Surgeons push outpatient centers

ATLANTA - General surgeons from across Georgia descended on the state board overseeing health policy Wednesday, asking to be treated the same as other surgical specialists.

One by one, they urged the state Board of Community Health to approve a proposal to make it easier for general surgeons to open outpatient clinics.

Freestanding outpatient surgery centers can perform the same services as hospitals at up to 40 percent less cost, Dr. Peter Meehan, an orthopedic surgeon from Atlanta, told board members during a public hearing.

"This will save money for taxpayers and individuals," he said.

At issue is a provision in Georgia's 28-year-old Certificate of Need law that defines general surgery as a multiple specialty. As a result, general surgeons wishing to open outpatient surgical centers must go through a state approval process that requires them to demonstrate a need for the services in their community.

General surgeons, backed by the influential Medical Association of Georgia, are seeking to have general surgery redefined as a single specialty, which would exempt them from CON regulations.

The proposed rule, which would make that change, will go to the board for a final vote on Dec. 13.

One of the general surgeons' key arguments is that Georgia is the only state that doesn't consider general surgery a single specialty.

Dr. Chris Smith, a general surgeon from Albany who has been trying to open an outpatient center since 1991, said that is a major reason why the current nationwide shortage of general surgeons has hit Georgia particularly hard.

Dr. Dan Hanks of Rome presented statistics showing that Georgia has only 8.4 general surgeons per 100,000 residents, well below the national rate of 12.8 per 100,000.

"All the general surgeons are asking is to be treated like all other specialists," Smith said.

But representatives of hospitals who addressed the board Wednesday warned that a proliferation of new outpatient surgical centers would draw paying patients away from hospitals, threatening their financial viability.

Jimmy Lewis, CEO of HomeTown Health Care, which represents 56 rural hospitals in Georgia, said hospitals have become more dependent in recent years on paying patients to offset declining Medicaid reimbursement rates.

"There will be a tremendous ripple when the hospitals cannot cover their costs," he said.

Unlike hospitals, physician-owned outpatient surgical centers are under no legal obligation to serve poor and uninsured patients.

But Dr. Price Corr, another general surgeon from Albany, said he and his colleagues would willingly provide indigent care.

"We don't want to take the cream from the top," he said. "We'll play by the same rules the hospitals have."

Georgia lawmakers took up a bill this year declaring general surgery a single specialty. However, it became entangled in a broader debate over CON reform and didn't pass.

The General Assembly's inaction prompted the community health board to begin pushing to accomplish the same goal through the rulemaking process.

However, the rule's opponents - citing an opinion from the attorney general's office - say board members don't have the legal authority to make the change administratively.

If the rule passes next month, a court challenge is expected.