[A]fter a legislative battle ended in a stalemate last year, state officials appear to have found a compromise for regulating a relatively new type of surgical center.
A Senate bill, S.73, and a new report from a study group propose that Vermont should license and regulate independent ambulatory surgical centers for the first time.
But the regulations are much different from rules proposed in 2018, and they have earned the endorsement of a leader in the development of what will be Vermont’s second independent surgical facility.
“It’s in line with what other states do,” said Amy Cooper, manager of the Green Mountain Surgery Center, which is expected to open this year in Colchester.
Independent ambulatory surgical centers — which offer outpatient services and are not affiliated with a hospital — are common across the country but are still rare in Vermont. The only facility currently operating in the state is the South Burlington-based Vermont Eye Surgery and Laser Center, which opened more than a decade ago.
But last year, ambulatory surgical centers made headlines when a proposed bill would have imposed a variety of new regulations.
Proponents of the legislation said the government has a responsibility to oversee a type of health care facility that is regulated by every state except Vermont and Wisconsin. But representatives of surgical centers said the proposal was overly burdensome and misguided.
Of particular concern was a proposed 6 percent provider tax on surgical center revenues, which Cooper said endangered the Green Mountain Surgery project.
Lawmakers nixed last year’s proposals and instead ordered a work group to look at the issue of regulating “freestanding health care facilities and their role in a coordinated and cohesive health care delivery system.”
The group is recommending that the state Health Department should license ambulatory surgical centers “to ensure they continue to meet patient safety and quality standards, and to ensure that patients … have a government authority available to receive and investigate complaints.”
S.73 takes a similar approach. The legislation says ambulatory surgical centers should operate in accordance with rules developed by the Health Department, which could deny, suspend or revoke a license if there is “substantial failure to comply.”
The bill also says the centers should be managed by a medical director who is a physician, and its nurses “shall be directed at all times by a registered nurse or advanced practice registered nurse licensed by the state.”
There’s no discussion in the bill of a provider tax, or of the Green Mountain Care Board approving a surgical center’s budget.
Also, the state’s bill of rights for hospital patients won’t apply to ambulatory surgical centers. Cooper said many of those provisions apply to longer stays, which aren’t an issue for the centers.
Cooper, who participated in the work group along with a representative of the eye surgery center, said it was important to take a closer look at regulatory questions after the 2018 debate.
“Having time to understand all the issues and having time to discuss and make recommendations was a great process, and completely different than what happened in this building last year,” she said.
Sen. Ginny Lyons, D-Chittenden and chair of the Senate Health and Welfare Committee, said the key is “not making it overly burdensome for any particular organization to be licensed, and at the same time, to ensure that patients are safe.”
The work group also recommended that regulation of freestanding birth centers “should be a topic for further regulation,” pursued separately from the surgical center issue. There are no such birth centers in Vermont at this point.
The group did not recommend any state regulation of urgent care clinics. Members wrote that “most states treat urgent care clinics as provider offices with extended hours and do not license or regulate them as entities.”
