Even at their inception half a century ago, anti-competitive certificate of need (CON) laws relied on controversial economic theories to justify their existence. As skeptics predicted, the promise that intentionally restricting the number of healthcare providers would lead to more, better, and cheaper health care never came to fruition. And since then, changes in payment reimbursement structures and care delivery methods have obliterated remaining arguments supporting the legislation.
This especially applies to CON regulations in 23 states that restrict ambulatory surgical centers (ASCs). The novel facilities played only a minor part in the healthcare system when CON legislation originated in 1964, so regulations throttling them went unnoticed by most patients. However, these convenient and cost-efficient centers now play a vital role, becoming, for many patients, a preferred location for surgery.
The first ASC opened in 1970 and performed just five surgeries on its first day; currently, 11,521 ASCs perform more than 23 million surgeries per year—roughly half of total surgeries—despite the protectionist legal hurdles they face. Allowing hospital associations and other parties with conflicts of interest to limit new ASCs deprives patients and providers of this invaluable resource.
Time
An entire ASC is often designed for specific surgeries, enabling it to cut unrelated red tape required in a general hospital. The team members have unique functions they perform together repeatedly. So it comes as no surprise that ASCs complete surgeries more than 30 minutes faster on average than a hospital, with quality and outcomes equal to or superior to those of similar hospital patients undergoing similar procedures.
In addition, travel contributes greatly to time spent on surgery, and ASCs relieve this burden. For example, California has only 353 hospitals spread over its 155,000 sq. mi. But it has 1,218 ASCs, enabling patients to reach a surgeon more quickly. Because California does not have CON laws, ASCs can proliferate as needed.
Cost
Reducing surgery time reduces cost, since many team members are paid by the hour. It also reduces facility overhead costs. But the financial efficiency extends further than these obvious benefits.
Medicare pays an ASC a mere 58% of what it pays a regular hospital for the same procedure, due to the ASC’s lower operating costs. Taxpayers could potentially save a staggering $5 billion annually by pivoting Medicare funding to ASCs. However, this is difficult to achieve unless current CON laws are abolished.
Patient Satisfaction
ASCs have proven their merit in time, safety, and cost. They relieve pressure on an overburdened healthcare structure by efficiently utilizing personnel and funding. The only remaining question determining their need is whether patients are happy once they use them.
And patients have indicated that they are indeed satisfied with ASC care. A comprehensive study by The Leapfrog Group, a watchdog organization devoted to healthcare industry transparency and safety, found that ASCs rated at least somewhat higher with patients than did hospitals in all poll categories, with 87.6% of the ASC patients willing to recommend their facility to loved ones, compared to 82.1% of hospital patients. ASC releases also reported a better understanding of their post-surgical instructions, indicating a superior experience from start to finish.
Let The Market Decide
ASCs meet the same safety criteria as hospitals. They fill a long-empty void in health care. They offer convenience, comfort, and cost control. Most importantly, they increase options for surgical patients, who are the only people who should decide where they can receive their medical care. CON laws, propped up by hospitals that do not want competition, need to go the way of any other useless healthcare relic.