asc management
We Struggle to Obtain a CON
Efforts to get a Certificate of Need for our ASC encounter obstacles, but unexpected help arrives.

By Larry Patterson, M.D., and Ray Mays

I apologize to those of you who don't have the "privilege" of operating in a state that requires a Certificate of Need (CON) to open an ASC. This month's article, which will focus on our efforts to obtain a CON, is primarily for those of you who are so privileged.

The process of receiving a CON was the most frustrating part of our 2-year ASC experience. At times, we questioned our sanity for trying to proceed. We experienced firsthand the inefficiency and apathy of government, and the absolute disregard for our time and money.

Hurry Up and Wait

In Tennessee, the CON board meets every month in Nashville, with the exception of June and July. For us to be heard at the August 2000 meeting, we had to have a complete package submitted and received by the end of May.

We began the process the first week of April by meeting with our architect and attorney. At this meeting, we received the first of what turned out to be numerous ridiculous surprises. We learned that in order to apply, we had to own -- or have an option to purchase -- the property on which the ASC would be built. We went ahead and bought the property with the idea being that if we were denied, we would at least own a piece of land. We proceeded with the application process, hand-carrying the completed forms to Nashville to verify that they had been received.

We received notification a few weeks later that we had been placed on the August schedule and needed to arrive at 8 a.m.

At the hearing room, we saw at least 100 people who apparently were all there for the same purpose. We were then given an "order of appearance" for the hearings. As one of the last applicants on the schedule, we wound up sitting around all day. This was frustrating enough, but we had the attorney and the architect with us, both of them charging by the hour.

Late that afternoon, we were informed that the board wouldn't be able to get to us, and that we would be rescheduled in October.

Another Roadblock Looms

The day before our October hearing date, we learned that our local hospital would oppose our request. We became truly concerned that the hospital would derail our plans.

Fate stepped in disguised as Steve Sheppard, an ASC consultant for the Medical Consulting Group. Steve made the presentation for an ophthalmology group in a similar-sized community as ours in which the hospital was supporting the request for an ophthalmic surgery center. Between Steve and the hospital administrator, the board heard a brilliant essay on the future of ophthalmic reimbursements and the rationale for "farming out" procedures such as cataract and YAG to ASCs because hospitals were losing money on these procedures.

Our attorney changed our presentation on the spot by telling the board that since our presentation was exactly like the previous case, he would like to ask the hospital to offer its objections. When the hospital finished its statement, one of the board members asked if the reimbursement for ophthalmic procedures was different in our town from the last hospital. When the hospital said "no," the hearing was over and we received a unanimous vote in favor of granting our request.

The board attached a few stipulations to our request that required us to return in December of that year for final approval. In the end, we were approved and were able to proceed. Our "lesson learned" from this experience was that we were glad we only had to go through it once.

Next month, we'll get started on describing the actual construction phase of the ASC.

Larry Patterson, M.D., is practice owner, and Ray Mays is practice administrator of Eye Centers of Tennessee, a general ophthalmology practice serving 300,000 residents of middle and east Tennessee. You can reach Ray Mays at raym@ecotn.com.