Asheville’s big day in Raleigh

Today at 10 a.m. two major local issues will be discussed (and finalized) in Raleigh at the General Assembly. The two issues include the debate regarding the fate of Asheville’s water system and whether Mission Hospital will continue to operate under the only Certificate of Public Advantage in the state.

Here are the nuts and bolts of these issues:

Asheville Water System
People in Buncombe County and surrounding counties have been getting pretty fired up about what will happen with Asheville’s Water System that is currently operated by the City. In a series of hearings, the Metropolitan Sewerage/Water System Committee has to make a decision. These are the three options:

1. The City keeps its water system
2. The City turns the water system over to MSD
3. The City turns the water system over to a separate, independent regional water authority similar to MSD

However, last week a draft of the committee’s recommendation was leaked to the public, showing the committee plans to give control of the water system to MSD. After the draft went public, the committee has been asking for public comments on the draft report.

Mission’s Certificate of Public Advantage:
Mission Health operates under the only Certificate of Public Need in North Carolina, and at a recent press conference CEO Ron Paulus said he would like to see its elimination. In a recent call-to-action, Paulus encouraged members of the community and the hospital to write to their local representatives. More than 9,000 letters were sent. However, not all hospital systems agree with him. Park Ridge Hospital and other medical groups have accused Mission of aggressive, monopolistic practices; Mission says that the COPA isn’t fair and no longer suits modern-day realities in the health care industry.

The recommendations made by the Select Committee on Certificate of Need Process and Related Hospital Issues are as follows:

1. Buffer zone: Recommend the creation of a reasonable buffer zone that limits health care organizations operating under a COPA from locating specific medical services lines within 10 miles of an existing hospital or health care provider.

2. Future CON applications: Recommend that any entity operating under a COPA must submit as part of its Certificate of Need applications a separate third-party economic impact analysis on existing providers to maintain healthy competition and local access to services in the region.

3. Extend physician cap: Recommend that a physician employment cap associated with hospitals operating under a COPA be extended to the entity’s true service area.

4. COPA reports: Recommend that COPA compliance reports be made annually to Division of Health Service Regulation and audited both for financial compliance by DHSR and for operational compliance with the law by the N.C. Attorney General’s Office. Biannually an economic analysis will be conducted by an independent economist selected by the state attorney general’s office. Reports will be open to the public for review and comment.

5. COPA transition: Recommend that the Program Evaluation Division study and identify circumstances, if any, under which a COPA may be withdrawn. Removal of a COPA must only be considered if sufficient documentation is presented to demonstrate that adequate competition has entered the health care market A request to withdraw a COPA should require a public filing, hearings, opportunities for public review and comment resulting in a written decision by the Department of Health and Human Services and the Attorney General’s Office, which allows for the right of appeal.
The committee also recommended a baseline audit of the current entirety covered by the COPA, including a review of both financial and operational compliance.

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