Special deal, or raw deal for Cedar Rapids doctor? Updated

Did a Cedar Rapids doctor get a special legislative favor? The Des Moines Register Editorial Board thinks so:

Don't like the law? Then write a check to state lawmakers and they might carve out an exception just for you.

That is what the public probably is thinking after hearing about Dr. Lee Birchansky. The Cedar Rapids ophthalmologist wants to open an outpatient surgery center there. A state board has repeatedly denied him the needed certificate to do so, and the Iowa Supreme Court has agreed with the board.

So Republicans in the Iowa House want to come to his rescue. They added an amendment to a state spending bill that would allow Birchansky's surgery center - and only his - to skirt a process known as the certificate of need. It's hard to imagine this is a coincidence after the doctor gave thousands of dollars to lawmakers supporting his efforts.

But the editorial doesn't mention, as The Gazette's Cindy Hadish reported in March, that the state also won't let Birchansky do cataract surgery in his office:

At first glance, Dr. Lee Birchansky's in-office cataract surgery appears to be an innovative model for lowering health care costs, but state health officials don't see eye-to-eye with the Cedar Rapids ophthalmologist. The Iowa Department of Public Health denied a rehearing on Birchansky's notice to perform the common procedure in his office at Fox Eye Laser & Cosmetic Institute, 1136 H Ave. NE, sending his staff scrambling last week to reschedule dozens of patients into hospital surgical rooms.

'We are open. We're seeing patients. We're doing surgeries that we normally do in the office,' said Birchansky, 53, who has practiced 21 years in Cedar Rapids. 'What's changed is that we are no longer doing cataract surgeries in the office.' The issue extends beyond the doors of Birchansky's clinic to the pocketbooks of patients and taxpayers.

Birchansky estimates saving his patients and Medicare $3 million in the three years he performed the procedure in-office.

Those 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.

Most patients undergoing surgery for cataracts - a cloudiness that forms over the normally clear lens of the eye - are elderly, so Medicare picks up the tab ultimately paid by taxpayers.

The state, however, considers Birchansky's office to be an uncertified surgical center, built at a cost of more than $1 million.

State health officials fined Birchansky $20,000 and ordered him to cease performing cataract surgery at Fox Eye.

This is not a story I've paid attention to, until today, so I have yet to form an opinion. If you have a helpful perspective or insight that you don't want to post below, please email me.

UPDATE -- It seems the House-approved amendment to help Birchansky is going nowhere in the Senate:

“There's no support” according to Senate Health and Human Services Appropriations Subcommittee Chairman Jack Hatch, D-Des Moines, for an amendment to Senate File 2336 to let Lee Birchansky circumvent the state certificate of need process that for more than a decade has blocked his 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