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Thank you for stopping by my website -- I'm Tom Piper. Click on each of the links in the left column to discover more about how I can help you make the most of your work and play!

Certificate of Need, one of the many branches of health care planning and regulation, is the most prominent category where I have almost 40 years of health-related experience. I have over 32 years experience working with Apple computers and their many excellent related devices such as Macs, iPhones, iPads, and iPods. Soon, I will also be able to provide motivational and inspirational productions to audiences of all ages and disciplines with a primary focus on BALANCE.

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Lawmakers tackle streamlining CON process – again

by Evan Belanger -- Birmingham Business Journal

The Alabama Legislature is again attempting to streamline the state’s criticized certificate of need review process, which controls the expansion of health care facilities statewide.

In a bill filed Feb. 21, Rep. Mary Sue McClurkin, R-Indian Springs, is again stumping for a host of tort reforms aimed at preventing abuse of the state’s CON process, which is administered by the State Health Planning and Development Agency in Montgomery.

One of 34 state CON programs nationwide, Alabama’s CON process is intended to control the cost of health care by limiting expansion of facilities to the needs of the local community. But ...

To see the rest of the story, go to http://www.bizjournals.com/.

New Hampshire CON Legislation in the News

Review board would stay, change
Panel determines need for services

By Annmarie Timmins -- CONCORD MONITOR

A House committee voted unanimously yesterday to save but change a state review board that decides whether new hospitals can build in the state and whether existing ones can expand.

The same committee will take up perhaps a trickier question tomorrow: Should an out-of-state specialty cancer hospital be allowed to skip this new and improved review board?

The state's existing certificate of need board has long been criticized as a barrier to competition, and the initial bill before the committee sought to eliminate the board.

For the rest of the story, go to http://www.concordmonitor.com/.

Bill could divert funds from hospital budgets

 By Kristin Yu -- THE DARTMOUTH

House Bill 1642-FN, which would exempt for-profit cancer treatment centers in the state of New Hampshire from state regulatory procedures and taxes to which existing hospitals are subject, is currently being debated in the New Hampshire House of Representatives. The bill has the potential to tilt the playing field unfairly in favor of for-profit cancer treatment centers, Dartmouth-Hitchcock Medical Center Interim Director of Communications Rick Adams said. Subversion of the established legal channels for health care facilities in New Hampshire by for-profit “destination cancer hospitals” is fundamentally unfair, Adams said.

HB 1642 applies directly to for-profit cancer treatment centers such as the facility that the Cancer Treatment Centers of America hopes to establish in southern New Hampshire. Such centers would be exempt from needing state Certificate of Need board approval to construct new facilities and would not be subject to paying the Medicaid Enhancement Tax if the bill were passed.

For the rest of the story, go to http://thedartmouth.com/.

Specialty Hospitals Get A Favorable Vote

By Rachel Gotbaum -- NEW HAMPSHIRE NEWS

The House Health and Human Services Committee has sent an amended bill allowing not just Cancer Specialty Hospitals but all specialty hospitals to bypass the Certificate of Need process. All other hospitals in the state must go in front of the CON board to gain approval for new or expanded services.

Rep. Lynn Blakenbeker, Republican of Concord, voted in favor of the bill.

"We as a state should be encouraging businesses all kinds to come into the state especially when it comes to specialty healthcare treatment we should be offering all options," she says.

For the rest of the story, go to http://www.nhpr.org/.

 

CON Board would expand to cover Doctors

By Grant Bosse -- NEW HAMPSHIRE WATCHDOG.ORG

Annmarie Timmins reports in the Concord Monitor that a House Committee has decided that the way to address the failure of the Certificate of Need Board to control health care costs is to give the CON Board even more power to limit health care supply.

The board would also have an expanded charge under the proposed legislation: Members would have to consider the cost of medical procedures and whether new facilities or equipment would improve health outcomes and increase overall health care costs in the state.

It would work with its existing $500,000 budget. And under the proposed legislation, the certificate of need board would be eliminated in 2017 unless lawmakers at that time decided to extend it.

For the rest of the story, go to http://newhampshire.watchdog.org/.

 

Destination hospital bill misses the mark

Unfair advantage for out-of-state firm

By Steve Ahnen -- CONCORD MONITOR

State Rep. Marilinda Garcia's recent column, "Hospital plan improves business climate" (Monitor Opinion page, Feb. 18) misses the mark on a number of fronts. Her legislation, House Bill 1642, would create a special exemption from laws to which all other hospitals in New Hampshire must adhere. How does giving preferential treatment to some at the expense of others improve the business climate for all hospitals in New Hampshire?

The state budget that was adopted last June that cut more than $250 million in Medicaid payments to hospitals has resulted in the loss of over 1,200 jobs in hospitals across New Hampshire and limits on access to services for Medicaid patients. But Garcia's bill would only make matters worse for New Hampshire's existing hospitals.

For the rest of the story, go to http://www.concordmonitor.com/.

Sunset CON in New Hampshire?

Certificate Of Need--Is It Still Needed?

By RACHEL GOTBAUM -- NHPR / NEW HAMPSHIRE NEWS

New Hampshire lawmakers are proposing a law that would do away with the Certificate of Need process. This is a state requirement for hospitals and other healthcare facilities that want to expand or establish new medical facilities. The aim of CON is to keep redundant healthcare out of the system.

That's why Rep. Cindy Rosenwald, D-Nashua, opposes the bill. She says without controls placed on new medical services, costs will rise. She cites studies that show healthcare costs are higher in regions where more care is offered. "The more capacity you have simply the more care that will be delivered," says Rosenwald.

For the rest of the story, go to http://www.nhpr.org/.

Irrational- Do Certificate of Need Laws reduce cost or hurt patients? 

By Grant Bosse -- NEW HAMPSHIRE WATCHDOG.ORG

Summary: Certificate of Need laws, or CONs, have been set up across the country under the assumption that rationing hospital construction and expansion would limit increases in health care costs. Four decades of experience have shown that CONs do not control costs, but do provide a significant barrier to entry to innovative health care facilities and limit competition in the health care marketplace. Faced with this evidence, CON supporters have created novel arguments to justify them, but these new rationales also fall under close scrutiny. New Hampshire should end its thirty-year experiment and repeal its Certificate of Need Law.

To read the entire study, go to http://www.scribd.com/.

 

House Select Committee on Certificate of Need Process Takes Action

by Poyner Spruill LLP - JDSUPRA

The House Select Committee on the Certificate of Need (CON) Process and Related Hospital Issues recently began deliberating the wide-ranging issues raised by interested parties – primarily hospitals and hospital-based health care systems - in public hearings that took place across the state this past Fall.

The committee’s January 19 meeting was the first of several scheduled meetings aimed at considering suggestions for potential modifications to North Carolina’s CON Law. Proposed changes under consideration include increases to many of the monetary thresholds in the law which some have contended are outdated and too low.

The committee voted to recommend the following changes to existing CON law:

For the rest of the story, go to http://www.jdsupra.com/.

Certificate of Need Reform (New York)

by The Editorial Team -- NEW YORK HEALTH CARE BLOG

Earlier this month certain Certificate of Need (CON) reforms went into effect. In addition to these reforms, there is an effort within the Public Health and Health Planning Council (PHHPC) of the New York State Department of Health (DOH) to realize further reform to the CON process.

Presently effective reforms include: (1) the recently implemented New York State Electronic Certificate of Need System (NYSE-CON) which became mandatory on January 12; and (2) the elimination of certain construction applications from the CON process which became effective on January 20. Accordingly, going forward all Limited Review and CON applications must be submitted electronically via NYSE-CON as DOH is no longer accepting paper applications.  Further, the following types of construction projects by a hospital possessing a valid operating certificate no longer require CON submission and PHHPC approval:

1. Routine repair or maintenance (regardless of cost);
2. Non-clinical infrastructure projects regardless of cost, including but not limited to, replacement of heating, ventilating and air conditioning systems, roofs, fire alarm and call bell systems, parking lots and elevators; and
3. One-for-one equipment replacement, regardless of cost (including replacement of old equipment with more current technology).

For the rest of the story, go to http://blog.harrisbeach.com/.

New hospital certificate of need being presented in Jefferson City

by Staff reports -- Chillicothe Constitution-Tribune

Hospital and city officials were in Jefferson City (on January 9) in support of the hospital’s presentation of its certificate of need for constructing a new hospital in Chillicothe.

A delegation of between 20 and 30 people were making the trip. The presentation was to be made to a committee of elected and appointed individuals, and local officials said they were optimistic that they will receive approval before leaving the state Capitol.The group will make its presentation, and the committee will then render a decision as to whether construction should be approved.

“We fully expect approval rendered on Monday,” said Matt Wenzel, Hedrick Medical Center CEO. “There is no reason to believe that we will not get approved. We are very confident that we have made a strong case for approval and swift execution thereafter.”

A report of the day’s events, as well as an update regarding construction of a new hospital, will be presented during a workshop of the Chillicothe City Council, beginning at 5:30 p.m. Tuesday, in the conference room at City Hall.

The hospital update workshop will be followed by the regular city council meeting at 6:30 p.m. in the council chambers at City Hall (see related story).

http://healthychillicothemo.org/

(Editorial Note: this proposed "replacement" hospital, reduced from 49 to 25 acute care beds to be a mile from the existing facility, was unanimously approved)

Mercy's Appeal of Patient First's 3-Bed Hospital at Supreme Court

Patients First, Mercy back in court... again

by E.B. Solomont, Reporter -- St. Louis Business Journal 
Remember that three-bed hospital built last year in Washington, Mo.?

Built by physician group Patients First and hotly contested by Mercy Hospital Washington, the hospital and its builders have landed in the Supreme Court of Missouri.

The legal fighting began last fall, after Patients First sought to build the hospital without a Certificate of Need (CON) from state health planners by keeping costs under $1 million, with projected costs of $953,750. Mercy, located nearby in Washington, sought to prevent construction by filing a lawsuit.

St. Louis County Circruit Court ruled against Mercy, and Mercy subsequently appealed, but the three-bed hospital was completed in April 2011, according to briefs filed ahead of today’s arguments. The Court of Appeals in July ruled against Mercy.

For the rest of the story, go to http://www.bizjournals.com/.

High Court to Hear Arguments in Patients First Hospital Case

by emissorian.com

The Missouri Supreme Court will hear oral arguments this week in a challenge by Mercy Health Systems to prevent Patients First Health Care from building a three-bed hospital in Washington without obtaining a certificate of need.

Arguments in the case are scheduled for 9 a.m. Thursday in Jefferson City.

The case involves the validity of a Missouri Health Facilities Review Committee rule that interprets the state certificate of need statute.

The certificate of need law was passed to prevent excessive amounts of health care facilities and to reduce costs of health care.

Under the law, proposed facilities must obtain a certificate acknowledging need for the facility from the Missouri Health Facilities Review Committee (Missouri Health). The law originally required many types of facilities to obtain certificates before offering new institutional health services.

For the rest of the story, go to http://www.emissourian.com/.

 

Court Hears Arguments in Three-Bed Hospital Case

by Jason Rosenbaum, Missourian Correspondent

The Missouri Supreme Court heard arguments this week on the ongoing dispute between Mercy Hospitals East Communities and Patients First over a three-bed facility in Washington.It’s not known when the high court will issue a ruling in the case.

The skirmish between the two entities involves the state’s Certificate of Need program, which approves applications for hospitals and equipment that is over $1 million. In September 2010, the Missouri Health Facilities Review Committee voted 4-3 to exempt Patients First from going through with the CON process to build a three-bed hospital in Washington.

The committee decided that since the facility was under $1 million, it didn’t need to go through with the CON process. Mercy eventually sued in St. Louis County Circuit Court before the MHFRC made a decision.
St. Louis County Circuit Court Judge Richard Bresnahan dismissed the case without prejudice because it was “not ripe for judicial determination.” And while Missouri Court of Appeals Eastern District ultimately decided the case was ready for review, it then ruled “that the New Hospital Rule is consistent with the CON Law and the MHFRC was within its authority to promulgate the rule.”

At the heart of Thursday’s proceedings was the interpretation of a state statute listing the definition for a “new institutional health service.” According to state statutes, any person “who proposes to develop or offer a new institutional health service within the state must obtain a certificate of need from the committee prior to the time such services are offered.”

For the rest of the story, go to http://www.emissourian.com/news/.

Maine Voices: Legislature is tackling the causes of Maine's high health care costs

by Deborah Sanderson -- THE PORTLAND PRESS HERALD

Maine's Medicaid system is one of its biggest obstacles to affordable insurance, the writer says.

It's no secret that health insurance in Maine is costly. Maine people pay some of the highest rates in the country and have for quite a while.

There are a number of reasons for this. First, medical services in Maine are very expensive. Second, we have a large medical welfare population that pays little to nothing into the system. Finally, Maine's restrictive health insurance laws have decreased competition among insurers and forced individuals away from private insurance.

In order to bring health insurance premiums in line, all three issues, as well as other related problems, are being confronted by the current Legislature.

The cost of care itself is addressed in several ways. Maine's previous Certificate of Need (CON) law forced any health care provider to first apply to the state and then be approved for a CON before expanding an existing health care facility or opening a new one, no matter how small. It added unnecessary costs and red tape, protected health care monopolies and stifled innovation within the industry. The new law, passed last June, will allow facilities or expansions up to $3 million to be built without a CON, injecting some much needed competition into our existing health care network.

For the rest of the story, go to http://www.pressherald.com/.

Legislators eye return to reviews as hospitals build

By Andrew Conte and Luis Fabregas -- PITTSBURGH TRIBUNE-REVIEW

Pennsylvania should bring back a review process for hospital spending on construction and medical equipment, some state lawmakers said on Thursday in response to a Tribune-Review investigation.

Sen. Jim Ferlo, D-Highland Park, plans to introduce legislation that would reinstate the certificate of need, or CON, law requiring hospitals and doctors to justify whether such medical expenditures are necessary.

"We need the Legislature, the public sector and consumers to come back into this picture," Ferlo said. "We're paying for all of this, and we should have more say-so."

Leaders of both parties said they would work with Ferlo to restore the CON law, which expired in 1996.
For the rest of the story, go to http://www.pittsburghlive.com/.

Medical building boom increasing Americans' health care costs

by Andrew Conte and Luis Fabregas-- PITTSBURGH TRIBUNE-REVIEW

Hospitals nationwide are spending billions on large new facilities in a medical arms race to dominate markets and increase profits, while ultimately raising health care costs for patients, taxpayers and anyone with insurance.

From 2008 through Nov. 1, U.S. hospitals borrowed $144 billion through public bond issues for construction, refinancing, equipment and other expenses, the Tribune-Review found as part of a yearlong investigation into the rising cost of health care.

Pennsylvania ranks fourth in spending, the Trib analysis showed, and like the top two states -- California and Texas -- has no agency to regulate the need for hospital construction. Many hospitals are nonprofits competing for patients like big retail chains, and experts say it's gone too far.

"Hospitals can't be like Starbucks, where you have one on every corner," said Dr. Dan Pesavento, an obstetrician in Barrington, Ill. "There's pressure to fill the beds."

For the rest of the story, go to http://www.pittsburghlive.com/.