Delaware Health Resources Board
Ambulatory Surgery Center Task Force

December 2005

Delaware Health Resources Board
Ambulatory Surgery Center Task Force
December 13, 2005
2:00 – 4:00 p.m.
Conference Room at Smyrna Welcome Center
5500 North DuPont Highway
Smyrna, Delaware

Meeting Summary

Background

Suzanne Raab-Long provided background information regarding the formation of the task force. Key points:

• Increase/proliferation in the number of applications from Ambulatory Surgery Centers (ASCs) in the past 3-4 years
• Six month Board moratorium on new applications from ASCs instituted in June 2005; goal was to provide time to identify factors that should be considered during Board review
• 2.75% charity care condition on CPR for Freestanding ASCs; goal was to “level the playing fields” between not-for-profit hospitals and for-profit ASC
• Guiding principles in Health Resources Plan reliance on market forces instituted; compromise with Delaware Health Care Commission in 1995 to prevent CON sunset

Research

• Ms. Raab-Long shared that 27 states have CPR/CON like programs
• Information on other states’ programs being collected for development of summary
• Most literature focuses on impact on hospital finances; ASCs in-house lab and other ancillary services removes services profitable to hospitals
• Other impact area: hospital staffing; difficult to compete with ASCs

Discussion/Comments

• Presumed societal savings of ASCs; is it being realized?
• Hospital hours offer flexibility that ASC cannot
• Is guiding principle #6 (market forces and competition) in the Health Resources Management Plan still valid in today’s environment, or should it be revisited?
  • Inserted in the Plan as a result of compromise with Delaware Health Care Commission
  • DHCC reviewed CON in 1995 and concluded the program should expire; not all Board members agreed
  • Question whether market forces are as effective to assuring access to quality cost-effective in today’s environment as they were 10 years ago when managed competition (managed care) was more prevalent.
• Concern about physician self-referral to ASC\
• Quality concern: Physician-owner in an ASC may use less expensive, which sometimes may translate to lower quality, implants/devices when performing surgery in an ASC they have ownership in than they would if performing the same surgery in a hospital.
• Thomas Mulhern shared that generally 1,000 patients per operating room per year is required to “break even.” This figure used to be lower, but has increased in part due to increases in the cost of resources (salaries) and decreases in reimbursements from insurers.
• Many ASCs in New Castle County are just over the break-even point. If an ASC fails, how should the damage to the general public/community gauged. Or, is the development of a Freestanding ASC purely a business decision and the damage resulting from failure solely or primarily borne by the investors?
• Medicare payment differential, that results in ASC payments differing for same procedures performed in the hospital
• Consideration should be given to “weighted” application review criteria

Next Steps

• Start a running list of issues outside the purview of CPR, for discussion in more appropriate venues
• Invited Judy Zumbo, Office of health Facilities Licensing and Certification, to the next meeting
• Provide a summary of ASC credentialing/accrediting bodies
• Distribute Health Resources Management Plan to task force members

Next Meeting

• Chairperson and staff will work with Judy Zumbo to establish a date for the next meeting.