ALTERNATIVE FACILITIES: New “Mini-Hospital” Raises Hackles
A Louisiana surgeon and entrepreneur is producing the test case for a year-old state law that permits a "basic health care facility." This new type of health care facility is "a cross between a day surgery center and a recovery care center" where simple surgeries can be performed and patients can stay for up to 72 hours. Dr. Joseph Bellina, who is building the $5 million facility that is expected to open in October, says he plans to charge 15% to 30% less than area hospitals. Louisiana's new law may be the first in the nation to "marry treatment and recovery into a single institutional license." The special license will not require Bellina to provide "costly" emergency or intensive care or to have a 24-hour laboratory. Bellina said he will not treat Medicare patients, thus "removing the need to meet many costly accreditation standards."
Bellina's planned facility has "infuriated local and state hospital groups and attracted interest from outside Louisiana." Many hospitals contend that Bellina should not be permitted to run a "mini-hospital" without meeting the "proper" requirements. "This is stuff that's not even recognized by HCFA," said Dino Paternostro of the Metropolitan Hospital Council of New Orleans. Clark Cosse of the Louisiana Hospital Association said, "You can't have half a hospital. Either you do it all the way or not at all. And if you don't have the mandated levels of care to stay open 24 hours a day, the patient will be in danger." Bellina says he will transfer any patients who experience postoperative complications to an area hospital. Hospitals also fear Bellina's facility will siphon off their self-paying and privately insured patients. People who are admitted for less than 72 hours make up "two-thirds of hospital business," according to Cosse.
Will The New Breed Take Off?
Mary Grealy, senior Washington counsel for the American Hospital Association, predicted that new centers like these will not become "huge players" in the health care market because hospitals already provide similar services, such as skilled nursing and sub-acute care. "It's a niche of a niche market," she said. But Mark Mayo, executive director of the Illinois Freestanding Surgery Center Association, believes the trend will grow. Illinois already grants a special license to allow recovery centers to keep patients up to 72 hours under special circumstances. Mayo added that "Texas, Connecticut, Missouri and Arizona grant similar licenses."
But whether Bellina will get to open the facility remains to be seen. The state Department of Health and Hospitals "will not license any new facility until a committee draws up appropriate regulations." Because the committee is composed largely of hospital interests, Rene Rosenson, administrator for the new facility, expects the committee will delay production of the regulations (McGinn, American Medical News, 8/3 issue).