by James C. Sherlock
Every time the discussion in this space turns to COPN and its relationship to lack of capacity to deal with COVID-19, some commenters accuse the authors of these columns of favoring nonsensical solutions such as forcing hospitals to build excess capacity. Those same commenters then reject those concepts as unworkable. That is the very definition of a straw man. Unfortunately it mirrors what will be a all-hands-on-deck attempt by Virginia’s hospitals and their lobbyists to sweep the damning history of COPN under the rug in the 2021 General Assembly.
No author has suggested building excess capacity to “sit idle”; what we each have suggested is to let commercial businesses, both for-profit and not-for-profit, build what they think is necessary where the think it is necessary without state interference other than enforcement of antitrust and licensing laws. Every one has carefully wrought business plans. If some misjudge demand, then either they will fail or their competitors will. If it existing provider facilities fail, that means that the new entrant offered better care or a better price or both. Any restrictions on such creative destruction must be swept away for the good of all of us.
What about day-to-day non-crisis access for the poor?
“Recent research by Thomas Stratmann and Jacob Russ demonstrates that there is no relationship between CON programs and increased access to health care for the poor. There are, however, serious consequences for continuing to enforce (COPN) regulations. In particular, for Virginia (COPN restrictions) could mean approximately 10,800 fewer hospital beds, 41 fewer hospitals offering magnetic resonance imaging (MRI) services, and 58 fewer hospitals offering computed tomography (CT) scans. For those seeking quality health care throughout Virginia, this means less competition and fewer choices, without increased access to care for the poor.”[1]
That was a projection in 2015. Today, state COPN data show that the three levels (or now two everywhere but Northern Virginia) of COPN review came to different recommendations or decisions on 40% of the cases. It is clear that the state has no objective standards for restricting supply.
These applications did not seek to build excess capacity in order to let it stand idle. COPN records show that major businesses that have identified over the years unmet needs for extra hospital capacity, new facilities, additional ICU capacity and additional beds, have applied for a Certificate of Public Need and have been rejected.
As a refresher my March 16 column here “Blame COPN for Looming Bed Shortages”, I remind readers that “The certificate denials or withdrawals in the past 20 years that reduced current pandemic capacity include:
- New Acute Care Hospitals. Nine applications, three from Bon Secours in south Hampton Roads, two from Doctors’ (Riverside) Hospital in Williamsburg (second one revised, re-submitted 18 months later and again denied), one from Sentara to be built in Northern Virginia, one from Inova in an unspecified Northern Virginia location, a second different one from Inova Loudoun Hospital Center, and one from HCA, also to be located in Northern Virginia, were denied
- Additional hospital beds: The state denied six applications: three from Inova, two Sentara, and one Carilion.
- Acute care infant bassinets: Two applications from HCA Lewis-Gale Medical Center were denied.
- Inpatient Long-Term Care or Rehabilitation Hospitals: Eleven applications, nine for new facilities and two for additional beds were denied.
- Outpatient surgical facilities. Thirty applications for outpatient surgery centers, which would serve to relieve pressure on hospitals during the crisis, were denied. Hundreds more applications were never submitted. (Maryland data indicate that, with the same waiver for physician-owned surgical centers, Virginia would have about 700 ASCs. Becker’s ASC Review reported yesterday that “Array Analytics’ model shows how much the percentage of total available intensive care unit beds in each state would increase if health systems turn to ASCs for space. Overall, using ASCs could increase the national supply of ICU beds by 21% and boost the national supply of medical-surgical beds by 8% , according to the model’s projections.” Maryland has 523 ASACs, Virginia with a 20% larger population has 78. Commenters here imagine that ASCs will kill hospitals. Yet with all those ASCs Maryland has the same number of hospital beds per 100,000 population as Virginia.)
- Nursing homes. Ten applications for nursing homes, one for a 180-bed facility and nine for additional beds, were denied. Those would have provided space for COVID-19 isolation wards for the elderly in a nursing home setting.”
So let us discuss these issues based on fact, not misunderstanding of the actual historical functioning of COPN and its results. When COVID-19 is over, the hospitals will scramble to defend COPN once again. They have utterly dominated the crafting of state law and policy for the last 50 years and may prevail again in 2021. However, they will be forced, by me and others more influential than me, to answer for these historical facts, including the COPN’s deadly decision in Arlington County (see COPN’s Deadly Quid Pro Quo from March 26 in this space).
We then will truly see whether our Governor and General Assembly can look past their campaign treasuries, influence by hospitals in their districts and their own relative unschooling in the details of COPN restrictions on supply to listen to the facts and do the right thing.
[1] Certificate-of-Need Laws: Implications for Virginia, Christopher Koopman and Thomas Stratmann, Mercatus Center, George Mason University, February 24, 2015
