The blueprint behind ASC opposition

Opposition to proposed ASCs often follows a formula: Opponents, such as hospitals, say local providers will lose employees and patients, and proponents cite a need for competition or more independent care. 

This week, the University of Iowa Health Care raised concerns over Iowa City, Iowa-based Steindler Clinic's planned $19.2 million ASC in a letter to the state. 

"With respect to (Steindler North Liberty Ambulatory Surgery Center), UIHC is concerned that the data presented to date suggest construction of six new ambulatory (operating rooms) would duplicate existing, not fully utilized space at Mercy and (the Iowa City Ambulatory Surgery Center)," the health system wrote. 

Steindler Clinic's most recent ASC application, however, says the area needs more competition and that the UIHC facility is "targeting the patient population traditionally served by the private practice community."

However, some ASCs facing opposition prevailed in recent months. 

OrthoIllinois was recently approved to develop a $14 million ASC after a yearlong battle against Beloit (Wis.) Health System. 

Plans for the ASC were initially submitted in October 2020 and drew strong opposition from Beloit Health System, the city's largest employer. The health system argued the ASC would result in "excess capacity" at nearby facilities and "divert nearly two-thirds of their patients from local community hospitals while providing little to no Medicaid services." 

OrthoIllinois later withdrew and resubmitted its application to build the ASC amid planning and zoning controversies before receiving approval Jan. 14. 

Last month, OrthoIllinois again received approval to build a $17.7 million ASC in Elgin, Ill., despite opposition from Advocate Sherman Hospital, who said an ASC they had received a permit for five years ago but hadn't started building would be hurt by the OrthoIllinois facility.

Even when these ASCs receive approval, some hospitals double down on their opposition. In August, West Des Moines, Iowa-based UnityPoint Health filed a lawsuit to block a large physician group from opening two cardiac catheterization labs in its ASC after it received a certificate of need. 

UnityPoint argued a recent decline in case volume, excess cardiac catheterization services in the area and the revenue shift away from the hospital as reasons the new labs should not be approved.

The opposition will likely continue as surgeries migrate to ASCs and hospitals hit hard by the pandemic attempt to keep high-paying procedures inpatient.

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