Georgia lawmakers are rewriting the state’s regulations for approving new health care facilities, and several bills in the Capitol are making leaders of the Northeast Georgia Health System nervous.
Three bills, one in the Georgia House of Representatives and two in the Georgia Senate, propose alternatives to the state’s Certificate of Need program that could open the state to more competition among hospitals, but NGHS officials say weaker regulations could put well-established health care hubs at risk.
The program is administered by the Georgia Department of Community Health and requires health care providers to seek state approval for new or expanded facilities. The goal is to protect investments that community hospitals have made in specialized care or technology and prevent a redundancy in services.
NGHS has filed a certificate of need for an ambulatory surgery center at its Braselton hospital, for example.
House Bill 198 and Senate Bill 74 would replace CON with a licensing system. Senate Bill 114, which has been sponsored by State Sen. Butch Miller, R-Gainesville, and State Sen. John Wilkinson, R-Toccoa, would create a council that would develop a state health plan and recommend possible changes.
“The council is going to work to measure health outcomes, how are the health outcomes over time and what adjustments need to be made,” Miller said. “There’s going to be some adjustments over time in CON and patient health care, whether it is access to care, whether it is price of care, whether it is breadth of care. There will be changes, and this council is going to really look at that.”
Miller said the issue is especially relevant in Hall County, which serves as a health care center for the region.
“What we want to do is provide better access to health care, and hopefully in the meantime drive price down,” Miller said.
The council created by Senate Bill 115 would have members from urban and rural areas, members from the business community, and representatives from hospitals or facilities that provide a variety of services, including pediatric hospitals and nursing homes.
Wilkinson said that needs vary in different communities around the state, so a one-size-fits-all approach would not be a viable solution. He also said that many nonprofit hospitals would struggle to compete with facilities like outpatient centers if CON was eliminated.
Senate Bill 114, which would evaluate rather than repeal CON, is supported by the Georgia Hospital Association because it would allow for some changes without gutting the CON process.
“CON helps control costs by requiring all applicants to demonstrate the need for services and facilities in order to prevent over-utilization and unnecessary duplication of services, while also discouraging unfair competition from facilities that serve few, if any, Medicaid and uninsured patients,” Ethan James, GHA Executive Vice President of External Affairs, said in a statement. “GHA supports SB 114, which is a fair compromise to update and modernize CON while maintaining the health-planning process.”
All of the bills are expected to be amended as discussions continue.
Nonprofit hospitals like the Northeast Georgia Medical Center are required to re-invest any profits into services and programs that would benefit the community. NGHS’ financial assistance policy states that it provides emergency or medically necessary care to people in its service area.
“A not-for-profit hospital also needs to generate a profit in order to stay in business, but that profit is not distributed to shareholders – rather it is reinvested into services and facilities,” R.K. Whitehead, the NGHS board chair, said in a statement to The Times.
And some legislators say that not-for-profit health care providers could lose paying patients if for-profit entities can attract all the insured patients.
“If the paying patients leave a nonprofit like Northeast Georgia to go to a standalone, multi-specialty clinic where they can receive these services, sometimes at a lower cost because they’re not taking the numbers of Medicaid and indigent patients, that puts our hospital at risk,” State Rep. Lee Hawkins, R-Gainesville, said. “They’re losing paying patients.”
Carol Burrell, president and CEO of the Northeast Georgia Health System, said the two bills that would replace CON would be harmful to the health system and other nonprofit providers.
“There’s still time for both pieces of legislation to evolve and change before the end of the legislative session, and we’re hopeful legislators will find common sense solutions that better protect the care of our communities,” she said in a statement to The Times.
Whitehead also said those bills would put NGHS in a difficult position. The health system would still be required to provide vital services like emergency or trauma care to people who cannot pay, he said.
“That means the groups only focusing on highly profitable procedures can cherry pick the well-insured patients to make money, leaving hospitals to struggle to make ends meet to continue providing life-saving care the community needs,” Whitehead said.
The health system provided $58.2 million in charity care in its last fiscal year, which ran from October 2017 to September 2018. That number includes all NGHS hospitals as well as other facilities like its Heart Centers and imaging centers.
State Rep. Emory Dunahoo, R-Gainesville, said that some health care providers have created a monopoly, but “we need to make sure that we compare apples with apples,” and any changes should account for the challenges nonprofit hospitals face.
But competition does not always have to be negative, Dunahoo said.
“I still want to see a little more transparency where we bring to the table other options,” he said. “If I’m a patient and I can choose between six hospitals, that’s a lot better for me. … I like the opportunity of competition. I always have, as a businessman. It makes everybody better. It makes prices better.”
State Rep. Matt Dubnik, R-Gainesville, said the discussions about CON are part of a larger theme in the legislature of meeting the needs of rural Georgia. Legislators want to protect community hospitals, especially in rural areas, but there are a lot of factors to be considered in deciding the best way to do that, he said.
But Dubnik said the CON debate is especially relevant for his constituents in Hall County, where the health system is the top employer.
“This is a community that in a lot of ways is built around or built upon the health care industry, and I think if we have decisions that negatively impact our health care entities in our city or county, that has a negative impact on our city and county,” Dubnik said.
Hawkins said that while CON may be worth re-evaluating, legislators should be cautious.
“I do see that some of the CON language is restrictive, maybe too restrictive on some of the buildouts that hospitals can do in enlargements of their facilities,” Hawkins said. “I think there’s room for some change in the CON laws, but we have to be cognizant of a drastic change.”