The State Senate committee on health heard a proposed committee substitute (PCS) for a bill naming a state cat that would instead repeal the Certificate of Need (CON) law in the state, a major obstacle to choice and competition in medical care.
State leaders held off on voting on the PCS following discussions in the Health Committee Tuesday morning.
The PCS calls for the complete repeal of CON law in the state January 1, 2021, giving nearly five years of lead time before a certificate of need was no longer required for new health facilities or for expansion to existing ones.
The law was originally installed to control the cost of healthcare by making health providers prove there was a need for a service or facility before it could be built or added, but opponents of CON law say that it serves to limit supply, forcing prices higher.
In addition to discussions by legislators, a number of members of the medical field, advocates for the state hospitals and also conservative policy advocates spoke to the committee.
Dr. Charles Ford, an ear, nose and throat doctor in Boone who has been practicing for 21 years ever since leaving the U.S. Army, supports repealing CON law due to the cost to his patients.
Ford has to use the only surgical facility in Boone, driving up his costs for his patients.
“Thank you for the opportunity to raise my voice in support of CON reform,” he said. “Quality surgical care can best be described as having the right procedure in the right location at the right cost. CON is an obstacle to this goal, by blocking competition it limits patient choice and makes surgery more expensive.
“In Watauga County there is one high cost possible location where surgery can be performed. This penalizes me when my practice is graded by insurers regarding quality and cost. Now quality I can control, surgical cost I cannot.
“Consider a young couple with a four year old child who has a need for tubes for ear infections, in Boone they pay $5,2000, in Hickory $1,700. They save $3,500 by going to an ambulatory surgery center.
“Increasingly the patients are finding other locations for surgery via the internet and with the help of their insurance carriers. Thousands of dollars are wasted with every case I preform. No wonder we face a crisis in healthcare spending. CON limits patient access and choice allowing the most costly models of care to flourish physician like myself ask you to reform CON.
“As you vote consider this question, is the position you take going to give the patient the best access to quality care at the most affordable price. If that’s what you want then I strongly urge you to vote for CON reform.”
Cody Hand, vice president deputy general counsel for the NC Hospital Association, spoke to the committee about the need for hospitals to keep CON because price stability would help hospitals stay financially stable.
“Unfortunately we don’t have the luxury on focusing on what the insurance companies are asking to do, we don’t have the luxury of just focusing on what Medicare or Medicaid require of hospitals,” he said. “We have the mission, we have the desire and goal, to serve every community that we are in and Certificate of Need repeal right now I believe is shortsighted for all of the very things you have heard today; the market forces changing so fast, I would love to say what five years from now looks like in healthcare, more than me the planners in hospitals and in healthcare communities would love to say what five years holds from now but we just don’t know what that looks like.
“We don’t know what is going to happen with the Affordable Care Act (ACA), we don’t know what is going to happen in Washington. Speaking of Washington, you know you do have an option here of changing Certificate of Need, that is something that you have control over. What you don’t have control over, what we don’t have control over are the many mandates handed down to us from Washington D.C.
“The mandates not just that we see every patient regardless of their ability to pay, which we would do anyway. But the unreasonable mandates like the fact that we have to hold behavioral health patients, often against their will and often against our ability. We have to do all that stuff and underlying all of that is this volatility in healthcare. What we need from your guys as a state Legislature and frankly as a protector against the Federal government is some stability in that market as we move through transformation from volume to value, moving through the ACA, moving through the different changes in poor populations as we become a larger state and a less healthy state. What we need from you is the stability of Certificate of Need as we make those transitions.”
During the Long Session last year the Senate took aim at repealing CON law in its budget but the final product did not include CON law repeal.
Under the Senate plan last year CON law would have been stripped away in a three-part process beginning in 2016 and then with more sections being removed in 2017 and the rest in 2019.
The new plan would give healthcare officials more time to prepare but would repeal all of the provisions at one time in 2021.