An amendment that would hurt hospital care

This month, the future of health care in Florida will be in the hands of the Florida Constitution Revision Commission when it decides whether to place the fate of the Certificate of Need program on the November ballot.

While most Floridians have never heard of CON, this regulation has a tremendous impact on the health and well-being of all of the state’s residents. In simple terms, the CON program is a regulatory process designed to limit health care costs and promote planning for new health care services and facilities.

Some elected officials would like to see CON repealed, arguing that deregulating health care would reduce costs and improve quality. I, along with a large majority of my colleagues, disagree. While deregulation may lower costs in a free market, it’s important to remember that hospitals don’t operate in a free market. We don’t set the cost of our services, and we treat everyone regardless of their ability to pay.

We believe that deregulating health care is not good for our community and state. It could trigger a chain reaction that would cause three problems for residents: an increase in health care costs, a decline in the quality of care and a decrease in access to care.

I am the first to admit that CON is a complex issue. It can certainly be hard to understand in a snappy sound bite, and even harder to imagine how it could affect you and your family. So, let’s consider it from the patient’s perspective and examine what things could look like in Florida if CON is repealed:

Scenario 1

Stephanie comes to the hospital to have an outpatient knee replacement procedure performed after the repeal of CON. While CON was in place, her insurer had a set rate it paid for the procedure. But without CON, an influx of new providers could pour into the community and force significant consolidation — meaning health systems could add a number of hospitals across a geographic area, allowing them to negotiate higher reimbursement rates from insurance companies. This higher insurance cost could be passed along to Stephanie through premiums and deductibles. At the end of the day, she could actually pay more for her procedure in a post-CON world. This is the increase in cost of care.

Scenario 2

Mike schedules his brain surgery at his local hospital, an institution he knows and trusts. However, if CON goes away, the number of these surgeries that the hospital performs may drop dramatically. Imagine going from more than 2,000 brain surgeries each year to half as many because new rival hospitals in town do the same procedures. If cases decrease, the hospital’s medical team won’t work together as often. The number of procedures a medical team conducts correlates to quality and outcomes. An increase in volume equates to a higher quality; it’s the old adage practice makes perfect. Lower volume potentially means lower quality. This is the decline in quality of care.

Scenario 3

Patty is having a baby, but she might not be able to go to her local hospital to deliver because the hospital could be forced to discontinue its obstetrics program. With CON in place, many hospitals cross-subsidize obstetrics programs with more profitable programs. But if CON is repealed, the decrease in patient volume and revenue from those services could force the hospital to eliminate several services that make little or no money, including those needed by Patty. This is the decrease in access to care.

As you can see, the repeal of CON has the potential to negatively impact Floridians in a variety of ways. The bottom line is that everyone in our community deserves access to the best, most affordable health care and CON helps to ensure that.

Don’t Legislate Through the Constitution

As you may know from my blog posts last spring, I spent significant time and energy during the first half of 2017 working with other health care professionals and legislators across the state to ensure that the Certificate of Need (CON) program was not repealed here in Florida.

Certificate of Need is a regulatory process that requires certain health care providers to obtain state approval before offering new or expanded services here in Florida. In my opinion, repealing CON remains bad news for the consumer because it has the potential to not only increase costs, but could also lead to a decrease in the accessibility and quality of health care in our state. Thankfully, last spring the Florida Legislature failed to pass a bill that would have eliminated CON. This means hospitals like Tampa General Hospital can continue to offer the highest quality and most accessible care at an affordable price.

As I predicted last June, the debate on CON is far from over. This time, however, those that are set on repealing CON and have been previously unsuccessful have decided to take a new approach. They are now looking to revise the state constitution in order to eliminate CON and in order to do so, have filed a constitutional amendment with the Constitution RevisionCommission that would repeal CON. This would prohibit the State of Florida from limiting the number of hospitals, nursing homes, hospitals or care facilities for individuals.

The Commission’s General Provisions Committee voted inDecember to approve the proposed constitutional amendment, sending it to the full Commission for a vote. If the Commission gives the amendment the thumbs up, the fate of CON will be in the hands of Florida voters come election time in November.

And so, while I am passionate about maintaining CON here in Florida, I am equally passionate about keeping it off the ballot. And here’s why:

1. CON is a legislative issue and not a constitutional one. Lawmakers need to do their jobs. Regulation should be administered via the legislature.
2. A ballot initiative campaign will be incredibly expensive as millions of dollars will be spent on television ads trying to persuade voters to one side of the issue or the other. This is money that could be better spent on helping to provide accessible and affordable health care to millions of Floridians.
3. And most importantly, CON is a highly complex and nuanced issue that would be difficult to explain and be understood by voters in a thirty second sound bite. For a complicated issue that really affects people’s everyday lives, it would be irresponsible of the lawmakers to casually bury this into the ballot.

Everyone in our community deserves access to the best, most affordable health care. The repeal of CON has the potential to dramatically increase health care costs, as well as lead to a significant decrease in quality of health care across Florida. It also has the potential to dramatically decrease access to quality health care that members of my community currently enjoy.

I will continue to do all I can do to make sure that CON remains in place, including working to keep it off the ballot in November. I ask you to join me by making your voice heard.

Specifically, I encourage you attend one of the Constitution Revision Commission’s public hearings being held across Florida during February and March. There, you can let members of the Commission know your desire to have access to high quality and affordable health care and keep CON off the November ballot. 

For a full schedule of the Commission’s statewide tour, visit here.

CON Update

As you know from my recent blog posts this spring, Jupiter Medical Center spent significant energy to keep Florida legislators from repealing the Certificate of Need program. Certificate of Need is a regulatory process that requires certain health care providers to obtain state approval before offering new or expanded services here in Florida.

In my opinion, repealing CON was not good news for the consumer because it had the potential to not only increase cost, but could also lead to a decrease in the accessibility and quality of health care in our state. Thankfully, the Florida Legislature failed to pass a bill that would have eliminated CON. This means Jupiter Medical Center will continue to do what we do every day - offer the highest quality and most accessible care at an affordable price.

We were proud to work with others across the region to ensure that the bill did not come up for a vote in the Senate. But this work would not have been possible without the support we received from thousands of our fellow Floridians who sent messages, called their legislators and shared our efforts via social media. I am grateful and I thank them for their support. In addition, I am extremely thankful for the legislators who in return, took the time to listen and recognize the significance of the issue. Without them, we would not have had the success we did.

At the end of the day, the reality is that CON is smart and appropriate regulation that works and we are glad that it remains. Eliminating CON would end up benefitting the entrepreneurs that want to focus only on profitable services, instead of balancing these with vital services the community needs. When it comes to the people in our community, we cannot let profit be the sole driver of their health care.

However, we believe that the debate over CON is not over and will most likely get taken back up when the state legislature convenes in the fall. We will continue to do all we can do to make sure that CON remains in place and that all Floridians have access to the best and most affordable care. Stay tuned for updates here in the next few months on this vitally important topic and as always, thanks for reading.

Access: Denied!

I have spent the last several weeks talking about the negative effects of the potential deregulation of the Certificate of Need (CON) program in Florida. As I have previously mentioned, CON, a regulatory process that requires health care providers to obtain state approval before offering services in Florida, will be decided in the upcoming legislative session. 

This is not good news for our community. CON has the potential to dramatically increase health care costs, as well as lead to a significant decrease in quality of health care across Florida. It also has the potential to dramatically decrease access to quality health care that members of my community currently enjoy.

If CON were to go away, we would be left with a community where boutique health care businesses move in and offer only profitable services, instead of balancing these with vital services the community needs. This shift in health care would leave patients with fewer options because community hospitals would no longer be able to afford to offer many of the services they currently provide.

You see, the repeal of CON would mean that many patients would find themselves with fewer options for certain acute care services as community hospitals would no longer be able to afford to provide them. These hospitals would be forced to spend most their resources to provide services (the ones that are the most unprofitable) to patients without insurance or the inability to pay. At the same time, community hospitals would see a loss in market share (and thus revenue) of profitable medical services to these new specialty-medical practices that will flood the market post CON - leaving little room for necessary (albeit unprofitable) services and procedures. In Pennsylvania, state health analysts observed a serious decline in general acute care hospitals in the 10 years (1996-2005) after the state ended its CON law. At the same time, there was a dramatic increase in ambulatory service centers.

Finally, the deregulation of CON would hamper Jupiter Medical Center’s ability to provide community benefits like the $7 million we invested in Diabetes education, nutrition services, mammography screenings, wellness classes and support groups in 2015. A decrease in revenue that would come with deregulation could prevent us from providing the services our community needs and limited our neighbors’ access to these types of invaluable services.

I strongly believe that everyone in our community deserves access to the best, most affordable health care. So, I continue to advocate for our legislators to put down this legislation, convene a working group of health care leaders, physicians, medical professionals and patient advocates and work toward providing the highest quality and most affordable health care for this State’s most precious resource - Floridians.

If you are concerned about how the deregulation of CON and specifically, Senate Bill (SB 676) or House Bill (CS/HB7) will affect your access to high quality and affordable health care, I encourage to reach out to your legislators and make your voice heard.

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