State legislatures are considering a host of measures that would make it tougher — or easier — for doctors to perform surgery outside of their specialties, including in their offices.
Only 20 states require doctors doing surgery in their offices to have facilities that are licensed or accredited, according to the American Association for Accreditation of Ambulatory Surgical Facilities. Los Angeles plastic surgeon and AAAASF President-elect Geoffrey Keyes says licensing or accreditation helps ensure there is adequate emergency equipment and procedures and that doctors are properly trained in what they are doing.
But some doctors say it's too costly and restricts available care for needy patients.
Legislators are also increasingly grappling with "scope of practice" issues, which involve ways medical professionals want to expand what they are allowed to do.
It includes anything from OB/GYNs doing cosmetic surgery to optometrists who want to do cataract surgery to pharmacists seeking to expand the vaccines they can give.
Iowa state Sen. Jeff Danielson, a Democrat who chairs the State Government committee, says about a third of his time is spent weighing issues involving medical professionals wanting to expand what they can do. At least 10 bills in Florida involve scope of practice issues.
"As insurance reimbursements go down and physicians' overhead goes up, they're trying to find new ways to meet their economic needs," says Florida state Sen. Eleanor Sobel, a Democrat who is vice chair of the Senate Health Regulations panel. "But they're not necessarily qualified to do what they're doing."
New Jersey state legislators are deciding whether offices where doctors perform surgery should be licensed or accredited. Democratic state Rep. Herb Conaway says he sponsored the House version of the bill in part because of data showing many office-based facilities didn't have proper emergency equipment.
· Chiropractors in Florida are fighting to be able to provide medical clearance for young athletes to return to sports fields after concussions. Their opposition to a bill that would allow only doctors to grant clearance scuttled the bill last year.
· Iowa legislators are considering whether outpatient surgery facilities should have to be licensed and accredited as hospitals are.
· Dentists trained as oral surgeons could perform cosmetic surgery in New York under a measure reintroduced in that state legislature.
Conaway, an internal medicine doctor and lawyer, says accreditation or licensing of office surgery facilities is a matter of safety: "Who would have thought two years ago that someone would attempt to do breast augmentation in their office? Now we're hearing about those procedures being done."