Legislation Would Allow Patients to Stay Two Nights at Surgery Centers

The Oregon Ambulatory Surgery Center Association is likely to win approval of legislation that will allow patients to extend their stay while recovering from surgery. The association overcame opposition from hospital systems such as Providence Health & Services, which has invested in ambulatory surgery centers as a way to lower costs, improve care and reduce the need for larger facilities.

Ambulatory surgery centers could become a more attractive option for Oregon consumers if new legislation gets passed, allowing them to recuperate at the clinics for up to 48 hours after admission.

House Bill 2664 would limit the number of “extended care” or “convalescent care” centers to 16 for the first five years and require them to share data with the Oregon Health Authority to track costs and outcomes.

“Healthcare reform will drive patients into settings that are more cost effective,” Doug Riggs, the lobbyist for the Oregon Ambulatory Surgery Association, told The Lund Report. Allowing patients to stay a night or two at these outpatient clinics would align with the goals of the Triple Aim by providing high-quality care that improves the patient experience, reducing the need for them to head to big hospitals and mix with sick patients, who could carry communicable diseases, such as C. diff.

“The infection rate at these centers is very low,” he added, with rates of facility-acquired infections at less than 0.004% of patients in data reported since 2014.

The Oregon Ambulatory Surgery Association had previously put forth legislation similar to HB 2664, but faced opposition from the Oregon Association of Hospitals and Health Systems, whose members would lose business to the smaller clinics if surgery patients could check into the ASCs instead of a hospital.

But now Providence Health & Services has partnered with five ASCs and has negotiated with the Ambulatory Surgery Association to reach agreement on amendments, under a workgroup authorized by Rep. Mitch Greenlick, D-Portland.

“We are very confident that the compromise that we reached will pass this session,” said Riggs. “We’ve made significant concessions to get on the same page.”

Dr. Tom Lorish, the director of orthopedics and ambulatory surgery centers at Providence, said that proper utilization of these speciality clinics could help the health system reduce the need to build more hospitals.

“Providence views ASC extended care centers as a way to further improve the delivery of care and reduce cost – and done correctly, these new centers will not act as a threat to hospitals, but enable patients to be seen in the right setting – reserving hospital care for the sickest and most vulnerable patients,” Lorish wrote in his testimony.

The bill has broad bipartisan and bicameral support, with as many Republican sponsors as Democratic ones, including Rep. Knute Buehler, R-Bend, an orthopedic surgeon. The other chief sponsors are Rep. Rob Nosse, D-Portland, Rep. John Lively, D-Springfield, and Sen. Laurie Monnes Anderson, D-Gresham.

Riggs said that expanding services at ASCs would align with the direction of reform by the Centers for Medicare & Medicaid Services, which approved outpatient clinics for surgery for Medicare patients in 1980. He was optimistic that their increased use would be an area of common ground with the new Secretary of Health & Human Services, Dr. Tom Price, himself an orthopedic surgeon.

Five states already allow extended stays at ambulatory surgery centers, most notably Colorado. Despite a larger population than Oregon, and no caps on the number of extended-care centers, Riggs said Colorado has just 13 ambulatory surgery centers where patients are admitted for multiple-night stays. While his organization has interest from roughly that many centers, there may not be the demand for the full 16 centers as allowed in the pilot project.

Under the compromise, at least half of the extended-care centers would be affiliated with a hospital system, while at least five and no more than eight could be independent ambulatory surgery centers.

Chris can be reached at chris@thelundreport.org.