Georgia is one of dozens of states that require health-care facilities to ask for permission to build or expand by obtaining “certificates of need.” Basically, state regulators get to decide whether a town needs a new hospital or long-term care center. If the need is deemed real, they’re granted a “CON.”
The intent of the decades-old system is to reduce duplicating medical services in an area, which, supporters argue, drives up health-care spending and reduces quality — an idea generally supported by the hospital industry, especially nonprofits.
But some researchers are skeptical.
“The evidence is pretty darn overwhelming that CON laws don’t achieve the initially stated goals of increasing access, lowering costs and improving quality,” said Matthew Mitchell, a senior research fellow at West Virginia University.
Some researchers argue the rules, which allow health-care organizations to file petitions to block competitors’ projects, are weaponized by powerful health-care interests to assert market dominance. That’s led a swath of states to roll them back in recent years.
In Georgia, lawmakers felt the need to put special exemptions in a certificate of need reform bill earlier this year to make sure the rules weren’t impediments to efforts to revive two recently closed hospitals.
The first exemption involves a shuttered hospital in rural Cuthbert, Ga. The carve-out could help an effort to reopen the facility as a “rural emergency hospital,” which means it would receive more federal money but offer only emergency and outpatient care.
“It’s much needed. People are hoping and praying we get it back,” said Brenda Clark, a local resident.
The second exemption concerns filling the gap left by the recently closed Atlanta Medical Center, one of the city’s two Level 1 trauma centers. That carve-out clears the way for a potential new hospital that would partner with Morehouse School of Medicine, one of the country’s few historically Black medical schools.
“You’ve got a community that is struggling to find care in the wake of the Atlanta Medical Center closure,” said Josh Berlin, CEO of rule of three, an Atlanta-based health-care consulting firm.
Elsewhere in the state, an effort to build a hospital in another rural county showed just how intense debates over CON rules can get, especially when politicians, the health-care industry and communities have conflicting priorities.
This drama involves the state’s powerful lieutenant governor and his wealthy father, who wants to build a hospital in their home county, which both feel is needed.
It calls to mind discussions over certificates of need in recent years in other Southern states, such as Tennessee, South Carolina and Florida, where hospital regulations were eased as lawmakers looked to stoke competition.
“This kind of a regulation is often there because powerful businesses want them,” Mitchell said, “not because they protect consumers.”
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