Right now, most Georgia physicians have to get a Certificate of Need (CON) from the state if they want to open an independent ambulatory surgery center. But if they get their way, all of that will change in 2007 when a committee studying the state's CON process makes its recommendations. Georgia's surgeons are up at arms, in part, because their specialty doesn't qualify for an exception to CON rules known as a letter of non-renewability (LNR), which allows for new centers but generally proves much easier to get than a CON. Right now, some "single specialty" centers, run by, for example, orthopedists and plastic surgeons, quality for an LNR. But general surgeons specifically do not qualify, a fact which so upset the American College of Surgeons that it boycotted Georgia as host state for its conventions.
The committee is reviewing relevant data to determine whether the CON process works, and is due to report on its findings next year. Some public health observers suggest that if the state drops the CON requirement, mortality and complications rates could rise. And hospitals are strongly opposed to loosening these rules, arguing that a growing base of independent ASCs would siphon off all of the well-insured patients and leave them with too much under-compensated care to handle. Physicians, for their part, note that their services are far cheaper than those performed in hospitals.