Iowa Senate likely to axe special legislation for C.R. ophthalmologist

DES MOINES - Special legislation the Iowa House approved to benefit a Cedar Rapids ophthalmologist likely will be axed when the Senate takes up the health and human services budget.

“There's no support” according to Senate Health and Human Services Appropriations Subcommittee Chairman Jack Hatch, D-Des Moines, for an amendment to let Lee Birchansky circumvent the state certificate of need process. The process, for more than a decade, has blocked Birchansky's plans to operate surgical suites adjacent to his Cedar Rapids office.

Hatch called it a case of lawmakers trying to pick winners and losers. House Speaker Kraig Paulsen, R-Hiawatha, called it a matter of fairness.

Birchansky, who has given more than $18,000 to both Republican and Democratic candidates in recent years, has been denied approval of a certificate of need four times since 1996. In one case, he unsuccessfully appealed to the Iowa Supreme Court.

The amendment, approved 55-39 on a party line vote by the House with the specific support of Paulsen, would allow Birchansky to perform eye surgeries, such as cataract removal, at his office at Fox Eye Laser & Cosmetic Institute, 1136 H Ave. NE.

Pauslen's support won't be enough to win Senate approval, Hatch said.

“I know the Speaker wants it, but there's no support over here from the Cedar Rapids delegation,” Hatch said. Birchansky “has gone through the certificate of need process. He lost. Now he's mad.”

Sen. Wally Horn, D-Cedar Rapids, who like Hatch supported Birchansky's 2008 application to the Health Facilities Council, said he would defer to Hatch on whether the amendment would become part of the $1.6 billion health and human services budget.

Paulsen, who has received more than $4,000 in campaign contributions from Birchansky, defended the legislation as an opportunity to save taxpayers' money. He said Birchansky can perform cataract surgery more cheaply than local hospitals Mercy Medical Center and St Luke's. That means lower Medicaid costs to the state, Paulsen said.

Birchansky, who has practiced in Cedar Rapids for 21 years, performed the common cataract procedure in his office estimates for three years. He estimates saving his patients and Medicare $3 million in that time. The savings, spread over 2,143 patients, are from the $1,000 to $4,000 in facility fees that hospitals and outpatient, or ambulatory surgical centers, collect, he said.

The purpose of the certificate of need process is to avoid unnecessary duplication of services and to control medical costs. In this case, Birchansky said, the certificate of need is doing the opposite, creating a monopoly for larger institutes.