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Asante and Salem Health Swoop in for Attempted Kill of ASC Expansion Bill

Despite a lengthy work group process and the support of Providence Health & Services, two major hospital systems are trying to stop ambulatory surgery centers from offering expanded hours and instead are trying to belabor the issue with yet another work group.
March 24, 2017

Salem Health and Asante Health System have made a last-ditch appeal to kill a bill to expand services at ambulatory care centers, in an apparent attempt to prevent competition.

The hospital interests worked with Rep. Cedric Hayden, R-Cottage Grove, to write an amendment to House Bill 2664 that would form yet another work group to study the issue of overnight stays at ambulatory surgery centers, after nearly four years of discussion on this topic.

“We feel strongly that this issue has not been fully vetted,” said Roy Vinyard, the president and CEO of Asante. “This extended-care center is in essence a mini-hospital.”

Salem Health’s representative, Denise Hoover, talked in circles around the need for more discussion and a broader agreement by stakeholders.

HB 2664 would allow up to 16 ambulatory surgery centers to increase the maximum allowable stay for patients from 24 to 52 hours, and let them offer more invasive surgeries that require longer recovery times, and give patients and insurers an option outside of expensive hospital operations.

The underlying bill follows a model that's been successful in Colorado.

Despite Hayden’s amendment, his fellow Republican Rep. Knute Buehler of Bend expressed frustration at the 11th-hour appeal from Salem and Asante, and what he characterized as their representatives’ anecdotal evidence of higher costs and inferior patient experience at ambulatory surgery centers.

“There are a robust amount of studies on the efficacy of ambulatory surgery centers,” to hold down costs and maintain quality, said Buehler, who works as an orthopedic surgeon in Bend when not in the Legislature.

In Colorado, charges for a knee or hip replacement at an ASC are one-half to one-quarter the cost at most hospitals and the rate of facility-acquired infections -- a serious risk at many hospitals -- is infinitesimal at ASCs.

A visibly flustered Rep. Rob Nosse, D-Portland, agreed with Buehler: “It feels like it’s not a real compromise -- it’s a stall tactic.”

“You’ve been screwing around for four years and now you want us to screw around for another four years,” added Committee Chairman, Rep. Mitch Greenlick, D-Portland.

Still, Salem Health is the largest private employer in the state’s capital city, and Hoover seemed to gain the ear of Rep. Jodi Hack, R-Salem, in opposing the bill.

The Oregon Association of Hospitals & Health Systems is also backing its members who want to kill the bill, even as Providence Health & Services, which operates its own ambulatory surgery centers, maintains its support for expanded, convalescent care at the outpatient facilities.

One criticism from the opposing hospitals and the association was that Medicare does not yet pay for extended services at ambulatory care centers.

“With the underlying bill, OAHHS questions the justification for allocating scarce state funds to a rules and licensing process that only results in new services for a commercially-insured population,” wrote hospital association vice-president Sean Kolmer.

Doug Riggs, the lobbyist for the ASCs, said that while Medicaid won’t pay for overnight stays, his members work regularly with coordinated care organizations, and would welcome taking patients who need to be at the facility for more than 24 hours, even if the centers do not get paid additional money. If the bill passes, he expects ASCs to take on more Oregon Health Plan patients, which would help CCOs reduce costs while maintaining a high quality of care.

Riggs said that while Asante and Salem Health were not on a pre-session work group that crafted HB 2664, Providence, as well as a representative of the hospital association, had been part of a work group with the Oregon Ambulatory Surgery Association to find a viable compromise.

“There were many opportunities to meet and collaborate on this bill,” said Jessica Adamson, the lobbyist for Providence.

“My job is not to keep them up-to-date. It's the association's job to keep its members up to speed,” Riggs said. “They don’t want to have a bill. … In Colorado, there’s no indication that hospitals have suffered in any way, shape or form from the existence of convalescent care centers.”

Chris can be reached at [email protected].

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