Medical Monday: A weekly post of healthcare- and technology-related policy news, views and commentaries.
A mantra you’ll hear from policy research groups is that healthcare reform in Georgia and many other states can’t take place without Certificate of Need reform. And just as certain as that is true is that the average Georgian has no idea what they’re talking about.
What’s a Certificate of Need? To personalize it: Imagine, if you will, a subdivision in which you want to buy a fancy new grill for the patio in your backyard. You have the money and the space and you know how much the grill will improve your cooking repertoire and help provide alternative meals for your family and friends. It even has a fancy rotisserie attachment.
The Homeowners’ Association, however, has a clause that says you must explain why you need the grill and ask the board’s permission. Furthermore, everyone on the block has a say in whether you can add that grill, because neighbor Joe Smith, for example, might already have one and your purchase (with your money) could upset the balance in the community. If Joe had one and you get one, the neighbors might get the wrong idea and decide you throw a better barbecue party than Joe. And what would that do to Joe’s soirees?
You might ask yourself whose business it is whether you put your fancy new grill in your backyard – safely away from any structures, of course. After all, you’re paying for it, right? And you’ll use it for the guests you invite – which is not your neighbors’ business, either. How is it your fault if you have a better outcome on your grill?
At a higher level, consider what would happen if other businesses had to operate with a Certificate of Need (CON). The Publix would have right of refusal over Kroger’s plan to build across the road. McDonald’s could argue the Burger King a mile away can’t upgrade its kitchen because that would put the McDonald’s at a competitive disadvantage.
But, under Georgia’s CON regulations, that’s pretty much what healthcare providers and facilities are expected to do. The Georgia Public Policy Foundation publishes “CON Game” this week, an article that is part of the Foundation’s Investigative Journalism Initiative. It explains that Georgia’s CON law requires providers “to obtain permission before they open or expand their practices or purchase certain devices or new technologies. Applicants must prove that the community “needs’ the new or expanded service, and existing providers are invited to challenge would-be competitors’ applications.”
The interesting aspect is that CON regulations were mandated nationwide by the federal government in 1974. But if you believe that federal government programs never die, you’d be mistaken. There is at least one: CON regulations. As the Mercatus Center at George Mason University explains
[T]he federal government mandated state implementation of CON regulation in an effort to control healthcare costs, increase access to care, and improve quality. When early research suggested that CON regulations were failing to meet these goals, the federal government repealed the mandate, but many states kept their CON programs on the books. As of January 2020, 35 states and the District of Columbia required providers to obtain a CON before offering at least one healthcare service.
Across 35 regulated services, the most common CON requirements are for nursing homes, psychiatric services and hospitals (new construction and expansion). In Georgia, 22 services have CON requirements, Mercatus reports.
Gov. Brian Kemp’s executive order in March 2020 suspended CON regulations during the pandemic public health emergency. But even as hospitals delayed “elective” surgeries, not a single application among the 14 ambulatory surgery centers that applied to the Department of Community Health earned DCH approval.
What’s behind the CON continuation? Read the article by investigative journalist Matt Bolch.
Does the justification for CON continuation work? According to Matthew D. Mitchell, a Mercatus Senior Research Fellow, “While the original hope was that CON laws would restrain healthcare costs, increase healthcare quality, and improve access to care for poor and underserved communities, a large body of academic research suggests that CON laws have instead limited access, degraded quality, and increased cost.” Read his essay here.
Of sound mind: May is Mental Health Awareness Month, and it’s worth a check-in on how Americans are doing during the ups and downs of pandemic recovery. A May study of 2,000 employed adults found entitled 73% described their mental health as being good or excellent. This was up from 67% in the early months of the pandemic. Part of the reason for these better numbers is based on the support employees felt from their employers. And the majority ( 84%), across generations, were able to report one positive thing that came out of the pandemic. Among them, being employed/having enough work; the ability to work remotely; the ability to multitask between personal/professional life at home; and the ability to connect with colleagues virtually.
“According to one study, more than half of the people who used telehealth in May 2020 used it for a mental health concern. Virtual care has the added benefit of increased privacy and access to care for people who have difficulty getting to in-person care or end up on a waitlist for weeks to see a provider. Virtual care reduces the time commitment for therapy since it doesn’t require a commute. Overall, it’s a method that provides patients with more controlv over how they access mental health care.” — Erik Vanderlip
Compiled by Benita Dodd, vice president of the Georgia Public Policy Foundation.