Letters: Ambulatory surgery centers aren't getting a break on regulation

Your otherwise informative article about UnitedHealthcare’s decision to reduce costs by requiring greater use of ambulatory surgery centers was marred by perpetuating a myth that ASCs are less regulated than hospital outpatient departments. Not true.

For example, the CMS regulatory requirements for ASCs largely mirror those for hospital outpatient departments—one reason why it was has been so easy over the years for hospitals to purchase surgery centers and relicense them as hospital outpatient departments in a matter of days.

The reason that ASCs report on only four quality measures to the CMS is that the CMS suspended four other measures (on such important subjects as wrong-site surgery, patient falls, patient burns and hospital transfers) last year because ASCs were performing so well that the agency couldn’t justify requiring further data collection.

The ASC community strongly supports reinstating those measures and adding new measures to that system that would allow for meaningful comparisons across sites of service.

William Prentice
CEO
Ambulatory Surgery Center Association

The article “Independent hospitals hold their own on revenue growth” was informative, but not surprising. It noted that revenue at independent hospitals grew at a faster pace than health system-owned hospitals, suggesting that returns may be diminishing on mergers and acquisitions.

As a former vice president of acquisitions for a major for-profit chain, I know that not all acquisitions are based on rational decisionmaking. Human emotions and motivations are always in play, although in theory they shouldn’t be.

Hospital system leaders, who are directly compensated on the basis of successful acquisitions, sometimes tend to be more optimistic in their financial projections than is warranted.

Also, a hospital system may want to reduce competition or acquire a hospital due to its reputation. For all these reasons, these acquisitions may take a while to be as profitable as predicted. Or they might never pan out.

As for economies of scale, there are two key aspects: supplies, pharmaceuticals and capital equipment; and personnel. With the rise of group purchasing organizations, even smaller hospitals can get excellent prices if they’re fully committed. As for staffing, many facilities are already relatively efficient compared with what they were decades ago. It’s just harder to squeeze out more overhead, especially related to patient care.

The bottom line for systems is to know why they are acquiring a facility and how it fits with the organization’s vision. And make sure that economic assumptions driving the break-even analysis are accurate and unemotional.

Jack Bernard
Peachtree City, Ga.