AHA deplores migration to outpatient centers
'A biased attempt to protect the hospitals' turf'
A July report from the American Hospital Association (AHA) regarding the shift of care to nonhospital settings1 brought strong reaction from FASA, which said the association is playing "the blame game."
The AHA report says the migration of cases might be harmful to the entire health care system. "Physician ownership of ASCs and in-office imaging equipment not only sets up financial incentives for physicians to increase utilization but also encourages the steering of patients by acuity and payer, directing the more complex, costly and less well-insured patients to hospitals," the association says.1
The loss of electives cases presents "a financial challenge" for hospitals, which need to provide a wide range of services, including emergency services, the report says. "Ironically, ASCs rely on but generally don't support the emergency standby capabilities of hospitals," the AHA says.1 The report goes on to say, "ASC patients suffering from complications can appear in a hospital ED with no warning call, no medical history, no operative report, no information on the anesthesia used, and often no ability to reach the ASC's surgeon for consultation."
In its report, the AHA said "the potential for increased service use due to supply-induced and/or physician-induced demand — particularly in self-referral situations — has some payers concerned that the shift in care is driving overall costs for outpatient services up, not down. In addition, as the procedures performed in these settings have become more complex, patient safety and quality have come into question."
The AHA says that 37 states have some certificate of need (CON) oversight in place for hospitals, but this oversight often is not in place for other ambulatory settings. ASCs are more common in states that have minimal or no CON oversight, the AHA says.
The AHA report raises a set of policy questions, which includes:
- Is the public aware of differences in certification and quality standards across settings of care including hospitals, ASCs, and physician offices?
- Should ASCs be required to disclose the limitations of their service capabilities to patients?
Also, in the area of post-surgical recovery care centers, the AHA says that if those centers "in essence are providing hospital-type inpatient care, should they also meet hospital-level standards of inpatient care?" Hospital postoperative units are more likely to be better equipped to handle complications from surgical procedures, the report maintains.
The AHA report also had several sets of reports, including:
- "Medicare's standards for ASCs and physicians offices fall short of those required for hospitals" "while states' licensing requirements vary in filling in the gaps," "as do accreditation requirements."
- "Few states regulate surgeries performed in physician offices" followed by "and for those that do, regulation is variable."
- "ASCs treat a less complex mix of Medicare patients . . ." followed by "and ASCs treat a smaller portion of low-income patients."
Kathy Bryant, executive vice president of FASA, said in a released statement that the AHA is sending the wrong message to consumers.2 "Instead of empowering consumers to make their own health care decisions, the AHA is confusing Americans with biased reports, skewed rhetoric, and misplaced arguments that put preserving hospitals' market share above the needs of patients," she said.
The report is a "biased attempt to influence legislators to enact protective legislation," she said. "From the introduction to the policy questions raised at the end, the report demonstrates exactly what it is — a biased attempt to protect the hospitals' turf by throwing allegations at those winning the competition battle through better service, better outcomes, and better prices."
Bryant found it ironic that the report raises quality and safety concerns at ASCs "when data shows that ASCs are safe or safer than hospitals," she said. Bryant quoted the CDC's estimate that 2 million patients a year acquire hospital-related infections that result in 90,000 deaths. "Nearly 90% of ASCs report three or fewer infections per 1,000 patient encounters," she said. "Yet, the AHA alleges that there are higher standards in hospitals because they are required to have an infection control bureaucrat."
Bryant said another misleading section of the report is the part that discusses the tripling of Medicare payments to ASCs between 2001 and 2004. "The reality is that had those procedures been performed in hospitals, Medicare expenditures would have increased far more," she said. Research indicates that on average, outpatient procedures would cost $320 more per procedure at a hospital than at an ASC, Bryant says. [For more information on hospital-provided and ASC care, see highlights of a recent Medicare Payment Advisory Commission (MedPAC) report.]
References
- American Hospital Association. Trendwatch July 2006. The Migration of Care to Non-hospital Settings: Have Regulatory Structures Kept Pace with Changes in Care Delivery? Accessed at http://www.aha.org/aha/trendwatch/2006/twjuly2006migration.pdf.
- Federated Ambulatory Surgery Association. AHA Attempts To Mislead Policy Makers with Flawed Report Statement: Kathy Bryant, FASA President.
You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
- Award-winning Medical Content
- Latest Advances & Development in Medicine
- Unbiased Content