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health care professionals and legislators across the state to ensure that the Certificate of Need (CON) program was not repealed here in Florida.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.

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.

Like what you read? Want to keep in touch? Please connect with me on LinkedIn.

No Place for Health Care in a Free Market Economy

Last week, Florida State Senator Rob Bradley, State Senator Rob Bradley  introduced legislation (SB 676) which seeks to repeal the Certificate of Need program here in Florida. Despite the potential for an increase in cost and decrease in quality, that would come with deregulation, Governor Rick Scott has expressed his support of the legislation.

As I have explained in my previous posts, the Certificate of Need program is a regulatory process that requires certain health care providers to obtain state approval before offering new or expanded services. The CON program in Florida regulates the construction of new hospitals, hospices, skilled nursing facilities, and care facilities for the developmentally disabled, as well as certain hospital services.

As you also know, I oppose the deregulation of CON, in particular as it relates to the creation and expansion of inpatient care. I have outlined in significant detail the negative effects deregulation of CON would have in previous posts but in short, I believe it will have a negative impact on cost, quality and access to health care in our state. However, Senator Bradley, Governor Scott, and those who support the elimination of CON believe that free market forces will improve quality while lowering costs.

And while I staunchly believe in free market economics, the reality is that health care does not operate in a free market space. In a free market economy, prices, quality and quantity of goods and services are determined by the open market and consumers.  In addition, the government imposes very little - if any - restrictions and regulations on the forces of supply and demand that drive the costs of goods and services.

Hospital pricing cannot be determined by a free market system because a hospital cannot set their own pricing for services. Hospitals are reimbursed for services based on rates established by the Centers for Medicare and Medicaid and thus, must work with insurance providers and government agencies to negotiate wholesale pricing. In addition, hospitals cannot provide or deny services based on a patient’s ability to pay, making the system of supply and demand irrelevant. For example, if a patient comes to the ER requiring stiches, federal law requires that they be treated even if they do not have insurance or the money to cover the cost of the treatment they received.

Additionally, hospital and health care pricing is also incredibly complicated and there is a scarcity of price information out there for consumers. This makes shopping for certain types of health care services incredibly difficult and many times, consumers won’t know exactly what they owe for a procedure until they get the bill. There also tends to be significant variety in pricing from provider to provider and cost does not always directly correlate to quality. This is yet another complication when it comes to health care in a free market space.

When new hospitals come into the region due to deregulation, they will look to compete for patients with insurance coverage or the financial means to pay for their own care. And so, while I am a big believer in free market economics and know the positive effects it has on many sectors of our economy, free market economics and deregulation simply don’t work when it comes to health care. Despite the belief of those who support the legislation, it will drive up costs and decrease quality. Take it from someone who has been working to provide quality health care to the consumer for the past 20 years.

And so what, now? As I have said before, I think here in Florida we can buck the trend, put party politics and ideology aside and come together in the spirit of doing the right thing for our State when it comes to access to high quality and affordable health care. I don’t think we need to rush bills into the legislature but instead, we can sit down at the same table and thoughtfully and engage with each other to work towards a positive outcome that puts consumers and our neighbors first.

It is in this spirit that I want to challenge our legislators to put together a statewide “blue ribbon” working group comprised of legislators, health care leaders, physicians, medical professionals and patient advocates. This mission of this group will be simple: to come together, roll up its collective sleeves and work toward providing the highest quality and most affordable health care for this State’s most precious resource—Floridians.

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

Like what you read? Want to keep in touch? Please connect with me on LinkedIn.