COPN – Don’t Leave Home Without It

by James C. Sherlock

Sometimes I think we don’t personalize the effects of Virginia’s Certificate of Public Need (COPN) program on individual Virginians in ways that are relatable. Nor do many understand the power of the hospital monopolies.

Many readers here have followed the progress of our reporting of the increasing and relentless suppression of competition in healthcare by COPN. I will offer in this essay a single example that may personalize it.

In 2009, the regulation, not the law, that defined the radius from your home of facilities that would be considered when seeing whether you are adequately served by existing open heart surgery facilities was changed as follows:

Title 12. Health » Agency 5. Department Of Health » Chapter 230. State Medical Facilities Plan » Part IV. Cardiac Services

Article 2
Criteria and Standards for Open Heart Surgery

12VAC5-230-440. Accessibility Travel time.

A. Open heart surgery services should be within 30 60 minutes driving time one way, under normal conditions, of 95% of the population of a the [ health ] planning district [ using mapping software as determined by the commissioner ].

Simple change. Thirty minutes was changed to 60 minutes. You surely did not notice. You were meant not to notice. And your elected representatives were not asked to vote on it.

The regulation was changed to reflect that you, as a citizen, were well served with a sixty=minute drive to a facility which could perform open heart surgery as opposed to the 30-minute drive in the previous regulation.

Certainly the hospitals offering open heart surgery were more than fine with it.

When one doubles the radius of the circle from one unit to two, the area of the circle goes from 3.1416 square units to 12.5664 units. It quadruples.

So the chance of, say, your closest hospital getting a certificate to create an open heart surgery service just collapsed.

If that is OK, and it might be, we could at least expect a footnote explaining why it is so.