Taxpayers and patients unnecessarily pay hundreds of millions of dollars in medical costs because of arcane regulations, turf-protective hospitals, and a state regulatory agency that opposes reforms, say physicians seeking legislative relief to open more doctor-owned same-day surgery and diagnostic clinics.
“We’ve had a problem [for] many years” with the certificate-of-need laws that place restrictions on free-standing ambulatory surgery centers, Richard Bruch, chairman of the North Carolina Specialty Hospital Board, told a March 18 meeting of the Market Based Solutions and Elimination of Anti-Competitive Practices in Health Care Committee, a legislative task force.
Two bills were debated in last year’s General Assembly following an 18-month legislative study of health reform. The bills never reached a full vote due to conflicts between doctors and hospitals about the need for competition. As a result, the task force was created.
Speaking as an individual, Bruch, an orthopedic surgeon who also is team physician for the Durham Bulls, said one of the biggest impediments to cost-saving innovations is a state agency on whose board he serves — the North Carolina State Health Coordinating Council.
He said the SHCC’s goal appears to be “to protect the certificate-of-need holders and not allow for enough competition.” The agency oversees the legal process required to obtain certificates of need. The CON law is intended to prevent unnecessary market duplication of equipment, facilities, and procedures that could drive up health care costs.
Existing hospitals most often have the resources and clout to obtain certificates of need, as they have the capacity to tolerate the high regulatory costs, long waiting times, paperwork, and, sometimes, lawsuits involved to navigate the CON process and build new facilities.
Having a certificate of need gives unfair advantages to hospitals to enhance off-site operations not available to new applicants, physicians say.