In response to your January 5, 2015, opinion, “Certificate of Need: A Bad Idea with Political Staying Power,” Virginia’s Certificate of Public Need law has at its core the recognition that many preconditions for an effective “pro-business” marketplace don’t exist for health care and that a regulatory process designed to ensure that Virginians have access to essential health care services is necessary for the public good. The law has undergone significant reforms through its 40-year existence in Virginia; however, its fundamental role of providing Virginians access to essential and high-value health care remains intact.
Nearly every Virginian is within a 20-mile drive of a hospital, which is staffed 24 hours a day, seven days a week, 365 days a year. These full-service hospitals offer a wide array of services, some are profitable, others are not (oftentimes the profitable services help subsidize the cost of those that are not profitable). They are required to care for all patients regardless of their ability to pay; held to higher quality and safety standards; subsidize the societal costs of training the health care workforce; maintain services 24/7/365; and provide surge capacity to deal with natural or man-made disasters. They also must contend with environmental, labor, occupational health and safety and other regulations that many businesses face, as well as the fact that the major purchasers of health care – Medicaid and Medicare – pay well below the cost of providing care. They do this because their communities depend on them to be there in any situation. One must only look at local, state or national news coverage when a full-service hospital closes or stops offering a specific service in its community to see the public outcry. There are no strong market incentives to provide many essential services, and there is no business case for a new market entrant to treat patients who cannot cover the cost of their care.
Rightly stated, hospitals contribute to the financial burden of caring for Virginia’s low-income uninsured. In 2013, Virginia’s hospitals provided over $628 million in financial assistance. In the face of continued cuts imposed by the Affordable Care Act, sequestration under the Budget Control Act of 2011 and the American Taxpayer Relief Act, one third of Virginia’s hospitals operated in the red last year, before many of these cuts went into effect, and bond rating agencies are forecasting an even bleaker 2015 outlook.
In 2000, the Virginia General Assembly passed a bipartisan law to responsibly deregulate COPN. In phasing out the law, certain protections were put in place to ensure a balanced and controlled approach to adequately address access to essential services and health professions training; disaster preparedness; safety net health care; quality of care oversight and accountability of all health care providers; and market fairness. Unfortunately, lack of funding put the deregulation plan on hold. However, COPN continues to work for Virginians today.
While alternatives to COPN review may be more prevalent now than when the program was enacted, a solution for how best to cover the costs of serving the indigent and uninsured populations has not been provided, and the usefulness of COPN regulation in controlling use of resources remains an important consideration for how the state chooses to ensure access to care for low-income uninsured Virginians. If COPN was to be deregulated, the ability of all Virginians to receive access to vital health care services must remain intact.
The deregulation of other industries has led to public perception of diminished quality services in those fields. We cannot afford to let that happen with health care. We must insure that health care, if deregulated, is done in a responsible manner to protect all Virginians. Reasonable people can disagree about COPN, but no one wants to place the stability of our health care system and access to essential and high-value health care services at risk.
Sean T. Connaughton is president and CEO of the Virginia Hospital & Healthcare Association.There are currently no comments highlighted.