WASCA Meeting with WashingtonState Healthcare Authority

Wednesday, November 14, 2007

4:00 pm Offices of HCA

Attendees:

Steve Hill, Administrator, WashingtonState Healthcare Authority;

Dennis Martin, Director, Policy and Legislative Relations, Health Policy, R & D

Jim Jesernig, Lobbyist, WASCA

Rob Schwartz, Executive Director, WASCA

Matt Kilton, Eveia Healthcare Consulting

Wendy Taylor, Education Chair, WASCA

Following introductions, Steve Hill began the meeting by stating that he has been a patient at an ASC, having had shoulder surgery performed. He referenced a Study that indicated ASCs are driving up healthcare expenditures by affording physicians a vehicle to increase personal revenues. Mr. Hill quoted a study that claims 10% of surgical care delivered in ASC’s is evidence based, 30% is ______and 60% of ancillary services are provided without clinical justification by physicians because they maintain ownership interest in an ancillary service. Mr. Hill feels there is a high volume of ancillary services including outpatient surgery being performed that isn’t necessary, and that there are other alternatives that would be examined if physicians did not receive financial gain from an ownership in surgery centers.

At that time, Steve was asked if he determined this from data that was being published regarding imaging centers. He said yes. Further discussion revealed that the reputation for this tends to be with ancillary care that is not personally performed by a physician, like an MRI that is performed by a lower level provider, not by the physician himself. There was acknowledgement from all that this is where the concern has centered…that when physicians can earn money in other ways than by actually being with the patient one on one, that abuses of their ability to refer can occur. However, surgery is different. Profit margins on surgery centers are very low, and physicians would not risk losing their license by performing unnecessary surgery; beyond that, physicians reap much more financial reward from their surgical fee than they do from the amount they would receive from their ownership interest profit in an ASC.

Discussion continued regarding disclosure, and that physician owners of surgery centers are supportive of disclosing their ownership interests if all medical facilities must do the same. For example, hospitals are frequently owners in surgery centers or imaging centers. Hospitals also frequently own physician practices. Physicians have been disclosing ownership in surgery centers to their patients for quite some time.

Mr. Hill then asked what the HCA could do for surgery centers. Wendy Taylor stated that presently most payers are going through changes in 2008 to respond to the changes in the way CMS will be paying for ASC services. We asked to be included in stakeholder meetings and participate in how our state agencies will proceed. Mr. Hill did not see any reason why not, and is happy that surgery centers want to be part of the TAG meetings. Wendy also showed the code lists for L & I, DSHS and UMP, and stated how different they are. ASCs would like these code lists to be consistent across all State managed health plans, and expand to become inclusionary, rather than exclusionary. It is WASCAs position that a consistent, more inclusive list of codes that can be done in an ASC will enable the state managed agencies to save resources. We also noted that Doctors will not risk their licenses by performing surgery in an unsafe environment. Moreover, we noted that need to include a default rate for unlisted codes.

We feel strongly that ASCs are able to get cases scheduled more quickly, have lower infection rates, shorter recovery times, keeping costs down and getting employees back to work more quickly. This has to be a huge benefit to L & I and UMP patients. Articles were provided regarding infection control and complications from the FASA Outcomes Monitoring Project, and AARPs article on Dirty Hospitals, which relates to infections acquired in hospitals (2 million patients infected and resultant 90,000 deaths per year).

The meeting concluded with Steve Hill offering to connect WASCA to the stakeholder group that will examine ASC reimbursement.