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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/.

Health care needs aren't easily measured

By JIM LEUTE -- GazetteXtra.com

JANESVILLE — The goal might have been admirable in the mid 1970s: restrain health care costs and allow coordinated planning of new services and construction in the health care industry.

The reality of the federal government's mandate for certificate-of-need programs, however, was such a patchwork of programs that the law was repealed 13 years later. Many states—Wisconsin included—no longer require a formal review and approval of large capital expenditure programs in their health care industries.

"The feds mandated it for all 50 states because they weren't able to meet their Medicare and Medicaid budgets," said Rich Gruber, vice president of community advocacy for the Janesville-based Mercy Health System. "They used it as a cost-containment measure.

"But it just didn't work because there were so many different approaches in place across all 50 states."

For the rest of the story, go to http://gazettextra.com/news/2011/dec/11/health-care-needs-arent-easily-measured/.

COPA agreement still under scrutiny

by Chad Simons, Staff Writer -- THE MACON COUNTY NEWS

Committee may validate Sen. Davis’ concerns.

North Carolina state Senator Jim Davis (D – 50 District) took a lot of heat after introducing SB 638, a potential law that aimed to modify the Certificate of Public Advantage (COPA) agreement granted to Asheville’s Mission Hospital in the mid ’90s. The bill was introduced in the General Assembly last spring in response to an economic analysis report that evaluated the COPA agreement, and later discerned that the agreement gave Mission Hospital an unfair advantage over competitors in the region.

The 45-page report entitled “An Economic Analysis of the Certificate of Public Advantage Agreement Between the State of North Carolina and Mission Health,” was finalized and released in March 2011 and can be accessed online. After the report was released, Senator Davis was compelled to introduce the aforementioned bill, which has since failed to make it out of committee in the state legislature. Davis was the only sponsor of the bill, which sought to modify the COPA agreement in order to address the issues raised in the economic analysis report.

The State Houses’ Select Committee on the Certificate of Need Process and Related Hospital Issues later took up the study of the report in late August of this year, holding several public hearings across the state to seek input from experts and citizens alike. One such public hearing took place in Western North Carolina in October. The select committee consists of 11 members currently serving in state house, with each member being appointed by the Speaker of the House of Representatives, Thom Tillis.

The select committee has yet to release their final report, but according to Senator Davis, their research thus far has “validated my initial concerns regarding Mission’s advantages over smaller hospitals in Western North Carolina.” Davis added that he has nothing against Mission Hospital, but he fears that small community hospitals in Western North Carolina could be coerced into a merger with Mission due to the abuses of the COPA agreement.

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

Senate Majority Leader Pre-files Legislation to Eliminate Certificate of Need

by the South Carolina Hospital Association

South Carolina’s Certificate of Need program is being threatened both legislatively and administratively. 

Legislatively, a bill that would repeal all statutes related to CON was pre-filed November 28 by Senate Majority Leader and Chairman of Medical Affairs, Senator Harvey Peeler (R-Cherokee, Spartanburg, Union, and York Counties.) This pre-filed legislation (S. 999) comes as no surprise following his floor oration against CON this past June. The General Assembly will reconvene Tuesday, January 10, 2012, to consider new legislation and legislation carried over from last session.

The Department of Health and Environmental Control (DHEC) administers the CON program and both the DHEC board as well as the agency’s State Health Planning Committee can make recommendations or decisions that could result in radical changes to the process. In a positive light, each could serve as a venue to improve rather than eliminate the process. Remember that appointments to both the Board and the Committee are made by the Governor.

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

ER building boom is wrong prescription, critics say

By Carol M. Ostrom -- SEATTLE TIMES

As health-care costs spiral ever upward, hospitals race to build free-standing emergency rooms and expand existing ERs. Hospitals say it makes business sense, but critics say the hospital arms race is too costly for businesses, government and families.

With medical costs spiraling upward and state-paid insurance coverage evaporating, you might think hospitals would discourage patients with sprains and cuts from coming to their emergency rooms for care that would cost much less in clinics or urgent-care centers.

But you'd be wrong.

Hospitals throughout the Puget Sound region are in the midst of a boom, building spiffy new free-standing emergency rooms and entire hospital towers with expanded ERs, and drastically remodeling existing ones.
Swedish Medical Center and Evergreen Hospital Medical Center built free-standing ERs in Redmond, and MultiCare and Valley Medical Center plan to build them in Covington.

What's more, hospitals are marketing their ERs aggressively, crowing about amenities from valet service to private rooms. One hospital posts ER wait times online.

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