Georgia hospitals might follow South Carolina on certificate of need change

COLUMBIA — As South Carolina squirms over its newly suspended regulations on hospital expansions, a spokesman for the Georgia Hospital Association says Georgia could find itself in a similar spot.

Kevin Bloye said there’s a push underway by some physicians to try to weaken the certificate of need program in Georgia.

“We expect CON actually to be right at the top our legislative agenda in 2014 in Atlanta,” Bloye said. “It’s a hot-button issue everywhere. This is not unique to South Carolina.”

Nearly three dozen projects seeking a certificate of need are listed as under review in South Carolina. The list includes a new $77,000 Home Health Agency for Aiken County, sought by Augusta’s CareSouth HHA Holdings, and the $1.5 million construction of a freestanding endoscopy-only ambulatory surgical facility, sought by Aiken’s Center for Colon and Digestive Diseases.

The ability of poor and rural communities to maintain access to health services is one element at stake in the debate.

Under the program, which most states use, hospitals must apply for a permit in order to build a new facility, add to an existing one or purchase expensive equipment. A central purpose is to prevent duplicative services from existing in one place, while starving rural and poor communities of accessible facilities.

Medical health and safety standards are unchanged.

After voting last month to sustain Gov. Nikki Haley’s veto of $1.7 million in operating money for the program, South Carolina House lawmakers said they weren’t trying to kill the program. After all, they said, the law that requires permits was not repealed. South Carolina’s health agency has asked the state Supreme Court to weigh in on whether it is required to regulate hospital expansions – even without funding.

Haley’s intentions were clear.

“The certificate of need program is an intensely political one through which bureaucratic policy-makers deny new health care providers from offering treatment,” argued the Republican governor in her veto message. “We should allow the market to work, rather than politics.”

In Georgia, the targeting of certificates of need appears to be led by doctors.

Bloye said some physicians are hoping to expand the number of specialties that may be housed in a facility in order to cherry-pick patients.

“Really, when you’re talking about physicians who want to open these multispecialty outpatient surgery centers, they’re going after one kind of patient, those with insurance,” he said. “They’re not aiming for Medicaid recipients and uninsured patients. ... It’s very difficult for hospitals to keep their doors open if only providing care to uninsured and Medicaid patients.”

Bloye said the Georgia Hospital Association would like to see South Carolina’s program continue to operate, adding that it has served its intended purpose.

Paul Hinchey, the president and CEO of St. Joseph’s/Candler in Savannah, Ga., said the health system “strongly supports” the certificate of need program.

“Although St. Joseph’s/Candler currently does not have any pending CON applications, this decision could impact how we invest in services in the future,” he said. “We are hopeful a solution will be found.”

It’s possible that certificate of need-regulated Georgia hospitals and communities on the state line with free-wheeling South Carolina facilities would suffer competitively, but the South Carolina Hospital Association, which supports the regulatory program, said Haley’s action paralyzed the state’s facilities.

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