Changes Looming For CON Process

December 16, 2005
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LANSING — It may be more difficult for ambulatory surgical centers to get a start in Michigan if changes to the state’s certificate of need (CON) process are ratified by the legislature and the governor. On Dec. 13, the CON Commission, an advisory body to the state department of community health, modified standards that govern how certificates of need are awarded to ambulatory surgery centers (alternately known as “surgicenters” or ASCs). Those changes could be implemented as soon as January, pending legislative approval.

Currently, to obtain a CON, a proposed ambulatory surgery center is required to show that it can handle at least 1,200 surgical cases each year without adversely affecting the workload of any established surgical facility. Under the revised language, the only surgeries that the practitioners can count toward that 1,200 are those performed in a licensed operating room. Leading up to the commission’s decision, CON supporters argued that under the existing language, piercing a patient’s ear could be classified as a surgical procedure by surgicenter applicants.

Julie Greene, executive director of the Grand Valley Surgical Center in Grand Rapids and current president of the Michigan Ambulatory Surgical Association, told the Business Journal that the change, on its own, is not necessarily bad. However, she believes there are other factors that favor hospitals over new surgery centers trying to enter the market. For example, for a new center to determine the need in the community, it would need access to information about surgical cases handled by existing operating rooms.

“If you say you can only use what’s done in an O.R., then I want to know what’s going on in the community. And yet there’s no requirement for timely submission of data,” she said.

Because of that loophole, Greene said that hospitals could hypothetically recognize a need and apply for a CON to resolve that need before ever releasing information on their surgical volumes to other interested parties.

In addition to tightening up the definition of what constitutes a surgical procedure, the commission also proposed “more comprehensive changes in the standards,” according to Lody Zwarensteyn, president of the Alliance for Health, an agency that oversees and makes recommendations on West Michigan CON applications. Zwarensteyn said that those changes will be opened up for public comment.

It is not currently clear what those changes may entail. The CON Commission was unable to provide the Business Journal with a copy of the proposed standards. The public hearing to discuss the revised language will be held Jan. 31 in Lansing, though the commission was unable to provide any further detail.

Meanwhile, eight proposed West Michigan ASCs have CON applications pending with the state department of community health. Several of those are scheduled for Michigan Department of Community Health decisions in January, with the remainder due in March. If these changes in CON regulations are ratified prior to the department’s decision on any of those eight applications, the applicants may be forced to reapply to meet the revised standards.    

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