1. New proposed regulations for the CON process from the Maryland Health Care Commission. The Maryland Health Care Commission recently released proposed changes to the certificate of need application process (pdf) requiring ASCs to provide and post a charity care policy, provide a certain percentage of charity care appropriate to its patient population, ensure each OR is filled to 80 percent capacity and invest in an EMR system, among other requirements, in order to qualify for a CON. According to Ms. Hyatt, MASA opposes the changes because of the unnecessary burden on centers. MASA also fears the changes that would apply to new centers would later be enforced for existing centers, putting extreme financial pressure on those ASCs that can’t afford to meet all the measures.
“There are a lot of regulations about the physician environment and the design requirements, detailing just what constitutes an OR versus a procedure room,” she says. “They also want doctors to justify the amount of financial resources they’re putting into a center, which we feel shouldn’t have to be justified because the finances are coming from private dollars that are already taxed.”
Ms. Hyatt says the increased regulations on charity care may have been introduced to place ASCs on the same level as hospitals, which are mandated by the state to provide a certain percentage of charity care. But enforcing the same regulations seems unfair, she says, when Maryland hospitals are reimbursed at levels higher than the national hospital average and much higher than the average for Maryland ASCs.
To combat the proposed regulations, Ms. Hyatt says MASA is drafting comments on the changes and trying to “get word out to all the centers in the state.” She says Maryland ASCs cannot afford to sit idly by while proposed regulations are made into law; instead, ASCs need to be more proactive about fighting regulatory changes from the moment they are introduced.
2. An influx of new legislators. Ms. Hyatt says Maryland will soon see an influx of “new, green” legislators who lack experience dealing with the ASC industry. She says as new legislators are introduced, MASA and all Maryland ASCs must be proactive in inviting legislators out to see the ASCs and demonstrate their value.
She says the ASC industry is lucky to have secured positions in the Maryland Health Care Commission and other state organizations, meaning industry leaders will be involved in discussions about changes through health reform. “We’ve been lucky in this state that we’ve managed to get a seat at the table in state committees,” she says. “If the hospitals have a seat at the table, we also do.”
She says as the state legislators prepare to deal with healthcare reform, Maryland ASCs must make sure their voice is heard, rather than drowned out by hospitals and the state’s two large health systems — the University of Maryland Health System and Johns Hopkins. “ASCs will find that there will be legislation against us, and you can’t wait until you get to that point because you’re already five steps behind,” she says. She encourages ASCs to hold open houses and speak with legislators as soon as possible to demonstrate the value of ASCs to Maryland healthcare.
3. Low ASC membership in the state association. One of the 10 smallest states in the country, Maryland has the third-highest concentration of ASCs in the United States, the majority containing one OR and maintaining a connection with a single physician practice, Ms. Hyatt says. Yet only 10 percent of Maryland ASCs belong to MASA, meaning the voice of the organization represents only a small percentage of the state’s centers directly. “We’re struggling with membership and in these uncertain times, membership is so much more important,” Ms. Hyatt says. “You really need to support the state and national associations. If you think you can wait until a bill is put out there and in a legislative session to start to react to it, it’s too late. You need to have a consistent voice in your state and make sure your state legislators are familiar with your industry.”
Ms. Hyatt says many ASCs are unable to pay membership dues when finances are already tight. More importantly, though, she thinks Maryland ASCs have grown too accustomed to depending on MASA to fight their battles effectively and repeal potentially harmful legislation.
“We’ve been so successful squashing legislation that would harm us that there are no alarming issues out there that [ASCs] feel a need to stand up and fight against,” she says. “I think you’ll find the more successful trade associations at this time are the ones that really have a lot of battles. It’s hard to get people to support lobbying efforts when you’re successful and you don’t have a lot of bills [to worry about].” Despite MASA’s historic success, she says ASCs need to be concerned about legislation that may come with health reform.
Learn about the Maryland Ambulatory Surgical Association.
