While it seems just about every medical association in Georgia is taking sides, participants agree that the latest fight between hospitals and physicians wont spill across state lines.
Most recently, the Georgia Hospital Association has joined the cause of the 59 not-for-profit members of the Georgia Alliance of Community Hospitals against Albany (Ga.) Surgical and the Georgia Department of Community Health who, in turn, have the support of the Medical Association of Georgia.
The dispute centers on whether general surgeonsunlike surgical specialistsneed to go through a certificate-of-need process before opening an ambulatory surgery center. On Dec. 13, 2007, the Georgia Board of Community Health freed them of this requirement by redefining general surgery as a single specialty and, on Dec. 31 of last year, the Georgia Alliance of Community Hospitals sued the board and Albany Surgicala general surgical practice that was involved in similar litigation in 2002 and has announced its intention to build an ASC.
The American Hospital Association declined to comment, saying that it was a state issue, while the American Medical Associationwhich is on record as being against requiring physician-owned ASCs to get a CONnoted that it was aware of the case and was considering lending its support. The American College of Surgeons reported that it has decided to file an amicus curiae, or friend-of-the-court brief, but it hasnt done so yet.
The medical association is also helping out financially and has set up a legal defense fund to bolster its efforts in fighting the Georgia Alliance of Community Hospitals lawsuit.
This aggressive move by hospitals against physicians must be countered, wrote Medical Association of Georgia President Jack Chapman in a fundraising letter to members. By responding to this lawsuit, MAG is not just supporting our general surgery colleagues, but is also standing up against the latest attempt by hospitals to control physicians and the practice of medicine.
In his letter, Chapman noted that he has contributed $1,000 to the fund.
For the time being and despite the level of vitriol, participants said the battle may receive national attention but it probably wont gain national significance.
This lawsuit is unique to Georgia, said Donald Palmisano Jr., general counsel for the Medical Association of Georgia. It comes down to general surgeons being treated differently than other specialists. Palmisano cited studies that found surgeons can perform the same procedures in an ASC for one-third the costs incurred in a hospital, and added that hospitals have yet to provide evidence that ASCs are causing their demise.
Theyve made the cherry-picking argument, but theyve shown no proof that a hospital is going to close because a surgeon opened an ambulatory surgical center, Palmisano said.
The medical association brief also argues that the Board of Community Health did not overstep its authority when it redefined general surgery as a single specialtyrather than a multispecialtydesignation. But in a legal opinion issued almost exactly three years ago, a Georgia senior assistant attorney general wrote that the board would be outside of its authority if it exempted general surgery practices from the CON requirements that multispecialty practices must fulfill.
Georgia Alliance of Community Hospitals attorney Leo Reichert, a partner with Atlanta-based Parker, Hudson, Rainer & Dobbs, made note of that 2005 opinion and emphasized how it stated that redefining general surgery as a single specialty is a question of statute, and any alteration of that definition requires legislative action. Reichert said general surgery includes gynecological, neurological, orthopedic, pediatric, plastic, thoracic and urological procedures. He explained that an ASC that included surgeons with those areas of expertise could look and would look like a multispecialty center and should be treated accordingly.
Theres no question that, if you allow more of these centers to pop up, it will drain away these profitable patients, Reichert said, and negatively affect a community hospitals financial ability to care for indigent, underserved and Medicare and Medicaid patients.
But he, too, believes that whatever happens with the Georgia lawsuit will stay in the Peach State. This issue is unique, Reichert said. But its probably a symptom of a common theme of physicians and hospitals trying to get proper reimbursement.