers is higher overall than in hospital-based ambulatory
surgery centers or outpatient surgery. I think it’s dependent on the hospital.
I know that we’re involved in surgical care improvement processes and really [inaudible] in a lot of those quality
issues as our other hospitals in
Ms. Sonia Chambers:
I actually, in my completely
non-scientific review of the literature, I think there are studies that go both
ways and I think it partly depends on the services and the facility, but I have
seen studies that certainly take the position on both sides of the issue.
Ms. Debbie Hill:
I would also hate to leave
with the misconception that hospitals believe our inefficiencies should be
rewarded by keeping these services. That’s not at all what I meant to imply.
What I mean to imply is we are, by the nature of our mission and our
obligation, there to service every patient that enters through our doors or our
emergency room and we need some way to take care of those patients. Until this
country comes up with a system that takes care of everyone, we’re obligated to
care for them. We cannot choose whether or not to do a surgery if the patient
comes into the ER and needs that surgery, so that is the point I’m trying to
make, not [noise inaudible] we
should all be efficient, but we have to be able to take care of all patients
and there has to be something to offset that large majority of patients that
have no ability to pay.
Ms. Sonia Chambers:
All righty. I appreciate
everybody’s time and attention and particularly those who drove all the way
from Martinsburg to come down. I appreciate that.
Ms. Sonia Chambers:
Again, all the materials will
be available on our website, the transcript when it’s available will be on our
website, as will be all of the written comments as they come in and are
available, so I appreciate everybody’s attention and I believe we’re actually
looking at the broader issue of ambulatory care services and which ambulatory
surgery is imbedded on Monday, right?
Mr. Dayle Stepp:
Tuesday.
Ms. Sonia Chambers:
Tuesday, Tuesday, so you can
either call in or some participate for more fun and adventure. Written
comments: again, we welcome written
comments if anybody would like to and we’d like to have those within 30 days of
today, so I would appreciate that. We need to provide all of this to the
legislature before they get started in earnest. All right, thanks everybody.
END OF AUDIO