When disaster strikes a family or a community, it relies on its community hospital to be there to provide the care it needs. Our state is fortunate to have more than 115 acute-care hospitals that are staffed and ready all day, every day, to meet the critical health needs of their neighbors – whether or not they can pay for their care. Legislation being considered in the N.C. General Assembly, including a proposal to repeal the Certificate of Need law, threatens the ability of hospitals to continue as the community health care safety net.
Hospitals and health systems across our state are experiencing declining inpatient volumes. More than two-thirds of the patients admitted to our hospitals are covered by government-sponsored insurance that reimburses below the cost of providing care. Significant cuts to Medicare resulting from the Affordable Care Act also have taken a toll on community hospitals.
At the same time, we are seeing increasing numbers of patients in our emergency departments, including many individuals in behavioral health crisis with nowhere else to turn for help. In the existing fee-for-service payment system, this scenario should lead to hospitals closing or, at the very least, eliminating services. Yet our hospitals have responded by introducing innovative care models to help patients stay healthy after they are discharged from the hospital and to connect patients with primary care providers to avoid costly emergency visits.
We are advocating more appropriate treatment settings for individuals with mental illness and substance addiction. Hospitals and health systems are doing remarkable and transformative work to make their communities healthier, all without any promise of additional financial resources to cover their costs.
Through the Certificate of Need law, the state manages allocation of critical health resources based on community need, which ensures that all residents across our state have adequate access to health care services. CON has long been a target for medical entrepreneurs and profiteers who claim that hospitals are using it as a way to stifle competition. On the contrary, hospitals support competition, as long as it is fair. There is no free market in health care as long as hospitals are the only providers mandated to care for anyone who walks in our doors. Those arguing for competition are not looking to serve the uninsured.
A special interest group has been circulating a report at the General Assembly that claims
North Carolinians have access to nearly 13,000 fewer hospital beds because of the constraints of the Certificate of Need law. Nearly identical reports were produced with similar allegations about CON in Virginia, South Carolina, Kentucky, Michigan and New Hampshire. Clearly, the authors failed to take into account our declining hospital occupancy rates.
More hospital beds will not solve the challenges facing health care today. Neither will opening the door to single specialty providers offering a better price for care.
Hospitals and health systems across our state have longstanding commitments to their communities, and we have a moral and financial stake in improving overall health that goes far beyond a single cataract surgery or a joint replacement. If the special interest groups prevail, it would cost hospitals as much as $533 million and undermine our ability to offset the losses we incur from the 16.7 percent of North Carolinians who remain uninsured. It also would jeopardize our investments in community health – from school nurses and free health screenings to trauma care and newborn intensive care.
The journey from a health care system based on the value of the care we provide instead of the volume of services is a marathon, not a sprint. We hope that our legislative leaders will consider the effect of their decisions on their local communities and recognize that now is not the time to upend Certificate of Need.
Bill Pully is president of the North Carolina Hospital Association.