Certificates of Need (CONs) Not Needed !

Meeting with Jay Singleton, M.D.
CON Reform Bill Press Conference in Raleigh
CCTA Legislative Action Committee Report of 3-13-15

Our Legislative Action Committee has been busy. On March 4th, we met with Jay Singleton, a local ophthalmologist, who is trying to get the requirement for a “Certificate of Need” (CON) reformed, or at least the way the game is played changed. As you know, our Legislative Action Committee wants North Carolina to get rid of the requirements for a Certificate of Need for any medical facility and just let the free market work as it does wonderfully well when the government stays out of the way. However, pushing it back a bit at a time may work better in terms of getting results. You know the drill; baby steps, walk well, then run.

Jay’s particular concern is about “ambulatory surgical facilities” (aka “same day surgery centers” and “outpatient surgery centers”). Hospitals fight them. They do not want physicians to be able to set them up and run them independently.

When looking at this, there are 2 important things to remember.

First, Physician owned out-patient surgeries CHARGE SIGNIFICANTLY LESS than hospitals.

Second, they expose patients to fewer risks. For example, they avoid exposing patients to the airborne pathogens found in hospitals. Also, hospital operating rooms are staffed with people who help with a number of kinds of procedures. They’re usually very good, but they must be generalists. Physician owned out-patient surgery centers are staffed by people who work with the physician’s particular specialty all the time and get especially well versed in it. That kind of in depth experience helps avoid mistakes.

However, in spite of those things which make physician owned surgery centers very desirable, it is very difficult and expensive for a physician (or small group of physicians) to get a Certificate of Need to enable them to build one because of the silly games the regulations enable hospitals to play.

Hospitals do not have to build operating rooms for every Certificate of Need they have. And once built, they do not have to use them very often, or even at all. Every Certificate of Need they hold will count as “one operating room” no matter how many are really in operation. So far as the regulators are concerned, every CON they’ve issued is an operating room!

In theory, this means operating rooms are overbuilt and there is no “need.” Imagine trying to prove there is a need in this Alice-in-wonderland world.

While operating rooms approved for individual (or groups of) physicians DO GET USED, imagine the situation already described, and add to that the fact that a local hospital con VETO their application, and you’ve some idea of the David and Goliath situation that exists.

Two things are going forward simultaneously to try to improve things.

A law firm has filed a petition asking that the North Carolina State Medical Facilities Plan’s methodology for calculating “operating rooms needed” be changed At a point down the road, CCTA may be asked to help get signatures on the petition.

The second thing is that House bill 200 (H200), a bill to “Amend Certificate of Need Laws,” was filed by Representative Marilyn Avila on 3-10-15. If passed, this bill would exempt ambulatory surgical centers (and diagnostic centers, gastrointestinal endoscopy rooms, and psychiatric medical facilities) from the requirement to obtain a Certificate of Need. However, this is a huge “IF.”

Representative Avila held a press conference to introduce the bill to the press at noon on 3-11-15. It was short notice, but 3 CCTA members (Kim Fink, Kathryn Blankley, and I) attended.

The press conference was conducted very well. Representative Avila spoke first, followed by her co-sponsors, two people from Americans for Prosperity, and an ophthalmologist and a practice manager. Each spoke from his or her own perspective, and the package made a compelling argument. However, questions from members of the press made it clear that they recognize that hospitals will come down solidly against this, and as we all know, hospitals have buckets of money and influence.

To have a prayer of passage, we and others need to follow the bill, attend the committee hearings on it and stay on it like “ugly on an ape” the way Kim Fink’s Public Education Committee is following the progress of efforts to get rid of Common Core.

Respectfully submitted,


Raynor James, Chairman, CCTA’s Legislative Action Committee

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