Virginia must change its COPN laws in favor of improving access and lower cost for surgical services and imaging services.  Last night, I operated on two patients with obstructing kidney stones.  One patient had been sitting in the emergency department of a large hospital system for 7 hours prior to me being called.  The patient had been to the emergency department twice in one week.  He had labs and two CT scans during those visits.  As a result of not having any competition or better access to an independent surgical center/ imaging center, this patient will have two bills in EXCESS of 25,000 dollars for those two visits.  If a facility existed which was owned by a NONHOSPITAL entity, the CT scan would have been less than 400 dollars, labs less than 250 dollars and his surgical procedure would have been less than 2000 dollars.  He would have NEVER waited for 7 hours in an emergency department. The second patient has nearly an identical story.  Finally, did you know that hospitals who have hired physicians prior to last October, can use provider based billing to bill a facililty fee (even if just a doctors office during a patient visit) and a professional fee for all services rendered by that physician as long as it is within 35 miles of an existing facility.  Said another way, a patient gets at least two bill from a hospital when seeing a doctor employed by the hospital - one for the facility (at least 200 dollars) and one for the physician's professional services.  If a procedure is done in the physician's office, they bill as if it were done in the hospital (could be ten times the cost of the same procedure done in an independent physician office).  

Physicians treat more self pay or "inability to pay" patients on a percentage basis than any hospital system. Moreover, hospital systems get to balance bill their unpaid care under CMS/Medicare law, collecting a significant amount of that "loss" back. Physicians and physician owned centers cannot do such activity and moreover cannot write losses off or get any breaks yet we continue to treat and take care of all patients.  Our two largest health systems have over 7 BILLION dollars of cash and assets on hand and pay no Federal, State, or Local taxes.   Isn't it time for Virginia to stop supporting such activity?  

I urge to to phase out the COPN laws for emergency services, imaging (CT, MRI), radiation services, and surgical services.  You will see competition lowering the prices of services, a shift of services from the MOST expensive to most economical.  You will see no change in employment as hospitals will still remain open and more hiring will occur by these independent centers.  Finally, you will see a vast improvement in the Healthcare of Virginians.

Thank you.

Michael D. Fabrizio MD FACS

Urology of Virginia, PLLC, CEO

Professor of Urology, Eastern Virginia Medical School

Founder, The Atlantic Clinic