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Reworked Bill Would Apply Same Standards to Single-Room Surgeries and ASCs

Vitale says he has eliminated taxation issue that sank earlier measure.

Credit: Amanda Brown
State Sen. Joseph F. Vitale (D-Middlesex), chairman of the Senate health committee.

State Sen. Joseph F. Vitale (D-Middlesex) is reworking his bill to bring single-room surgeries in doctors' offices up to the same standards as multiroom ambulatory surgery centers. His original measure, which was pocket-vetoed by Gov. Chris Christie in the final legislative session, proposed that the state Health Department license and inspect one-room surgeries, just as it does with ASCs, but the department objected that the provision to exempt single-room surgeries from the state tax on ASCs ran afoul of federal regulations

Vitale said he is optimistic that his new bill will eliminate the taxation issue, while creating a level playing field where oversight of patient safety is uniform, whether surgery takes place in an ASC or in a doctor's office.

Currently, single-room surgeries fall under the state Board of Medical Examiners, which oversees surgeons, but they are not inspected as often as ASCs. Vitale said his new bill retains Board of Medical Examiners oversight, but the one-room practices would be required to pay a fee to cover the cost of inspecting them every two years, like ASCs. He said the board would outsource the inspections to a recognized accrediting group, and the bill would not create a new expense for state government.

Vitale said that because the one-room surgeries won't be licensed by the Health Department or called "ambulatory surgery centers," they should not have to pay the ASC tax. The Medical Society of New Jersey and other physician groups support Vitale's plan to heighten scrutiny of single-room surgeries, but objected to paying the ASC tax of 2.95 percent tax on ambulatory centers with more than $300,000 a year in revenue. The tax collects about $16 million a year.

The new version of the bill is not yet final, and Vitale said he expects to hold a hearing when the Legislature returns in the fall from its summer recess. "We have to hammer out final details with the Board of Medical Examiners, to make sure they have the capacity to operationalize this program, and I believe they will." He added that he wants to be sure the board "understands what we want to do, and they are comfortable with the way we are proposing it."

The patient safety issues raised by having two different inspection standards were highlighted in a 2011 report by the New Jersey Health Care Quality Institute. The institute reviewed 91 inspections by the Health Department, in 2009 and 2010, half of which were one-room surgeries and the other half were ASCs. The study found that 45 percent of the one-room surgeries were noncompliant with serious safety requirements, compared with 15 percent of the multiroom ASCs.

Larry Trenk, president of the New Jersey Association of Ambulatory Surgery Centers, said his group is advocating for uniform standards for all surgical facilities. "We don't want two sets of standards," he said.

Jeffrey Shanton, chair of the advocacy and legislative affairs committee for the New Jersey Association of Ambulatory Surgery Centers, said he has met with the state Health Department to discuss possible legislation to create one standard for all venues. He said health plans are moving in the direction of requiring their members have surgery in facilities that meet a higher standard. Cigna spokesman Mark Slitt said the company's standard plan requires surgery to be performed at a licensed facility.

Shanton said that unless a level playing field is created by new regulations, one-room facilities are likely to close because they won't qualify for reimbursement by insurance plans. According to the state Health Department, New Jersey has 177 single-room surgical practices and 149 multiroom ASCs. Shanton noted that both create revenue for the state and provide high-paying jobs.

Vitale said the same complicated, invasive procedures are done in both ASCs and single-room surgeries "and the health and safety and well-being of patients are paramount, and the same standards should apply. If you go in for an invasive procedure, you should know that the inspections were conducted, and the room is safe and clean, and that the best practices are employed across the board."

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