Faced with a deluge of opposition from angry doctors and health maintenance organizations, a state planning panel yesterday scrapped the idea of a six-month moratorium on new outpatient surgery centers.
The chairman of the Maryland Health Resources Planning Commission, Marcia G. Pines, said its decision was not a signal to health care providers to flood the panel with applications to open the freestanding centers.
If they do, she said, the planning staff would be unable to focus on the topic that prompted the proposed ban -- the financial impact of such centers on traditional providers and the need to devise a new health care delivery system in Maryland.
A subcommittee of the panel voted Jan. 28 to recommend the six-month ban while the commission studies alternative-site medical services and whether and how these should be regulated.
The unanimous vote against the moratorium yesterday followed an energetic 10-day campaign by the state's medical society and others who said the ban would interfere with physicians' practice, hurt consumers and work counter to the planners' goals -- reduced cost and good service.
Hospitals had sought the ban, saying the freestanding outpatient centers are luring patients and leaving them to absorb the cost for care of the uninsured.
However, doctors argued that the battle so far has centered on insured patients from relatively affluent areas in Baltimore and Montgomery counties.
How charity care should be paid for and whether independent centers should treat some of the uninsured is one of the issues the planning panel will consider.
The ban was bitterly opposed in part because it comes at a time when health care providers are setting up and marketing new systems, including outpatient centers, to managed-care companies. The marketplace is changing so rapidly that providers who don't move now could find themselves without patients or places to practice six months from now.
Many insurance companies, for instance, are negotiating directly for patient care with freestanding centers, which are generally cheaper and more efficient than hospital outpatient facilities.
Representatives of the state health maintenance organization industry and Cigna Health Plan spoke against the ban yesterday.
"We want to be sure the state does not inhibit the development of lower-cost alternatives," said Pamela S. Metz, spokeswoman for the Maryland Association of Health Maintenance Organizations.
Rhonda Anderson, speaking for St. Agnes Hospital, said the ban was warranted by what she said was growing duplication of services that would raise costs for everybody.
The movement of patients to alternative medical providers has created a whole system of care outside the regulatory system, which governs only hospitals -- the traditional providers. Because hospitals' rates are set by the state, they aren't free to make their own deals or cut rates in exchange for volume.
Larry Lawrence, senior vice president of the Maryland Hospital Association, said the moratorium made sense to prevent the proliferation of such facilities, "which might be counter to the findings of the study." He called for a "well-funded and well-organized" study of the issues surrounding the growth of such centers.