Page 11 - April 2017 Newspaper

Three Bad Ideas

The Florida Legislature is considering three bills this session they be manufactured.
believe will increase competition and lower costs in our healthcare Third, and this keeps recurring, is the proposed expansion of
system. Their assumptions, premises and rationale, however, are not Ambulatory Surgery Centers’ (ASCs) hours of operation; letting patients
consistent with how health industry economics work. stay more than 24 hours. Currently good surgeons and well-informed
First, laboring under the false assumption that there isn’t sufficient patients make decisions about where to have an operation based on
“competition” they plan to eliminate the Certificate of Need (CON) patients’ demographics and health status, as well as the complexity of the
program. Originally crafted to assure orderly growth and develop- procedures. Hospitals, even their out-patient departments, are preferred
ment of expensive institutional medical care (hospitals, nursing site if “sleeping over” after the surgery is likely to be recommended or
homes, specialty facilities, and new technology) CONs were required required. If and when ASCs can add the “hotel” part of the episode to
to prevent unnecessary proliferation. Over the last three decades, their menu, it a) won’t be a lot less expensive, and b) won’t be a level
Florida and much of the country realized that if everyone who want- playing field for price competition. Although there is a lot of inside
ed a CON got one, the process was itself costly and time consuming. industry conversation about the need for more “site neutrality,” we’re not
What remains is minimal but has in fact slowed the progress of there yet. ASCs aren’t required to have an emergency room or to take
expanding and duplicating an already saturated supply side approach BY LINDA S. QUICK Medicaid and charity patients. Hospitals are! If and when they lose
to medical care. Unfortunately, much of the State already has an ambulatory surgery patients to ASCs, some significant revenue is lost,
excess capacity of facilities and underutilized programs. Coupled making paying for under- or un-funded care more expensive. Another
with technological and pharmacological advances, many of the current institutions example of excess capacity increasing costs, not lowering them.
aren’t anywhere near full. Prices go up to support infrastructure costs when volume Finally, to be fair, there is no question why proponents of these legislative changes
goes down. The difference is that medical care isn’t for the most part something we support them. They value competitive free markets. But if you’ve been working in
choose to use; it is something we have to have. Free market economics only work health policy and economics for any length of time, you know there is nothing “free”
when customers are freely making decisions about what to buy, when, where, and about it. As consumers we know less about how our bodies work than we do about
from whom. our cars and phones. Medicine, when you are sick, is not a choice. Even with greater
Second, the legislators seem to think that having a “trauma center” in their district transparency of prices, most of us have no idea what it should cost. Whether it is
is some kind of badge of honor. The term “practice” of medicine is not an accident; employer financed insurance or Medicare and Medicaid, there is a fiscal intermediary
the more you practice the better you get. That is why medical experts in emergency that doesn’t exist with any other purchase.
medicine have always called for a very few very sophisticated Trauma Centers among
a sea of hospital emergency rooms. The good news is truly traumatic events don’t For almost forty years, Linda Quick’s work has been at the forefront of South Florida's
happen very often. Legislation adding 12 to 14 trauma centers that are underutilized healthcare industry, serving in leadership roles in community-based health policy planning,
will raise price and jeopardize quality. Similar to the lifting of CON, this kind of hospital advocacy, the creation of hospice care, and in finding solutions for homelessness.
deregulation will have too many facilities competing for the same few real experts, She can be reached at lsquick2016@gmail.com.
who won’t want to work in low volume settings. The “need” for trauma surgery can’t

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South Florida Hospital News southfloridahospitalnews.com April 2017 11