Physician ownership of ambulatory surgery centers remains under attack from the hospital lobby, with state regulatory bodies and legislatures shaping up to be the new battlegrounds, according to industry officials speaking Thursday at the opening session of the American Association of Ambulatory Surgery Centers' annual meeting in Reno, Nev.
Michael Romansky, general counsel and chief lobbyist for the AAASC, said the hospital industry is lumping ASCs together with specialty surgical hospitals, labs and other nonhospital healthcare entities as "niche providers," painting them all as "scum-sucking leeches" that drain the lifeblood from established hospitals.
"It's shameful what they are doing, but they are a very, very powerful industry," Romansky said. And, he conceded, they are very effective at setting the terms of the public debate by capitalizing on long-established relationships with the media and political leaders.
He blamed the hospital lobby for the 18-month moratorium on Medicare payments to new, physician-owned specialty hospitals, in effect, eliminating their safe harbor exemption from Stark laws prohibiting physician self-referrals.
The moratorium is set to expire this summer, but the Medicare Payment Advisory Commission has recommended that it be extended and the American Hospital Association's position is that it should be made permanent. Romansky sees that action as a threat to ASCs.
"We worked hard 15 years ago to get an exemption from Stark," Romansky said. "That's a golden goose we want to protect."
And while the hospital industry says it's not interested in challenging ASCs' Stark exempton on a national level, Romansky said, "I don't know if we can afford to believe them. Our position is very simple: We're going to preserve physician ownership of ASCs. It's vital to our interests."
Overt anti-ASC activity seems to be focusing at the state level, he said, with expanded certificate-of-need reviews and more rigorous licensing requirements. He cited a South Carolina moratorium on new ASCs and a New Jersey tax on ASC procedures as examples.
Romansky said ASC owners need to launch a counteroffensive by supporting the association's political action committee financially, their state ASC organizations and AAASC write-in campaigns.
Making personal contact with public officials will help, too, said Colorado State Rep. Debbie Stafford of Aurora.
"I have experienced the lobbying effort against you," Stafford said. "We're coming up against a dinosaur system that is petrified of change. I do not believe we can allow fear to hold back the marketplace. I would encourage you to pick up the phone and contact your local representatives."
She advised ASC owners to focus on members of their state legislatures' healthcare committees because other legislators will look to them for leadership on healthcare issues. Invite committee members for a tour and be sure to buy lunch, she said.
Rob Schwartz, executive director of the Colorado Ambulatory Surgery Center Association and an AAASC director, said economic credentialing has been the "weapon of choice" for hospitals battling ASCs in his state.
Hospitals also have raised the issue of physician conflict of interest in owning an ASC and have pressed hard on the line that ASCs financially weaken hospitals and therefore jeopardize their community-service role.
To fight back, Schwartz said his association is developing partners with employers, most effectively with the small business community, in making the case that ASCs are a good value in terms of quality and cost. Recently, the organization also has developed a working relationship with Colorado's AFL-CIO, he said.
"They (hospitals) have made the case very effectively that the sky is going to fall," he said. "Are we going to be viewed as part of the problem or part of the solution?"