As president of the American Association of Ambulatory Surgery Centers, I am confronted on a daily basis with the barrage of legislative, regulatory and legal issues impacting the ASC industry. These threats have recently been gathering like so many storm clouds above our industry. Depending on the prevailing political climate, these clouds have the potential to coalesce into a powerful force that could wreak untold devastation across the landscape of ambulatory surgery.

All at once, it seems, an alarming number of Federal agencies are critically examining many aspects of our facilities. A recent MedPAC report recommends a cut in the payment rates for ASC services that exceed hospital outpatient rates for comparable services. MedPAC also recommends that Congress eliminate entirely the Cost of Living Adjustments for fiscal year 2004.

The Office of Inspector General (OIG) jumped into the reimbursement fray with its own equally arbitrary proposed reimbursement reductions. OIG extended MedPAC's initiative to suggest lowering hospital rates to ASC levels in those instances where they exceed ASC rates. OIG is also scrutinizing the cost of intraocular lenses, physician investment in ASCs and complimentary local transportation. It's difficult to imagine that there are no more pressing issues confronting the legal arm of our Federal government than a van full of senior citizens en route to an ophthalmologist.

As both a physician and as a member of the ASC community, these examinations, regulations and restrictions are bewildering and offensive. ASCs have historically provided a unique environment where physicians, nurses and other practitioners could combine their talents to deliver exemplary patient care. I seriously question the logic behind an approved procedure list based on a bureaucratic actuarial analysis. This restriction bears absolutely no relationship to where, and under what conditions, we can best meet the needs of our patients.

Just as abhorrent is the practice by hospitals of economic credentialing and the Byzantine Stark and Safe Harbor Regulations that deprive me and my fellow physicians of our right to invest our own money as we see fit. I find it demeaning and insulting that our government has become less an advocate for quality patient care than an interference in the patient-physician relationship.

As discouraged as I am about the demonization of our industry, I am optimistic about its future. That's because we've succeeded where it counts, in creating a platform for better patient care. And that is what provides a ray of sunshine amidst the darkening regulatory sky - the knowledge that together we provide our patients some shelter from the storm.