Cedar Rapids ophthalmologist tries again for outpatient surgery center

A Cedar Rapids ophthalmologist again will seek permission Wednesday to open an outpatient cataract surgery center, hoping new members on the State Health Facilities Council will be more empathetic to non-hospital providers.

Lee Birchansky, owner of Fox Eye Laser and Cosmetic Institute in Cedar Rapids, is asking the five-person council at a hearing in Des Moines for a certificate of need to open an outpatient surgery center next to his office on H Avenue NE.

The request - his fifth - comes a month after Birchansky and other plaintiffs teamed up with the Institute for Justice in Virginia to file a federal lawsuit alleging Iowa's process is unconstitutional.

'The certificate-of-need requirement places severe burdens on medical entrepreneurs in Iowa, requiring a difficult and time-consuming application process that offers no reliable way to predict whether a certificate will actually be granted to any given applicant,” the lawsuit asserts. 'And the program exists for no reason beyond protecting established businesses from competition.”

Five Eastern Iowa hospitals or hospital-affiliated surgery centers have written letters opposing Birchansky's latest application, saying they have adequate surgery bays to do all the cataract surgeries and other eye procedures Birchansky would like to offer in his own center.

But Birchansky says he can provide more convenience with morning eye surgeries and drive-up service. Medicare also reimburses ambulatory surgery centers - such as the one he proposes - at a lower rate than hospitals, which Birchansky says would reduce health care costs overall.

Iowa's certificate of need law, in place since 1977, is intended to prevent duplication of expensive health services in communities.

Thirty-four states had certificate of need laws as of August, according to the National Conference of State Legislatures. Three additional states, Wisconsin, Minnesota and Arizona, have limited oversight of facility expansion.

Former Iowa Gov. Terry Branstad spoke out against Iowa's law last year, saying it stifled competition among health care providers.

Birchansky did outpatient eye surgeries adjacent to his office at 1136 H Ave NE from 1998 to 2004 in a partnership with UnityPoint Health-St. Luke's Hospital. When St. Luke's pulled out, he was left with an empty surgery center. He applied for his own certificate of need and was denied four times.

Birchansky later did cataract surgeries at Fox Eye without having a certificate of need, but the Iowa Department of Public Health ordered him in 2010 to cease or risk a fine.

Birchansky said last week he decided to apply again because the Health Facilities Council has two new members: Dr. Harold Miller, of Bettendorf, and Brenda Perrin, of Cherokee.

Miller has served as a board member and president of the Iowa Medical Society and chairman of the group's delegation to the American Medical Association, the Quad-City Times reported in March. Perrin, who will fill a partial term, is president of Screenbuilders, a family-owned business in Cherokee that builds custom patio rooms.

The other members are Roberta Chambers, a retired Corydon lawyer; Connie Schmett, of Clive, who has worked as a lobbyist; and Roger Thomas, of Elkader, a retired lawmaker and former director of the Elkader Development Corporation. Schmett, Miller and Perrin are Republicans, Thomas is a Democrat and Chambers has listed no party affiliation.

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