More than most states, Maryland has been successful in containing the ever-rising costs of hospital care. Through a system of sharing the burden of paying for indigent care -- and paying for the essential and expensive role of teaching hospitals -- Marylanders as a group have avoided the skyrocketing costs that have plagued other states.
But the uncontrolled growth of free-standing, unlicensed surgery clinics poses a danger. While these centers provide lower costs and greater convenience and comfort for many patients, they draw business away from hospitals -- especially patients with health insurance coverage. These centers skim off increasing numbers of paying customers that hospitals depend on to compensate for uninsured patients and for the educational expenses incurred by the state's teaching hospitals.
That poses a risk to the state's cost containment program, and to the stability of teaching hospitals. Legislators in Annapolis have sent to summer study measures that would require these centers to share in the costs of hospital care for the indigent and to spread the burdens involved in graduate medical education. Not surprisingly, cost-sharing was bitterly contested by surgery centers, insurers and many doctors, since the added expenses and paperwork would cut into the competitive edge these centers enjoy. Even so, some form of cost-sharing is necessary if Maryland is to continue its system of hospital cost containment, as well as its tradition of leadership in medical education.
Aside from cost-sharing, surgical centers enjoy another exception that does not apply to hospitals. Except for the state's malpractice laws, they are exempt from regulation. They do not have to go through Maryland's existing "certificate of need" process, which is designed to control the number and location of health care facilities. Legislation subjecting them to that oversight has passed both houses, and legislators are now ironing out differences between the two versions.
Free-standing surgery centers still would enjoy some advantages over hospitals. Many patients find them friendlier, more efficient and convenient places for simple surgical procedures, regardless of cost. That can be a powerful marketing tool. Regulating these centers, and requiring them to be part of the same big-picture planning process as hospitals, is a reasonable expectation -- one that serves a greater good.