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Some elected officials would like to see CON repealed, arguing that deregulating health care would reduce costs and improve quality.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 So, let’s consider it from the patient’s perspective and examine what things could look like in Florida if CON is repealed:
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.
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.
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.