To the editor:

The Massachusetts Department of Public Health (DPH) is currently working to codify a series of regulations that would seriously limit the ability of Massachusetts ambulatory surgery centers (ASCs), independent outpatient facilities, to provide vital procedures such as cataract surgery and colonoscopies at low cost to some of the commonwealth's most vulnerable populations.

Currently, a Medicare patient can save up to 60 percent by having one of these procedures done at a physician-owned ASC facility as opposed to a hospital. But DPH's "emergency" Determination of Need (DoN) regulations would ultimately take this low-cost, high-quality option away from patients by prohibiting ASCs from expanding facilities or services. This would perpetuate and amplify the uneven playing field between hospital outpatient facilities and ASCs in the state, resulting in increased health care costs and decreased options across Massachusetts at a time when health care is already being hotly debated nationwide.

The outdated (1994) DoN regulations are hugely inconsistent with the commonwealth's so-called "dedication" to affordable, universal health care. They were created in a time when health care was not as critical an issue as it is today, and reworking the regulations has been delayed multiple times over the past few decades as DPH task forces have struggled to define need, showing just how antiquated they truly are. As administrator of the Pioneer Valley Surgicenter in Springfield, I have seen firsthand that ASCs provide the same high-quality outpatient services as hospital-owned facilities, and at a fraction of the price. Vital cataract surgery, for example, costs only $190 at ASCs as opposed to nearly $500 at hospital-owned outpatient facilities, a savings of 61 percent, according to proposed 2012 Medicare payment rates. While hospitals in the state continue to argue that ASCs are less affordable for patients, the numbers simply speak for themselves.

The governor and other members of the Patrick administration claim that providing affordable health care is a top priority. But how can this be the case when a state agency (DPH) openly sides with politically powerful hospitals at the expense of the people of the commonwealth?

Health care is supposed to be affordable, accessible and transparent, at least according to Gov. Deval Patrick's 2011 inaugural address, traits that apply to the state's 62 ASCs, which provide the highest quality care at surprisingly manageable prices to more than 200,000 patients across Massachusetts each year.

If DPH passes the DoN regulations and ASCs are no longer able to remain competitive with hospitals in infrastructure expansions or by altering or adding services, health care costs will continue to rise for patients already struggling with expensive medical bills, which will cause more people to avoid seeking preventive procedures like colonoscopies, cataract surgery and gastrointestinal care, thereby further compounding the problem.

It is DPH's duty to protect the people of the commonwealth and their right to affordable health care. But the agency appears to have decided that it would rather perpetuate an unfair system controlled by the politically powerful at the expense of Massachusetts residents.

I urge DPH to take a closer look at the regulations it is about to pass and seriously consider how they will widely impact health care in the state. With Massachusetts' leadership position in health care reform made even more critical given the Supreme Court's ongoing policy review, it would be alarming for our leaders in state government to support a series of outdated regulations that directly contradict the very goals of cost containment, transparency and access they originally set out to achieve.

Linda Rahm


Mass. Association of Ambulatory Surgery Centers


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