[T]he Legislature’s ongoing effort to regulate independent surgical centers may again be headed for controversy.
House Health Care Committee members on Friday discussed several proposals – including a provider tax and Green Mountain Care Board budget review – that have spurred protest from surgery center administrators in the past.
The provider tax was suggested by Rep. Ben Jickling, I-Randolph and a member of the board that oversees Gifford Medical Center. In a debate that frequently has pitted hospitals against surgery centers, the tax could be an issue.
But Jickling said he sees no conflict in his role in the debate. And he said the committee is doing its due diligence in determining how to best handle an entity that’s currently unregulated.
“We are approaching it with open minds and considering what type of regulation is appropriate for a new type of health care provider in the state,” he said.
While independent ambulatory surgical centers are common in other states, Vermont has only one – an eye surgery center in South Burlington. A second, Green Mountain Surgery Center, is expected to open later this year in Colchester.
Still, the two centers have generated an outsize amount of acrimony. While surgical center advocates say they can offer lower prices and better accessibility than hospitals, some hospital leaders say the centers are unnecessary and will negatively impact their budgets.
The Green Mountain Surgery Center received state approval in 2017. But the facility’s functions are still in dispute, as hospitals are fighting the center’s plans to add ophthalmology and plastic surgery procedures.
Additionally, lawmakers’ attempts to license and regulate ambulatory surgical centers have been fraught with complications. A bill last year in the Senate rankled surgery centers and eventually died in committee.
It appeared that a regulatory compromise was in the works earlier this session with S.73, which passed the Senate last month.
But House Health Care members now are exploring ways to beef up that bill. They’re using the Green Mountain Care Board’s certificate of need for the Green Mountain Surgery Center as a frame of reference.
“The question is, are there conditions here that would apply to ambulatory surgery centers generally – or that should apply – and that we would want to continue beyond the end of any particular (certificate of need),” said Rep. Bill Lippert, D-Hinesburg and the committee’s chair.
Committee discussions on Friday included issues such as price transparency and federal certification requirements that may be imposed on ambulatory surgery centers.
Two other proposals that may be more contentious are not in Green Mountain Surgery Center’s state permit. Rather, they are concepts that were explored – and hotly debated – in last year’s Senate bill.
Rep. Lori Houghton, D-Essex Junction and the committee’s ranking member, said she’s interested in having the Green Mountain Care Board review and approve ambulatory surgical center budgets.
She noted that the care board already approves hospital and accountable care organization budgets. Surgical centers are “one more piece of our health care system that I think should be looked at,” Houghton said.
Care board budget review likely would carry an additional price for surgery centers via the “billback” function, in which the regulated entity is charged a certain amount to support the board’s activities.
Houghton suggested that care board budget review could be delayed for a few years to allow the board enough time “to come up with the appropriate process specific to (ambulatory surgery centers) and the appropriate billback.”
Her proposal won favor with a few other committee members. Rep. Woody Page, R-Newport, said he’s “not a fan of the Green Mountain Care Board.” But in terms of health care regulation, Page said he’s in favor of “fairness and equality across the board.”
Jickling also floated a provider tax proposal, though he said the idea wasn’t his alone.
The provider tax was a point of contention last year, when the manager of Green Mountain Surgery Center said a 6 percent tax – the same rate that’s paid by hospitals – could financially cripple her organization.
Jickling said Vermont imposes provider taxes “on many different types of health care organizations in the state.” In addition to hospitals, a 2017 report shows provider taxes levied on nursing homes, home health, intermediate care facilities, pharmacies and ambulance services.
Jickling also told the committee that “other states, as they’ve seen other ambulatory surgical centers come into their market, have (imposed) similar provider taxes.”
In a later interview, Jickling said he didn’t see his membership on Gifford Health Care’s board as a potential conflict in the provider tax discussion. Gifford Health Care is the parent organization of Gifford Medical Center.
Noting Gifford’s distance from Green Mountain Surgery Center’s planned home in Colchester, Jickling said it would be a different matter if he were affiliated with Northwestern Medical Center or University of Vermont Medical Center – the two hospitals closest to the surgical center.
“Gifford Health Care doesn’t really have a problem with the ambulatory surgical centers, and whether they’re regulated or how they’re regulated really has zero impact for them in Randolph,” Jickling said.
At some point, an ambulatory surgical center could set up shop much closer to Gifford. But Jickling said that shouldn’t stop him from participating in the current debate.
“If, in every issue that we talked about, we were precluded by some theoretical occurrence down the line, that would really change the dynamic,” he said.
The Health Care Committee is expected to hear testimony from both ambulatory surgical centers next week as members consider possible amendments to S.73.
“I’m looking forward to having a frank discussion with them and their representatives about where they fit in our health care landscape,” Jickling said.
