TWO NEW SURGERY CENTERS PLANNED; ONE APPROVED, ANOTHER PROPOSED

Two new surgery centers are in the works for Cape Girardeau.

Dr. William Kapp III, an orthopedist, has issued a letter of intent to apply for a certificate of need to build a $5.4 million ambulatory surgery center.

And the Missouri Department of Health has given the go-ahead to the Silver Springs Surgery Center LLC.

Robert L. Bauer, president of the Silver Springs center, said the center should be operational next year.

Plans now call for the center to handle plastic surgery procedures and "possibly dental-type procedures," Bauer said.

"We're still really in the planning stages," Bauer said. "With the support that we have, we feel that there's more than enough demand in the community."

Bauer's center, because it didn't meet the minimum expenditure requirements set by the state, didn't have to go through the full certificate of need review process, said Donna Schuessler, a certificate of need specialist with the state health department.

To receive a full review, which applies to new construction, expansion or the purchase of major equipment, applicants must spend at least $1 million.

Under a full review, a committee of health-care experts, legislators and others determine whether the expenditure is justified or if there is a need for the facility or equipment in the community, Schuessler said.

In the case of Kapp's Mississippi Valley Surgery Center, "They'll have to justify a need for it, and we'll take into consideration all of the existing operating rooms in the community, whether in an ambulatory or a hospital setting," she said.

Kapp's letter of intent describes the facility as containing six operating rooms.

Kapp has not yet filed for a certificate of need for the facility and, under state regulations, can't file for the certificate before July 2.

The earliest it could come before the state for review would be Sept. 14, Schuessler said.

Opponents of the applications can register their opposition with the state.

James Sexton, president and chief executive officer of St. Francis Medical Center, and Jim Wente, administrator of Southeast Missouri Hospital, said they weren't familiar enough with Kapp's plans to comment.

The state is seeing more certificate of need applications for ambulatory surgery centers, Schuessler said. In Missouri, there are 40 licensed ambulatory surgery centers, according to state records.

Cape Girardeau now has three free-standing ambulatory surgery centers: Doctors Park Surgery Center, the Outpatient Surgery Center and HealthSouth Surgery Center of Cape Girardeau.

And Southeast Missouri Hospital and St. Francis Medical Center both provide outpatient surgery services. At Southeast, more than 4,000 outpatient surgical procedures were performed in 1997. St. Francis performed approximately 5,000 outpatient procedures last year.

Nurse Dottie Worley, director of surgical services at St. Francis Medical Center, said there are pros and cons for patients undergoing outpatient surgery at a free-standing ambulatory surgery center rather than at a hospital.

Full-service hospitals are better-equipped to handle emergency cases if something goes wrong during an outpatient procedure, Worley said.

"I guess where I see the benefit to patients of an outpatient procedure at a hospital is, if you plan your procedure outpatient and there is a need for some reason to stay, all of the services that you need are right here," she said.

And hospital surgical teams are more experienced in dealing with both acute and less serious cases, Worley said.

Nationally, more than 5 million surgical procedures are performed at more than 2,400 free-standing surgery centers, according to the Federated Ambulatory Surgery Association.

More and more free-standing surgery centers have popped up around the country since the 1970s as part of the move to contain health-care costs.

Ambulatory surgery centers can offer surgical services more cheaply than full-service hospitals because they have lower overhead costs -- including the facilities, personnel and unreimbursed care costs that hospitals must pay.

But that difference in cost is also taken into account as the state reviews surgery center applications, said Tom Piper, who directs the state's certificate of need program.

Piper said he thinks the state is seeing more ambulatory surgery centers start up because they make money.

"We're seeing investment groups set up by physicians who can set up a limited liability corporation or something like that and compete directly on the managed care market against hospitals," he said.

Physicians can make more money by running their own surgery centers than by affiliating with hospitals, Piper said.

"It will save money out of the right-hand pocket, but we are concerned about the left-hand pocket because, if the hospital does not have the revenue to cover the capacity they already have, that means raising rates somewhere else," he said.

There could be an argument that free-standing surgery centers wind up costing the community more -- because both the hospital and the surgery centers have to be supported, Piper said, and the surgery centers don't replace any of the services offered by the hospitals.

"The hospital still has to be there 24 hours a day. The emergency room has to be there 24 hours a day," he said. "So we're not sure about the net effect on the community."

State health regulators are still studying how the change in the health-care marketplace will affect consumers, Piper said.

"Admittedly, we have more questions than answers," he said. "Just trying to figure out the revenue stream of one versus another is difficult at best."