To CON or not to CON

I recently returned from Tallahassee, where I made a presentation to the Florida House of Representative’s Health Innovation subcommittee on the potential deregulation of the Certificate of Need (CON), here in the State of Florida. 

For those outside of the industry, the Certificate of Need program is a regulatory process that requires certain health care providers to obtain state approval before offering new or expanded services. The CON program in Florida regulates the construction of new hospitals, hospices, skilled nursing facilities, and care facilities for the developmentally disabled, as well as certain hospital services.

The deregulation of CON is a hot topic in the health care sector and while there is not currently a bill in front of lawmakers, legislators are weighing the pros and cons of maintaining the practice. I felt it was important for them to hear from those directly involved in providing care to Floridians.

As a health care provider, our goal at Jupiter Medical is three-fold: 1) to improve patient outcomes and the quality of care we provide; 2) maintain or, when possible, decrease cost; and 3) improve access to the services we offer. If we can do these things at the same time, then we are batting a thousand.

With this goal in mind, I have spent a lot of time studying the positives and negatives of CON deregulation. Research is all over the map regarding whether deregulation improves quality, lowers cost and increases access. There are those who believe that it will achieve these goals, while others feel it will have the opposite effect.

I am a strong believer in the free market system and understand that healthy competition can be good for business and consumers. This is not about competition - we compete every single day at Jupiter Medical Center. This is not about a free market economy. Free market economics does not apply to acute hospital care. We must take care of every patient that walks in the door. 

What the regulation of CON is about is what is best for the consumer. As someone who provides health care in a non-profit setting within a specific local community, and whose primary responsibility is to the people we serve, my recommendation is to continue Certificate of Need for acute care hospitals.

The deregulation has the potential to negatively impact the consumer in the following ways:

• Cost: It is true that with deregulation, we will see more hospitals come into the community. However, with the arrival of these new hospitals comes the likelihood that independent hospitals will get consolidated into larger health care systems. This will mean less choice and higher cost for the consumer. The reality is that larger hospital systems are reimbursed for the work they do at a significantly higher rate than independent nonprofit hospitals, which results in the consumer footing a larger portion of the bill.

• Quality: While I don’t believe there is a correlation between CON and quality, what is well-documented through extensive research is the fact that the more times a hospital performs a specific procedure, the more proficient it becomes and the better the outcomes. With CON in place, hospitals gain expertise in specific procedures due to increased volume among fewer hospitals.

• Access: With the deregulation of CON comes more hospitals which means more hospital beds. This also means more pressure to fill beds. In our community, we have plenty of beds and do not need more. Many of the hospitals in our region are operating at less than 60% capacity. Where additional access is needed is in the ambulatory and post-acute service markets - in everything from physical therapy rehabilitation centers to urgent care facilities to imaging facilities. This is why I support deregulation of CON for these types of services.

And so, for those consumers who want to ensure high-quality, affordable and accessible health care for themselves and their families, I encourage you to reach out to your elected officials and make your voice heard. 

Finally, I would ask government officials, health care leaders and those that have an opportunity to play a role in the future of health care in Florida, to think about what would be repaired - if anything - by deregulating Certificate of Need. Would changing Florida’s healthcare planning process through Certificate of Need improve health care for your community and constituents? I think you will find the answer to be no.