ADVOCACY SPOTLIGHT


ous at the time, but now that we have all these details nailed down, all we have to do is implement.


Q: Do you expect changes in those conditions down the line? COOPER: No, and this is based on prece- dence of other hospital CONs that were issued in the state. There tends not to be a lot of updates on CON requirements.


Is Your State Facing a Legislative Challenge?


ASCA’s State Affairs Department works with state ASC associations and industry leaders to identify and analyze critical health policy issues concerning ASCs at the state level. ASCA can help your state association tackle tough legislative issues, build broad coalitions and create relationships with state officials to accomplish your leg- islative goals. ASCA also provides a variety of resources to help state ASC associa- tions and leaders advocate more effectively for ASCs and their patients.


For more information, contact Ali Legros at alegros@ascassociation.org or 703.636.0622.


was open the entire time the appli- cation was open. The board received about 120 pages of public comments.


Q: What advice would you have for another facility in a CON state that is thinking about applying to open an ASC? COOPER: It was not immediately apparent to the regulatory board how our surgery center would fit in with new value-based payment models and the movement away from pure fee- for-service (FFS) payment. Spend time figuring out how your center will participate in accountable care orga- nizations (ACO) in the local mar- ket, bundled payments or other qual- ity programs, and be sure to explain how this will work. The ACOs are an important reform tool in some states, and Vermont happens to be one of those states. Make the case for how your ASC would fit into the reform paradigm. ASCs already are a lower- cost and more patient-centered option in the health care field. Leapfrog on


that reform paradigm and tell legisla- tors that you already do lower cost and more patient-centered work.


Q: The board made its approval contingent upon a lengthy list of conditions. What will those conditions mean for the ASC day- to-day initially and long-term? COOPER: The conditions were gen- erally in line with our expectations, so I don’t think they will materially impact our operating plans. Because it was such a lengthy approval process and we had eight rounds of questions from the board requiring clarifications on different things, we could interpret where their concerns were and where their conditions would be. So, we weren’t surprised with the conditions when they finally came out. The board wanted detailed information, such as planning around the number of desk- top computer stations that would be at the center, or the EHR system and data security measures—a lot of IT and equipment planning. It was oner-


28 ASC FOCUS OCTOBER 2017 |www.ascfocus.org


Q: Do you see your success as paving the way for more ASCs opening in Vermont? If not, why? COOPER: Most folks in the regula- tory establishment are taking a “wait and see” approach since this is the first multi-specialty ASC in the state. We will have to prove our value first, and then it might possibly be easier for oth- ers. I think it’s hard to say.


Q: What are your top three lessons learned through this process? COOPER: Get the local community involved. This was critical to our success. Always stay positive and focus on


the value to the patients. It can be a long and arduous process. Provide


evidence everything you say.


Q: What legislatively needs to change to make the environment in Vermont more hospitable for ASCs? COOPER: Vermont has among the most stringent CON requirements of any state. Legislators and regulators need to take an in-depth look at whether or not these requirements are really serving the best interests of regular Vermonters from an access to care and cost perspective. There is a real opportunity to look at the whole of the CON regime and update or change certain elements and leave oth- ers as is. I am hopeful that the regula- tors will take a more surgical approach to the whole CON regime. Massachu- setts, New York and New Hampshire are already in the process of making their CON more pro-patient. Vermont is just following the regional trend now.


that backs up


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