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. That was the word from industry officials speaking earlier this month 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 association, said the hospital industry is lumping ASCs together with specialty surgical hospitals, laboratories and other non-hospital healthcare organizations 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, 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 temporarily 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 AHA'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 exemption 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, more rigorous licensure requirements, a South Carolina moratorium on new ASCs and a New Jersey tax on ASC procedures cited as examples.
Romansky said ASC owners need to launch a counteroffensive by supporting the association's write-in campaigns and political action committee, along with their state ASC organizations.
Making personal contact with public officials will help, too, said Colorado state Rep. Debbie Stafford.
She advised ASC owners to focus on members of their state legislature's healthcare committees because other legislators will look to them for leadership on healthcare issues.
Rob Schwartz, executive director of the Colorado Ambulatory Surgery Center Association and a director of the national group, 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 partnerships with small-business owners, making the case that ASCs are a good value in terms of quality and cost.