Emboldened by their success in harassing physician-owned surgical hospitals, lobbyists for acute-care hospitals now pose the greatest threat to physician ownership of ambulatory surgery centers, an ASC trade group leader said today.
David Shapiro, M.D., president of the American Association of Ambulatory Surgery Centers, told attendees at the 25th annual AAASC convention in Orlando, Fla., that ASC owners need to get active politically and be alert to assaults from hospital competitors at both the federal and state levels. Shapiro is the senior vice president of medical affairs for Surgis, a Nashville developer of ASCs.
As recent examples of what he likened to a coming hurricane of hostility, Shapiro cited the economic credentialing actions taken by hospitals in Ohio, Idaho, Arkansas and elsewhere against physician owners of competing facilities. These challenges are "occurring with alarming frequency, and, as yet, without judicial interference," he said.
Hospitals also will use certificate of need laws, where applicable, to derail or delay ASC development at the state level, Shapiro said.
He also warned that ASCs could have their Medicare exemptions from Stark laws banning self-referrals as well their safe harbors from anti-kickback provisions challenged by the hospital lobby. A warning shot was the hospital-inspired rollback of those protections for physician-owned specialty hospitals under the Medicare Prescription Drug, Improvement and Modernization Act of 2003.
"A victory by the hospital lobby could empower them to wage war against ASCs," Shapiro says. "These (Stark and anti-kickback) exemptions can as easily be taken away as they have been granted."
Mike Romansky, an attorney with McDermott, Will & Emery and a lobbyist for the AAASC, said a little paranoia by ASC owners isn't a bad thing these days.
"Just because you're paranoid doesn't mean they're not trying to screw you," Romansky said. "The hospital industry is doing just that right now. Their number-one goal in the (Medicare) bill that was just passed was the elimination of surgical hospitals.
"You're going to need to respond to that," Romansky said, referring to ASCs as "cousins" of surgical hospitals.
Even with upward of 3,000 to 4,000 ASCs in operation, compared with the size and the power of the hospital industry, ASCs "are the flea on the elephant's back," Romansky said.
Right now, MedPAC, the federal agency that advises Congress on Medicare issues, is looking at physician self-referral as an issue with ASCs, Romansky said. He said he doesn't think ASCs will lose their safe harbors -- he gave that dire consequence a 10% chance of happening. But, Romansky warned, that was the same chance he gave hospitals of getting a moratorium passed on Medicare payments to surgical hospitals. President Bush signed that moratorium into law in December.
"If all of you don't get off your butts and help us with our lobbying campaign, we're going to get killed," Romansky said with a laugh. "This year, I mean it."