Over the past five decades, as America’s for-profit health care system continues to seek ways to minimize costs and maximize profits, same-day “surgery centers” have proliferated. They are great for the corporate bottom line, but are exacting a heavy toll in lives; results of an investigation by Kaiser Health News revealed that over 260 patients since 2013 have died unnecessarily after undergoing “minor” procedures in surgery centers. In the state of Florida alone, there were 335 incidents of life-threatening or fatal complications among patients in surgery centers during that time period. Despite the serious safety questions that are being raised, however, use of surgery centers continues to expand – and lawmakers across the country are doing very little to regulate them.
The investigation was carried out by journalists in six states across the country as well as Washington D.C. who examined thousands of state and Medicare records and conducted hundreds of interviews with doctors, patients, and health policy experts. What they found constitutes nothing less than gross incompetence, largely due to cost-cutting measures.
In a number of cases, surgery centers fail to provide proper training for personnel. In one reported case, a surgical center nurse was forced to call 911 when a patient developed a life-threatening condition commonly associated with her procedure – because nobody else on duty knew how to handle the situation. Shockingly, this is not unusual. A number of surgery centers have come under fire for being short on emergency equipment and having workers who are poorly trained in emergency life-saving techniques.
Surgery centers also face accusations of failure to recognize (or even disregarding) underlying health risks in patients who should undergo their procedures in a fully-staffed and equipped hospital. Under Medicare regulations, surgery centers are required to have ready access to a hospital in case of emergencies. However, it can take as long as thirty minutes for EMTs to arrive, even when a hospital is nearby. In rural communities that are more than 15 miles from the nearest hospital, this can be an especially serious problem.
One troubling aspect of this issue is the financial incentive for doctors that encourage them to perform high-risk surgeries in such facilities. Physicians who own a share of the center receive part of the facility’s fee as well as their own payments for services rendered. At the same time, insurance companies prefer to have surgeries performed at these centers because of lower costs. Currently, surgery centers receive over $4 billion a year from the Medicaid program.
Unfortunately, lawmakers are dragging their heels when it comes to addressing the problems with surgery centers, of which approximately 5,600 are currently in operation across the country. In Vermont, a bill to regulate and tax surgery centers was soundly defeated by the state senate. In 2010, the state of New Jersey placed a moratorium on the construction of new surgery centers. Thanks to a bill signed by former Governor Chris Christie, all surgery centers will be subject to new, more stringent licensing requirements from the state Department of Health (formerly, they were licensed by the medical licensing board).
It should be noted that most surgery centers do an excellent job when it comes to minor procedures, However, the industry is still poorly-regulated – and as long as profit is a consideration, risks to patients will remain.