Two Sides Apparent in CON Debate on Outpatient Surgical Needs
The State Certificate of Need Unit held a public information gathering session on Monday, Dec. 22 in Portland to gather, "information on the need for ambulatory surgical services in the greater Portland area." In attendance were several physicians, hospital representatives, health plan representatives and consumers organized by the Maine People's Alliance and Consumers for Affordable Healthcare. Although the meeting was not held in connection with any particular CON application, there is a current proposal by local surgeons to build a multi-specialty ASC in the Portland area and both Maine Medical Center and Mercy Hospital are expected to file applications later this year to expand their outpatient surgical capacity. The last time a similar project was proposed, it was turned down by state regulators when local hospitals opposed the project.
There is currently a one-year moratorium on acceptance of any Certificate of Need applications. The moratorium is due to expire in May. The proposal by the Portland area surgeons was filed prior to the moratorium and is not subject to it. Most of the surgeons involved in the project attended the public meeting, as did representatives of both the Maine Medical Association and the Maine Hospital Association.
Although no evidence or data was presented, several self-designated consumer representatives offered comments to the regulators opposing any increase in capacity. The one point that both hospital and physician representatives agreed upon, however, was the very real need for additional outpatient capacity in the Portland area. The difficulty of scheduling cases in the Greater Portland area was noted by virtually all of the surgeons who spoke. Many speakers noted the significant increase in the percentage of surgeries that are now done on an outpatient basis. The following additional points were made, as well:
* The significant % of patients who have a procedure done in the area but who are not residents of the immediate area. Representatives of one existing ASC noted that 40% of their patients come from beyond Cumberland and York Counties.
* The aging of the population. It was stated that Maine is the 10th oldest state in the nation, demographically.
* That in recent history, there has been virtually no growth in the capacity for outpatient services in the region.
* That in some parts of the country, 80% of surgeries are done on an outpatient basis.
* Maine has one of the lowest penetrations of ASC's in the Country. Patients in many other states have far more choices available for their surgery.
* In some instances, patients in Maine who are unable to be scheduled in a timely manner are going to Boston for their procedures.
* There is increasing demand for endoscopy services, demand that is far outstripping supply.
* One hospital representative noted that in his facility, in l995, 60% of cases were done outpatient. Now the percentage has grown to 75%.
* Outpatient capacity needs to be increased if physicians are to be successfully recruited to the area.
* A study done for the Maine Health Management Coalition showed a substantial monetary savings could be achieved by doing more sugeries in free-standing facilities.
Despite these assertions, consumer representatives continued to say they would oppose any expanded ASU development in Greater Portland. Joseph Ditre' of the Consumers for Affordable Healthcare claimed that the problem was simply one of scheduling and that his organization would continue to oppose additional capital development in this area.
Defenders of free-standing centers noted that competition could drive down costsand improve access. They noted that hospital monopolies now control access. Hospital representatives responded with their traditional allegation that the free-standing ASC's did not have 24 hour access and did not have the flexibility of full-service hospitals. Consumer representatives added their allegation that the ASC's would "cherry pick" the paying patients.
All in all, the meeting presented little real data justifying one position over another, although clearly the physicians and hospitals believe additional capacity is needed. Written comments can be submitted until Jan. 7, 2004 at 5:00pm. MMA expects to submit comments in favor of the need for more outpatient capacity and in favor of patients having a greater choice of facilities. [return to top]