General surgeons push for outpatient centers

ATLANTA - The state could increase access to health care and cut medical bills by making it easier for general surgeons to open outpatient centers, two prominent surgeons told a study commission on Monday.

But some members of the panel said lifting restrictions on so-called "ambulatory surgical centers'' would hit already struggling community hospitals with a loss of business, threatening health care across rural Georgia.

The State Commission on the Efficacy of CON was created by the General Assembly this year to consider whether Georgia should change or even scrap altogether its Certificate of Need law regulating the number of hospitals and other health care facilities.

About three dozen states have CON laws, which require applicants to demonstrate to health planning officials that a need exists for a planned facility in their community.

Georgia's law exempts ambulatory surgical centers practicing a single specialty, which allows them to receive construction approvals without going through the CON process.

However, regulations accompanying the state law define general surgery as a multiple specialty, thus, it doesn't qualify for the exemption.

Monday, two general surgeons testified that national and state medical experts have long considered general surgery to be a single specialty, like orthopedics, plastic surgery and


"Georgia is the only state that says we are multiple specialists,'' said Dr. Chris Smith, a physician with Albany Surgical PC and president of the Georgia chapter of the Society of General Surgeons. "We think (it is) grossly unfair.''

Smith, whose medical practice's application for a CON was denied, said the state should be encouraging ambulatory surgical centers rather than making it difficult for them to set up shop. He said they lower costs for patients and insurers by offering surgical alternatives that don't involve hospital admissions or overnight stays.

Dr. Thomas Gadacz, a general surgeon from Columbia County and longtime professor at the Medical College of Georgia, said the CON law as it is currently being applied is hurting the state's ability to recruit and retain general surgeons at a time when their numbers are declining.

"To have general surgeons available, you have to have attractive places for being general surgeons,'' said Gadacz, also a governor with the American College of Surgeons' Georgia chapter.

But commission member Dan Maddock, a community hospital administrator from Hawkinsville, said not enough studies have been done to show how allowing ambulatory surgical centers to proliferate would affect the bottom lines of small hospitals.

Anecdotally, however, Maddock said his hospital - Taylor Regional - lost 70 percent of its cataract surgery business when an outpatient center opened in his community.

Joseph "Rusty'' Ross of Savannah, another member of the commission, said it's difficult for hospitals - with their huge overhead expenses - to compete with ambulatory surgical centers.

"When a surgical center opens down the street from us, it takes business out our door, and that's a problem,'' said Ross, general counsel at Memorial Health University Medical


Maddock also questioned how indigent patients would get health care if ambulatory surgical centers are allowed to run rural hospitals out of business. The CON law requires hospitals - but not surgical centers - to care for the indigent.

But Smith said Albany Surgical has agreed to provide indigent care if the state allows it to open a center.

The commission has plenty of time left to hash out such complicated issues. The law that created the panel gave it two years to make its