More doctors plan independent centers


March 08, 1994|By Patricia Meisol | Patricia Meisol,Sun Staff Writer

A growing number of Maryland doctors have announced intentions to open their own office-based centers for endoscopy and other medical procedures used in their specialty.

The reason is that insurance companies are directing care away from more expensive hospitals, and doctors who don't have an alternative service center lined up could find themselves dropped by many health insurers.

In the past two months, about 35 doctors or groups of doctors have applied for exemptions from state regulations in order to conduct procedures in their offices that can be performed without anesthesia or a sterilized environment.

Many of the procedures were limited to the operating room until advanced gadgetry, often some combination of lasers, cameras, and long tubes, made it possible to enter and work in the body without drawing blood.

The applicants include a vascular surgeon, three ophthalmologists, a gynecologist, three urologists, four podiatrists, some plastic surgeons, some ear, nose and throat specialists, and 10 gastroenterology practices. In contrast, there are only two independent GI centers now open.

Some of the applicants want to open two, three and even five "Medicare-certified" centers where they and their colleagues can collect professional fees and be paid for the use of their facilities and equipment by the federal government.

They are hoping to contract directly with insurance companies for patients, and they promise rates far cheaper than those charged by hospitals.

But others don't have an immediate plan, state records show. They just want to preserve the option to open such centers in the future in the face of renewed efforts by hospitals to ban any more doctors from moving their "operations" from the hospital to their own offices.

Right now, doctors who perform medical procedures in their offices are exempt from state regulation as long as what they do is not surgery and doesn't involve more than four suites or procedure rooms.

In such cases, doctors need only ask for an exemption from state rules governing ambulatory surgery centers. That's what the 35 or so doctor groups are doing.

The influx of new applicants comes after the doctors beat back a proposal by the state Health Resources Planning Commission to ban any more centers for a year.

Hospitals had argued that the centers were unfairly competing for paying patients.

The ban was dropped when the hospitals couldn't prove they were losing patients and revenues -- their numbers turned out to be guesses. Also, doctors and health maintenance organizations had condemned the ban as anti-competitive and anti-democratic.

The health planning agency is trying to determine how such centers affect hospitals before it suggests ways to regulate them.

Unwilling to wait for this study, the Maryland Hospital Association moved its battle elsewhere -- the General Assembly.

Several proposed bills would impose an 18-month moratorium on independent, doctor-run centers. Existing centers and those in the pipeline would be exempt from the ban. The impact: Doctors with existing centers or letters in hand would have a monopoly on the managed-care business in their specialty.

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