by James C. Sherlock
Do Not Regulate Surgical Decisions
There are things the state should not do during an emergency. Regulating elective procedures is one of them. I agree with the statement of the hospitals[1]. If we had more hospitals and far more physician-owned ambulatory surgical centers, the problem would have an alternative solution. But we don’t because of 47 years of Certificate of Public Need regulation. The decisions of Virginia’s Health Commissioners artificially limiting supply are available in state records for all to see.
A key reason I agree with the hospitals position that decisions on surgery should remain at the local level is that even if some might think such things should be regulated by the state, and I don’t, it is far too late for intervention in a matter that the state is not set up to oversee. Blind regulation is a terrible thing to contemplate.
Deal with the Connected Issues of COPN and State Oversight of the Business of Healthcare
The Governor just waved Certificate of Public Need (COPN) restrictions, but effectively only for certificate holders. The Governor and the General Assembly can heavily reduce the restrictions in COPN or repeal it next year, but there are legislative solutions immediately available that can help. In the upcoming special session, the General Assembly should pass two bills that were laid on the table in the House of Delegates earlier this year:
- HB 608 to set up Healthcare Enterprise Zones to bring better primary care to the poor; and
- HB 1094 to exempt physician-owned surgical centers from COPN.
The bills would take effect in the summer and fall and are necessary as soon as they can be implemented. Waiting until 2021 to pass those bills is clearly wrong. Each is modeled after successful programs in Maryland where they have proven to save Medicaid tens of millions of dollars[2] (in the case of HB 608) and hundreds of millions of dollars (in the case of HB 1094) in excess of their costs. The relative costs to Medicaid of surgeries between hospital outpatient departments and independent ambulatory surgical centers is available from the Department of Medical Assistance Services. They basically cut the costs in half. Appropriations Committees should base budget cost-benefit analyses for HB 608 and HB 1094 on those documented data.
Each bill was modified heavily in the drafting process and in committees from the language submitted. I can provide more detail to flesh out each bill to restore language to more closely model the bills on the Maryland models should the General Assembly request it.
Finally, I recommend legislation next year to appoint and empower the State Corporation Commission to oversee the business of healthcare delivery in Virginia. It is the business decisions of the healthcare providers, not their medical decisions, that has left us short of supplies, equipment and training with which to combat COVID-19. State oversight is entirely missing except for the COPN program. COPN limits supply with provides permission slips, but does not otherwise oversee the business, including the regional monopolies it has created. The Department of Health will retain oversight of the practice of medicine.
[1] https://www.vhha.com/resources/wp-content/uploads/sites/17/2020/03/Elective-Procedures-Position-Statement-3.18.20.pdf
[2] https://www.jhsph.edu/news/news-releases/2018/maryland-health-enterprise-zones-linked-to-reduced-hospitalizations-and-costs.html
