Not all health care fights are in Washington
The continuing political debate over Medicaid expansion is about to intensify in Georgia. Meanwhile, another and more familiar conflict is already fully engaged.
Georgia's hospital "certificate of need" (CON) process, well known to many -- for better or worse -- in this regional health care community, is a regulatory vehicle whose ostensible purpose is to govern public access to and affordability of medical care. Not surprisingly, it becomes a flashpoint just about every time somebody wants to build a new health facility or expand an existing one.
The case of the Cancer Treatment Centers of America facility in Newnan is no exception.
Hospitals, especially public ones, frequently cite CON as their primary protection against other health care centers, especially private for-profit hospitals, luring away paying patients and those with private insurance, leaving the public facilities to care for the poor, the indigent, the uninsured, all at taxpayer expense. That expense can be unsustainable, as demonstrated by the alarming spate of rural hospital closures in recent years.
The Florida-based Cancer Treatment Centers chain obtained CON approval to open its Newnan hospital, limited to 50 beds, and the state stipulated that at least 65 percent of its patients come from out of state. Now CTCA has applied to the Georgia Department of Community Health for recertification as a general hospital, in effect freeing the business from the original CON restrictions.
The department has given the application preliminary approval; some incensed lawmakers say that approval is moot, because the legislature voted down these very changes in CON restrictions in the most recent legislative session.
"This is about subverting the power of the General Assembly," said Sen. Renee Unterman, R-Buford, chair of the Health and Human Services Committee, "and using the bureaucracy to go around what the intent of the legislature has been."
And, as might be expected, spokespersons from other hospitals around the state were doing some pretty heavy lobbying of their own. Among them was Georgia Hospitals Association CEO Earl Rogers, who accused Cancer Treatment Centers of not even living up to its original agreement to accept a certain percentage of Medicare and Medicaid patients -- an accusation to which CTCA officials responded by saying they will report those figures when they are required.
It's not a simple matter to resolve, because health care has never been and can never be a true "free market" in the traditional sense.
"This whole conversation has to do with which policy changes would raise patient costs or reduce access to care entirely," Bill Custer, a business professor at Georgia State University, told Associated Press. "If a hospital nearby goes under, your ability to get care is undermined, regardless of your ability to pay."
This story was originally published October 21, 2015 at 5:16 PM with the headline "Not all health care fights are in Washington."