Monty Veazey
Special interest groups from outside Georgia are once again waging attacks on Georgia’s long-standing, successful Certificate of Need program that protects access to lifesaving hospital care.
Their arguments sound enticing in a state that’s the No. 1 for business. They say removing regulations will open up the free market, expand choices and lower costs while improving the quality of care. They portray hospitals as monopolies abusing the system to quash competition, citing the few cases in the past four years where the state has denied certificates of need to certain applicants wanting to open standalone surgery, imaging, or birthing centers.
These arguments, however, quickly fall apart under scrutiny.
For starters, l believe in free markets as much as CON’s opponents do. But these principles only apply when competitors play by the same rules.
Under federal law, hospitals must serve every patient who walks through the door regardless of ability to pay. In 2021, Georgia’s nonprofit hospitals provided more than $7.1 billion in indigent and charity care. A study by Cleverley and Associates, experts in hospital finance, also found that Georgia’s not-for-profit hospitals write off nearly 8.5 percent of net patient revenues. Hospitals not only treat uninsured patients who pay nothing at all, but also those covered by Medicaid, which reimburses providers far below the cost of the care provided. Hospitals offer many services that our communities need but that lose substantial sums of money, including trauma care and intensive care for newborns.
The CON opponents have no intention of building facilities to serve all Georgians or providing needed but unprofitable services. They’re seeking to rig the system. They plan to serve only the highest-paying customers and provide only the most profitable procedures.
Already struggling with tiny margins, hospitals left with only nonpaying or low paying customers won’t survive. This harms all of us. Whether rich or poor, we all need the comprehensive emergency and other specialty care that only hospitals provide. Patients suffering trauma, a stroke, or a heart attack at 3 a.m. need a 24/7 emergency department, not a for profit freestanding center that closes before 5 p.m. When COVID broke out, the sick flocked to hospitals while freestanding ambulatory surgery, imaging and other centers closed.
Georgia’s CON law protects these assets while at the same time providing tremendous flexibility in allowing new services to enter a market when needed. Contrary to the assertion that vested interests are quashing competition, Georgia’s Department of Community Health approves over 90% of CON applications.
Look no further than the examples put forward by opponents of CON. A recent op-ed by Americans for Prosperity claims that the CON laws “banned” healthcare providers from “expanding critical care to our most vulnerable populations.” But most of the projects cited ultimately were approved by DCH.
In the minority of cases where the state denied a CON, one did not serve vulnerable populations and attempted to cherry-pick profitable services from local hospitals. Patients in the area had plenty of access to the service offered.
AFP called the denial of CON for the Augusta Birth Center a “prime example” of how regulations are “hurting patients and their access to care.” In reality, the state’s rejection protected the unsuspecting public from a provider unable to document that she met several standards designed to ensure safe deliveries.
The birth center’s founder and director wasn’t trained, certified, licensed or experienced as a Certified Nurse Midwife. She was not even a trained or licensed registered professional nurse. Instead she was a “master personal trainer” at a golf course, an exercise physiologist and a doula. At the time of the CON filing, she was in college to get a Bachelor of Science in Nursing. The family practitioner identified as the medical director and physician on call for medical interventions later disclosed that she would not be a practicing physician with the proposed center, and the physician identified as the OB/GYN did not have admitting privileges at two local hospitals as initially represented.
Far from demonstrating CON as a hurdle to care, this case exemplifies the role that CON plays in public health.
Georgia’s CON laws have worked for Georgia’s communities and families for more than 40 years. We face a choice once again this year: To stand by the nonprofit hospitals that reinvest in our communities, provide lifesaving treatment and undergird economic development or to aid the profiteers that would cannibalize and cripple the system that works for the benefit of all.
Veazey is president and CEO of the Georgia Alliance of Community Hospitals.
