To CON or not to CON

As I recently wrote, Certificate of Need (CON) has come up once again this legislative session. For those outside of the industry, the CON program is a regulatory process that requires certain health care providers to obtain state approval before offering new or expanded services. The CON program in Florida regulates the construction of new hospitals, hospices, skilled nursing facilities, and care facilities for the developmentally disabled, as well as certain hospital services.

To start out, let's remind ourselves that as health care providers our purpose is three-fold: 1) to improve patient outcomes and the quality of care we provide; 2) maintain or, when possible, decrease cost; and 3) improve access to the services we offer. If we can do these things at the same time, then we are batting a thousand.

And so, I have spent a lot of time studying the positives and negatives of CON deregulation. Research is all over the map regarding whether deregulation improves quality, lowers cost and increases access. There are those who believe that it will achieve these goals, while others feel it will have the opposite effect.

I am a strong believer in the free market system and understand that healthy competition can be good for business and consumers. This is not about competition - we compete every single day in the health care space. This is not about a free market economy. Free market economics does not apply to acute hospital care. We must take care of every patient that walks in the door. 

What the regulation of CON is about is what is best for the consumer. As someone who provides health care in a non-profit setting within a specific local community, and whose primary responsibility is to the people we serve, my recommendation is to continue Certificate of Need for acute care hospitals.

The deregulation has the potential to negatively impact the consumer in the following ways:

• Loss of Vital Services—Community hospitals across our state could no longer afford to offer many critical health care services. With no regulation, boutique health care businesses can move in and choose to offer only profitable services, instead of balancing these with the vital services the community needs. That means losing many essential programs you and your family may depend on.
• Reduced Quality—It is well-documented that the more times a hospital performs a procedure, the better the outcome. Adding more hospitals spreads out the patient volume, leaving providers performing complex procedures only a handful of times. Think about it—would you rather have neurosurgery in a hospital that performs 100 of these sophisticated procedures a year, or only four?
• Higher Costs—While eliminating CON is being touted to create more competition and drive down costs, the opposite is more likely to happen. We compete against other hospitals in our area every day, and that’s a good thing. But delivering healthcare is not like selling widgets. Bring more widget sellers into a market and sure, prices will go down. But let more health providers come into a market without any oversight or planning to determine the need for more services, and costs will rise.

And so, for those consumers who want to ensure high-quality, affordable and accessible health care for themselves and their families, I encourage you to reach out to your elected officials and make your voice heard. Become informed about the issue and even attend your local town halls to participate.

The deregulation of CON matters because it is about you. It is about the patient. It is about the health and well-being of our community. And so, I invite you to engage with me on this topic, as I continue discussing ways we can all contribute. You can connect with me both here and on my blog, Inventing Health.