Hospitals sue to stop new rule

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ATLANTA --- Nearly five dozen hospitals filed suit Monday, seeking to overturn a state rule they contend is illegal and could drive many of them out of business.

Supporters of the new rule say the lawsuit's claims are flimsy and that patients will be hurt by any delays the legal maneuver causes.

The lawsuit, filed in Dougherty County Superior Court, is not a surprise. Hospitals had long threatened to sue if the Department of Community Health changed its rules to allow general surgeons to open physician-owned surgery centers without going through the state's health care planning process.

The Board of Community Health voted unanimously in mid-December to allow general surgeons to open the centers without getting a "certificate of need," which requires major medical facilities and some outpatient surgery centers to show before they open that the services they provide are needed in an area.

The certification process is designed to ensure there will be enough customers for each facility to break even while charging reasonable fees.

Under the new rule, general surgeons, who focus on abdominal surgeries, are classified as a "single specialty."

Single-specialty surgery centers that are located in a doctor's office are exempt from the state's certificate of need laws.

The hospitals argue that a series of court rulings in recent years have held that the General Assembly never intended general surgeons to classify for the exemption, leaving the department powerless to change the rule.

"As the Department of Community Health and its board members know full well, the new general surgery rule flies in the face of multiple court decisions and is a naked and illegal attempt to override the will of the General Assembly of Georgia," said Monty Veazey, the president of the Georgia Alliance of Community Hospitals, in a statement issued by the alliance. "DCH has been publicly and repeatedly advised by its own legal counsel -- the state attorney general -- that it lacks the authority to make this rule change."

The alliance filed the lawsuit on behalf of its 59 members, including MCG Health Inc. and University Health Care System, both in Augusta, and Wayne Memorial Hospital in Waynesboro.

Hospitals say the rule change would prompt some general surgeons to refer patients with private insurance, who are usually more profitable, to their own surgery centers while sending less profitable Medicaid and self-paying customers to the hospital for care.

Supporters of the rule contend the courts were only upholding the department's rule at the time -- which did not include an exemption for general surgeons -- and the agency is free to change the rule at any time.

"We still believe the Department of Community Health has the ability to change a rule that they make, and that's the bottom line," said Kathy Browning, the executive director of the Georgia Society of General Surgeons, which pushed for the change. She also said that patients would be hurt by the legal maneuvering.

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patriciathomas
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patriciathomas 01/01/08 - 08:18 am
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Using the courts instead of

Using the courts instead of the market place to decide demand. This always causes hardship for the masses.

getagrip
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getagrip 01/01/08 - 12:10 pm
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The Dept. of Community Health

The Dept. of Community Health covers most state employees and local board of educations for their health coverage. As a member of the SHBP I certainly would prefer the option to have surgery performed in a hospital rather than a clinic type operation. I would be extremely disappointed if that option was taken away. We all seem to pay more for less.

LaTwon
1
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LaTwon 01/01/08 - 12:28 pm
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all the hospitals need to do

all the hospitals need to do is hunker down and refuse to see medicare and medicaid patients if this passes. dont let these
interest cherry pick their good paying patients and dump the losers (financially) on our already stressed public system. trinity is set up this way. the surgeons take their good paying patients there and dump the care and caid and uninsured patients on ones they have no financial interest in. in a typical surgeons practice 40% of his patients generate all of his profit. so if you could cut out the 60% that you break even or lose on you would work alot less, have less headaches, and make more money. you are also at a greater risk in a free standing facility should an unforseen emergency arise. where do you think these guys will dump you when that happens? call an ambulance and get this patient to the hospital.

WW1949
19
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WW1949 01/01/08 - 01:00 pm
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I would want to be in the

I would want to be in the hospital with all the other doctors where I can get help if needed. Never would I go to a clinic for major surgery.

wearefor16
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wearefor16 01/01/08 - 01:10 pm
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Not True about Trinity my

Not True about Trinity my daughter was on medicaid and gave birth at this hospital and she was treated no differently than my mother who had medicare and private ins.

tiredofit
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tiredofit 01/01/08 - 08:52 pm
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it seems our

it seems our society/politicians don't want a two tiered system but this is another example of how we are already there. Maybe we need to look at why insurance companies/medicare/medicaid can decide how much they want to pay a hospital and physicans for a surgery/care. Why is there such a difference? If the playing field were more even we would not be having these issues, including making prices fair for self-pay. Most people don't realize that if they are self pay the supposed "indigent" hospital , MCG, is actually the most expensive way to see a doctor in an outpatient facility. Meanwhile, insurance companies make huge profits and pay much less for individual bills for care. The inequities abound. What other business(and lets all agree, health care is a business or the insurance companies wouldn't have so many lobbiests in Washington) has the disadvantage of the government telling them how much they can get for a service-take it or leave it. If Medicare follows the path of Medicaid all the hard working babyboomers who helped build this country will find in their old age that doctors no longer accept Medicare because their fees are so low. A shame

The Knave
24
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The Knave 01/02/08 - 11:04 am
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As is the norm,

As is the norm, patriciathomas, the self-appointed rabid right-wing arbiter of all things political and economic, has it fundamentally wrong. The article addresses an economic issue of control of "supply," not "demand," as she says. Since "ignorance is bliss," being "marginally informed and piously convicted" must be nirvana for those in the dog pack. ---- “The illiterate of the 21st century will not be those who cannot read and write, but those who cannot learn, unlearn, and relearn” (Alvin Toffler)

skeptical
84
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skeptical 01/03/08 - 07:48 am
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The fundamental problem here

The fundamental problem here is that our state's certificate of need law is badly outdated. Certificates of need were put in place in an era when medical service payments were based on the facility's costs. Currently, payments are not related to costs, and the facility takes the risk to insure that it can provide the services at a profit. If it can, the facility flourishes. If not, it closes. Just like any other business. CON laws are used by big hospitals as a shield to protect them from more agile players in the marketplace. Such laws should be scrapped.

Why the heck do two big centers like MCG and UH belong to a community hospital alliance anyway?

katydid
0
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katydid 01/04/08 - 03:37 pm
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Why would anyone want to have

Why would anyone want to have surgery away from a hospital with all the emergency personnel and equipment readily available.
Yes, MCG may be expensive, but it is staffed by physicians with the most current medical expertise. If I ever have a medical emergency take me to MCG immediately. Often people are taken to University then have to be transferred to MCG for the expertise that is available at the Medical College.

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