The Politics of SC Certificate of Need

After being demoted by the Speaker before the session this year, I decided to make the best of it and dig in to some medical issues since I was being sent back to the same committee I started out as a freshman five years ago: the Medical, Military, Public and Municipal Affairs Committee (commonly referred to as “3M”).

One-third of the committee are freshman members (the largest number on any House committee) and it’s currently the only committee chaired by a Democrat, Chairman Leon Howard (D-Richland). This year has given me a chance to revisit some important issues that often get lost and don’t appear as “major legislation” before the body. (Of course, what “major legislation” has even become law this year by the House or Senate? Anyway…)

This year the committee has seen legislation dealing with Podiatrists v. Orthopedic Surgeons; Optometrists v. Opthalmologists; and several “scope of practice act” bills in the process.

One of the most interesting issues I’ve been looking into (and kept under the radar so far to avoid the entire medical community up in arms) is the whole Certificate of Need process that was a federal mandate back in the 1970s. Basically, all 50 states were told they needed a process to regulate healthcare/facilities. Less than two decades later a President many admire, Ronald Reagan, repealed that mandate and gave control to the states to determine for their selves whether or not to continue.

Several states did away with the CON process while others kept them in place.

If you live in the Midlands of SC, you’ve no doubt heard about “C.O.N” for the past several years. Specifically – the feud between hospitals in Lexington, Richland and Newberry counties.

What is a Certificate of Need? It’s part of our State Health Plan and it’s more valuable than those certificates being passed out around our state at high school and college graduations.

Why? Because it’s about money folks. Plain and simple.

Sure, you’ll hear “it’s about the quality of care” but, trust me, it’s about money.

For you policy wonks out there, you can visit the National Conference of State Legislators to see the pros/cons and information about CON across the country.

It now appears that after at least five years of fighting the CON process in our state, Lexington Medical is closer than ever to the heart hospital they’ve wanted.

What finally is gonna make this possible? Money.

One hospital is paying $15 million, getting their CON, and also dropping their lawsuit against the issuance of a CON for the hospital that is getting that $15 million.

I find that interesting.

DHEC and judges weren’t issuing those CON to hospitals for several years but with some money exchanging hands – suddenly “quality of health care” is ok?

From The State (earlier this year) :

***
As part of Wednesday’s deal, Providence agreed to give up one of its four open-heart surgery units to Lexington Medical. In return, Lexington Medical will pay Providence $15 million and drop a lawsuit it filed to block expansion at the Providence’s Northeast campus. The deal is unprecedented in Midlands health care. The settlement ends an almost five-year-long dispute that cost both hospitals millions in legal expenses.

Lexington Medical first applied for an open-heart surgery unit in April 2004. That plan was opposed by Providence and Palmetto Health. DHEC rejected the proposal, saying the added unit would threaten the quality of Midlands health care by spreading surgical talent too thin.

Executives from Lexington Medical and Providence said the new plan won’t compromise the quality of care.
***

Wow! This plan won’t compromise the quality of health care? It also appears one hospital may be on the outside looking in – Palmetto Parkridge (right here in our community – Exit 102B). While it does appear that one hopsital is actually giving up one of its surgery units, that can’t be the sole reason “it’s all good now”, can it?

As Palmetto’s CEO was quoted in the same article earlier this year:

“Frankly, I am at a loss to understand why a private agreement regarding health care delivery would be negotiated and announced that excludes the region’s largest health system,” Palmetto chief executive officer Charles Beaman Jr. said in a written statement.

To be fair, every CON is different in scope; but I remember a few years back when speaking to one of the hospital CEOs in the area when I asked: “If you get your CON will you drop the lawsuit against the other hospital?” His reply ? “No. That CON is not needed and should be denied; but ours IS needed and should be approved.”

You tell me: Do we keep the process like it is or do we change it – and if so, how? The process now is very political but is it better than the alternative? Could health care costs and the quality of care improve or get worse if we de-regulate in our state as other states did 20 years ago?

Did Ronald Reagan understand that de-regulation and free-market systems can work better than federal mandates?

Today’s times make me realize that everything happens for a reason. Maybe some good came out of being put in “time out” by the Speaker so I could focus on medical issues in our state? 3M was where I was able to pass legislation that is leading to improved health care for the elderly in our state as well as our special needs children.

While I’m not yet ready to file this Health Care Reform bill quite yet, you can read several bills here in SC dealing with Certificates of Need that are already filed and sitting in various committees.

I’d still like to get more input from “real people” in addition to the expert opinions of the medical community before I make a decision on reforming or leaving it be. Please share your thoughts/ideas or contact me directly at Ballentinen@scstatehouse.net. Plesae put ‘HEALTH CARE REFORM’ in the subject line so I can give priority to your email! I’ll have several months before we return to session and I want to give you a chance to participate in perhaps what could be one of the most sweeping open-market, de-regulation event in years.