House Passes Bill to Expand Hours at Outpatient Surgery Centers

An amendment to HB 4020 also restores a policy thought to be killed earlier this session -- requiring hospitals to issue copies of their financial assistance policies to patients.

The Oregon Ambulatory Surgery Center Association appears poised to get a big win in the 2018 session, as legislation allowing centers to keep patients overnight heads for passage after a years-long fight.

An amendment included in House Bill 4020 also resurrects a policy pushed by Portland Democratic Rep. Mitch Greenlick to improve the transparency of hospital charity care policies.

The House of Representatives unanimously passed House Bill 4020 on Thursday, sending it to the Senate for a final vote. The Senate followed Friday with unanimous approval.

“More and more surgeries could be produced in these settings -- with good outcomes and cost savings for patients,” said Rep. Rob Nosse, D-Portland,

New statutes would restrict where these “extended-stay centers” can be located to protect low-margin rural hospitals from competition. Centers could keep patients for up to 48 hours and would need to have an agreement with a nearby hospital to admit patients in case of an emergency. Ambulatory surgery centers that wished to provide extended stays would have to be under operation for two years.

“We want a clear track record of safe operating procedures,” said Doug Riggs, the lobbyist for the Oregon Ambulatory Surgery Center Association. “Oregon has very high standards for ambulatory surgery centers and we wanted to maintain that.”

The 2017 bill capped the number of extended-stay centers that could be opened and required that a fixed proportion be owned by hospital systems. Those restrictions were tossed in the 2018 bill.

Resistance from the Oregon Association of Hospitals and Health Systems has waned over the years as these outpatient surgery centers have become a growth area for the big hospital systems. Providence, Legacy and Kaiser now all have their own, and PeaceHealth partners with ambulatory surgery centers as part of its menu of care offerings for patients.

Patients wouldn’t see the longer hours immediately -- a rulemaking process with the Oregon Health Authority would get underway for the rest of the year and centers couldn’t apply until January. Riggs said no centers would likely extend their hours until fall 2019.

OHA would likely submit a waiver to the Centers for Medicare & Medicaid Services to get payment for the extended hours approved for the Oregon Health Plan. Since private insurers often follow the lead of Medicare, they may bluff at paying ambulatory surgery centers more than they currently do -- but Riggs said the longer hours would allow the facilities to offer their services to more patients, particularly those with higher acuities because of age, hypertension or diabetes.

Under the charity care policy, hospitals will have to post signage and provide copies of their charity care policies to patients, and the hospital association will work with OHA to develop a common form for all hospitals to use by 2020. This provision was slipped into HB 4020 through an amendment from Sen. Betsy Johnson, D-Scappoose, closely mirroring a bill that Greenlick killed because of lack of support from the Oregon hospital association. Under the radar and without public comment, it was revived and added to this bill.

“They came back to me and said, ‘We made a mistake,’” explained Greenlick.

Andy Van Pelt, executive vice president of the hospital association, said the association changed its mind and sought out the amendment to ensure its patients were given clarity. "We don't want any patients in need to find there are barriers to receiving financial assistance. All hospitals in the state offer financial assistance, and we need to be sure everyone who qualifies is getting it," he said. 

Greenlick said that the bill was only a start toward improving hospital charity care practices. He plans to introduce legislation next year creating minimum standards and amounts of money the hospitals must give to charity in order to continue their tax-exempt status. “We’re gonna go back to that,” he said.

Reach Chris Gray at [email protected].

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