MONTPELIER — At the Senate Health and Welfare Committee, senators took testimony regarding whether to impose additional taxes and regulations for independent health care providers that aim to provide more affordable care than their hospital counterparts.
S.278 sponsored by state Sen. Claire Ayer, D-Addison, proposes to establish a regulatory framework for ambulatory surgical centers. The Vermont Eye Surgery and Laser Center in South Burlington, and the yet-to-open Green Mountain Surgery Center in Colchester, are the only two centers the measure would affect.
On Thursday, representatives from each testified on how overregulation will overburden their ability to function. Testimony that day included written comments from William Prentice, CEO of the Ambulatory Surgery Center Association, which represents the interests of the two providers.
“Many of the provisions outlined in S.278 are more limiting than federal regulations. We believe … Vermont would become the most restrictive state for ASCs in the entire country,” he stated.
“In order to participate in the Medicare program, ASCs are required to meet certain conditions set by the federal government to ensure that the facility is operated in a manner that assures the safety of patients and the quality of services.”
Jessica Holmes, a member of the Green Mountain Care Board, told the committee that there is a national trend away from independent practices towards to the public sector. She cited a 40 percent market shift from private sector to public since the 1980s. Also, since 2012, the number of physicians identifying as independents has fallen from half to one-third.
“Both national and here in Vermont, more providers are choosing employment in hospital systems rather than practice independently,” Holmes said.
The result is more concentrated healthcare systems centered around big hospitals, with full or partial control of other smaller healthcare centers within the region. Holmes said such an industry shift has its pros and cons.
“There’s potential for higher prices and a more concentrated market,” she said. “But there’s also the potential for greater care coordination and cost savings through economies of scale.”
According to Holmes, surveys of independent and public physicians found the top threats to their practices are over-regulation, healthcare payment reforms and low Medicaid reimbursements.
Sen. Ann Cummings, D-Washington, said the two private centers emerged in Vermont because they can offer care at lower costs than hospitals. She appeared to agree that too much regulation might raise costs and undercut the purpose of the new centers.
“If we do to them what we have done to everybody else, which is to make it so they have to hire new people to comply with our requirements, we are impacting that benefit,” she said.
On the regulation side, David Herlihy, executive director of the Vermont Board of Medical Practice, said affordability is important, but so is safety. His organization is responsible for issuing licenses and certifications to physician assistants, allopathic physicians, podiatrists, anesthesiologist assistants and radiologist assistants.
“I think they look at safety and they ask, ‘Is this applicant, is it going to be good from an economic standpoint and are they going to provide safe care?'”
Herlihy added while he generally supports S.278, it might go a bit too far. “I think there are a lot of things in the bill that go way beyond what is required of the hospitals, from a regulation point of view.”
Devon Green, vice president of government relations for Vermont Association of Hospitals and Health Systems, spoke to why her organization is in favor of the measure. She said there are two primary philosophies that states can take for health care, which are to treat it as a commodity or to treat it as a public good.
“Those states that treat it as a commodity, they generally have a hands-off approach to regulation and that can sometimes lead to competition, but in the world of health care that sometimes leads to an increase in overall costs,” she said.
Green said Vermont needs to focus on the public good, and said the creation of the Green Mountain Care Board was based on this notion as well.
“[We need] to put emphasis on providing Vermonters with quality care while reducing the total cost of care,” she said.