Letter writer: Repeal N.C. certificate of need law

Graphic by Lori Deaton

North Carolina needs to repeal its certificate of need law. CON laws stifle competition in health care, and North Carolina has among the most restrictive CON laws in the country. These outdated laws severely limit the development of health care facilities such as ambulatory surgical centers and diagnostic imaging centers.

Independent ASCs increase patient choice and convenience, improve quality of care and dramatically lower health care costs. The cost of having a procedure done in an independent ASC can be roughly one half the cost of the same procedure done in a hospital.

You can find out more here: www.reformconnow.com and here: http://avl.mx/2qy

Please contact your state senator and state representative and ask them where they stand on the issue of CON reform!

— David C. Napoli, M.D.


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10 thoughts on “Letter writer: Repeal N.C. certificate of need law

  1. bsummers

    I’m still not sure where I come down on this issue – I see compelling arguments on both sides.

    But the fact that the loudest advocates for repealing CON laws include Civitas, Americans for Prosperity, ALEC, Heritage Foundation, Cato Institute and Sen. Ralph Hise… I’m leaning towards keeping them in place.

    Sorry if that seems knee-jerk, but this club isn’t often the place I see sound public policy coming from.

    • bsummers

      Oh, yes – and the John Locke Foundation, which is where that 2nd link takes you to. Odd.

      • This is how progressives make up their minds. No thought, just reactionary impulses. No discussion of the merits, just ‘ad hominem’ hysterics.

        • bsummers

          Another insult. What a surprise.

          Unlike you, I made no ‘ad hominem’ comments, nor was I hysterical. I acknowledge that I see both sides of a complex issue, but take note that prominent supporters on one side are those who push an ideology that I do not support. Until I learned more, that’s the first thing that I absorb about the issue.

          That, and the fact that the letter writer is associated with a Political Action Committee that has spent tens of thousands of dollars on political campaign contributions in order to influence this issue just in the past few years. There appears to be a strong financial aspect to his advocacy that ,maybe ought to be acknowledged. That’s not ‘ad hominem’ either – that’s wanting to see transparency about one’s motives. Financial self-interest and doing the right thing on principal are not mutually exclusive – but readers should know & make up their own mind as to motivation.

          As to the merits, I share the concerns of NC hospitals, large and small, urban and rural, about the effect of allowing ’boutique’ clinics to siphon off profitable patients and services, leaving them to shoulder the cost of providing emergency rooms, indigent care, and other non-revenue-generating services. Sure, ‘competition’ sounds good, but at the risk of driving full-service hospitals out of business?

          • bsummers

            (Stilts?)… So no “discussion of the merits”, then? Just another insult? Huh. Who coulda predicted that?

            BTW, I think it’s really plucky of you to get back on the comment boards after your massive humiliation last week on the district elections bill. Atta boy.

            And speaking of knee-jerking, the PAC that has been lobbying on this CON issue for years, that the letter writer is a member of – they were Tim Moffitt’s earliest, largest donor, going back to 2008. That kinda seals the deal for me…


    • luther blissett

      I’ll offer a few points on both sides of the argument. Asheville punches above its weight in terms of provision for a city its size, thanks to its wealth and demographics, but there are still underserved needs, as demonstrated by long waiting times for certain specialist areas. It has also seen the consolidation of outpatient specialists under Mission in recent years, as part of a grand strategy to avoid being picked off by one of the even bigger hospital groups out east.

      There are certain medical advantages to consolidation — shared records, continuity of care — but it funnels proceeds into the Mission beast, and can lead to certain things being billed at hospital rates when previously they were treated as outpatient specialist-level procedures. There’s also the potential for monopolistic abuse, as the antitrust lawsuit against Carolinas in Charlotte makes clear: they’re accused of dictating terms to insurers about which facilities must be added to networks in order to gain access to their large hospitals.

      So the devil’s in the details. We know that ‘competition’ in health care is mostly BS. We know how imaging centers have been a source of kickbacks and unnecessary treatment in states with slacker laws: those million-dollar MRI machines don’t pay for themselves. We also know that free-market ideologues like the John Locke Foundation have no desire for American health care to follow the example of the world’s most effective systems, because that cuts into profits.

      I’d support intelligent reform to CON laws that take account of both the number of facilities and their corporate ownership — and strong regulations to ensure continuity of care and prevent monopolistic behavior. That kind of reform is probably not going to come from that particular gang. A “reform” that simply rewards one set of “docpreneurs” who have ample money to spend on lobbying and funding candidates is no reform at all.

      • bsummers

        and can lead to certain things being billed at hospital rates when previously they were treated as outpatient specialist-level procedures.

        Which of them is higher, and who wins/loses in that change – hospital/patient/specialist?

        • luther blissett

          It’s as you might expect: from low to high, general/family primary care, independent specialist, hospital outpatient department, hospital inpatient.

          When Asheville X-ology Associates becomes the outpatient branch of Mission X-ology, as has happened with a number of outpatient specialists over recent years, certain procedures or tests may be billed as Mission outpatient services, which generally costs more to both the insurer and the patient. The patient loses out because things that might have been covered by a co-pay may now be billed as coinsurance. Similarly, if an in-network family doctor now sends its labs to Mission because it’s cheaper and more efficient for them than having a lab on site, insurance may consider that an out-of-network service and not fully cover it, or not cover it at all. This is the case with some ACA plans in Buncombe County that don’t include Mission labs in-network: I assume it’s because they charge more than other labs in the area for the same tests and insurers weren’t willing to accept those charges.

          There are lots of medical advantages to more integrated relationships between family doctors, outpatient specialists and inpatient departments — conditions get diagnosed and treated faster and more effectively when your doctors are willing to talk to each other instead of just trading faxes. There are also medical and economic efficiencies in consolidating discrete and much-repeated services like lab work: as long as they’re not overworked, you should want the people doing your blood panels to be people who do blood panels every day. All that considered, Mission’s acquisition strategy has been accompanied by a willingness to “up-bill” specialist services, and that needs to be regulated.

          Of course, in a sane health care system, fee-for-service would go away, or at least there’d be transparent pricing for services and no mystery billing. But America can’t have a sane health care system.

          In short: it shouldn’t be this hard for patients, who currently have to interrogate their doctors’ front-desk staff to work out how they bill for in-house services and what they outsource, then check with their insurers, then come up with some arrangement that satisfies everyone.

          Sensible CON reform would bring providers — big and small — and insurers to the table and establish the facts on the ground. If large providers aren’t going to cut their rates, and insurers aren’t willing to pay those rates, then open the door wide for independent competition. Yeah, that sounds like central planning for capitalism, but that’s how great capitalist economies like Germany do health care.

          • bsummers

            Thanks – very good explanation. As I said, I see compelling arguments on both sides. You suggest a reasonable approach: treat healthcare “infrastructure” almost like a complex public utility. There is a strong public interest in regulating it beyond other sectors – but the threat of opening it up to competition might reign in abusive monopolistic behavior.

            Unfortunately, being the pessimist I am, I suspect that reason will not stand up to the ideologues and campaign contributors and lobbying thinktanks who want to create a free market jungle of competition that prizes profits over people, especially for well-placed cronies. Almost better to keep the can of worms shut until a saner General Assembly takes office.

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