Surgical centers seek a level field

Free-standing surgical centers can care for patients cost-effectively, but many patients don't have the option of using them because of insurance carrier policies that have several Utah centers teetering on the brink of financial disaster, according to members of the Utah Ambulatory Surgical Center Association, which represents 18 surgery centers statewide. There are about 30 ambulatory surgery centers in Utah.

The group met with Rep. Chris Cannon, R-Utah, Friday afternoon at the Utah Surgical Center in West Valley to discuss the need for legislation that would provide equal patient access, as well as reasonable reimbursement for services.

Because of increasing costs for energy, health care and insurance, patients are looking for safe, but lower-cost options, said Doria Robinson, of UASCA. And even though 80 percent of surgeries are now done on an outpatient basis, patients have limited access to the outpatient surgical centers.

Some hospitals are actively trying to prevent their success by telling insurance companies they will no longer provide discounts if the insurance companies contract with the surgical centers, said Dr. Paul Winterton, an orthopedic surgeon, and Brian S. Berg, administrator of MountainWest Surgical Center and both members of the UASCA.

It's not an uncommon story, they said.

The association's Craig Stout of Southwest Surgery Center said the delivery of health care has changed drastically. Twenty years ago, 20 percent of surgeries were done as outpatient procedures. Now that same percentage is in-patient, with the vast majority done as outpatient, even counting those performed in hospitals.

Still, hospitals have a built-in advantage, the UASCA members said, because Medicare and Medicaid pay them 40 percent more for the same services, a benefit designed to help cover the overhead of running a hospital — overhead that's greater than that of the centers, which are much leaner in their operational costs, Berg said.

For instance, Medicare pays $1,300 for a cataract procedure at a hospital, while it pays $970 for the same procedure at a surgery center, according to Dr. Martin Brown, medical director of the association.

Hospitals also control referrals, Berg said, because most family practitioners refer to the hospitals with which they affiliate.