Some N.C. House members voiced skepticism Monday about repealing regulations that govern new and expanded healthcare facilities.
House Bill 200 is one of two bills this session that would change the state’s process for granting a Certificate of Need – a crucial permit required for opening a new healthcare facility. A Senate proposal sponsored by Rules Chairman Tom Apodaca would eliminate the process entirely.
The House bill, sponsored by Republican Rep. Marilyn Avila of Raleigh, wouldn’t go that far. It would eliminate the CON process for psychiatric facilities, ambulatory service centers or diagnostic centers. Ambulatory service centers provide outpatient procedures that typically cost less than similar services at hospitals. The CON often forces healthcare providers to compete for the permit to open a new facility.
The House Health Committee heard from lobbyists on both sides of the issue Monday, but it likely won’t vote on the bill until next week. Connie Wilson, a former legislator who lobbies for eye doctors and orthopedists, argued that the CON laws force patients to use more expensive, hospital-owned facilities. She estimates that North Carolina would have 80 to 100 additional ambulatory service centers if the bill passes.
“We’re not talking about anything about quality,” Wilson said. “All we’re talking about is the ability to compete.”
But both the Senate and House bills are opposed by the N.C. Hospital Association, which says looser regulations would allow doctors to perform profitable procedures outside hospitals – making it harder for hospitals to provide charity care.
“This bill goes the wrong way: It raises silos, it makes doctors and hospitals separate so we don’t communicate as much on patient care,” said Cody Hand, a lobbyist for the association.
Hand said the change could harm struggling rural hospitals, which typically have a higher percentage of uninsured patients. “I can’t tell you that this bill will cause rural hospitals to close, but I can’t tell you that it won’t,” he said. “I would ask you not to take that gamble.”
Hand’s comments appeared to resonate with rural legislators who said they’re hesitant to support the bill. Republican Rep. Josh Dobson noted that in his district, Avery County’s only hospital will soon stop delivering babies.
“We’re on the margins in these rural areas, and that is my concern,” Dobson said. “Anything of this magnitude needs to be done in a way for full disclosure and full debate.”
Wilson, however, says more outpatient facilities will mean residents of rural areas won’t have to travel as far to see a doctor. “You give much more opportunity for doctors to go to rural communities to practice,” she said.
The bill requires that the centers include charity care for at least 7 percent of their business. But Hand noted that charity care makes up 20 percent of business at some hospitals.
The bill faces an uphill battle to reach the House floor before next week’s deadline. If it passes the Health Committee, the bill must also clear two other committees. And with major impacts on healthcare providers, legislators say they want to move slowly.
“We have to be very careful in the method in which we move this forward,” said Rep. Brian Brown, a Greenville Republican and co-chairman of the Health Committee.