Surgery centers want slice of Medicaid pie

At half past noon two Wednesdays ago, Jase Maudsley was in the doctor's office again, in pain again and, as usual, being a little trouper. The 18-month-old was getting all kinds of attention from the adults standing around him but not giving him the one thing he wanted — juice.

He hadn't had anything to drink or eat since about 8 p.m. the night before, a fast he clearly was not happy about but one necessary prior to surgery to implant tympanostomy tubes in his eardrums.

The procedure — the most common surgical procedure performed on children age 6 months to 12 years — will relieve the extremely painful build-up of pressure in his middle ear and finally put a stop to his recurring infections and most likely the recurring visits to the doctor.

Remarkably mundane is how the doctor who performed Jase's surgery, one of about 2 million that will be performed nationwide this year, described the operation, which was observed by two Utah lawmakers.

The method used in the procedure was secondary to where it was being done to Sen. Allen Christensen, R-North Ogden, and Rep. Paul Ray, R-Clearfield. The two are sponsoring a bill yet to be debated in public but that is already causing arguments.

Ambulatory surgery centers, like the Ear, Nose and Throat Surgery Center they were visiting, would be designated contract providers reimbursed by the state Medicaid program under SB82.

But there's controversy over the bill and new estimates from the health department that expanding access to outpatient surgery might not be the value to the system the proponents claim.

"They have refigured the net increase in use and other factors, and we may be doing the opposite of saving money," Christensen said. "I'm thinking at this point we're going to end up having to set up a few year-long pilot programs to determine once and for all if the proposed amendment changes will have any effect one way or the other."

Christensen announced during a committee meeting with SB82 on the agenda that he was going to substitute his bill with pilot programs for a year, then if the pilots bear out the savings and access improvement he intends, resubmit the original bill.

Stakeholders affected directly by the shift toward surgical center expansion met with Christensen most of Friday afternoon.

The idea has met strong resistance from hospitals and insurance carriers who say the proposal is counter to the health maintenance organization agreements worked out each year that trades the promise of patients for the promise of discounts on insurance premiums.

Critics say broadening the scope of the state's 55 ambulatory surgery centers will increase the overall number of surgeries and ultimately drive up the cost of health care.