Certificate of Need
Healthcare organizations in North Carolina are required by law to secure a Certificate of Need (CON) to add inpatient beds, operating rooms, and certain equipment like MRIs among other things. The purpose of CON is to prevent the unnecessary duplication of services in an effort to ensure healthcare access, cost effectiveness, and quality.
CON protects safety net healthcare providers like WakeMed by ensuring that approval to add new healthcare services is granted to providers who also provide their fair share of care to the underserved.
As the safety net provider, WakeMed provides many services that actually lose money. For example, we lose money on all inpatient services we provide in our operating rooms for all payers (managed care, Medicaid and Medicare) with the exception of cath lab cases. To offset these losses, we rely on profitable outpatient surgeries.
The legislature is considering changing CON law to allow for specialized ambulatory surgery centers that would take outpatient surgeries out of the hospital setting. This rule change could be good for patients. However, a targeted rule change like this will also remove the protective, positive aspects of CON and leave regulatory restrictions that would hamper a safety net hospital's ability to meet their missions of caring for all.
Ambulatory surgery centers will not provide their fair share of care to the underserved, instead cherry picking insured patients and ultimately reducing access to healthcare services.
This rule change will result in the unnecessary duplication of services and increase healthcare costs due to an oversupply of underutilized operating rooms, as has occurred in other states that have deregulated operating rooms.
Healthcare is changing and CON is certainly one of the regulations that needs to be considered with reform, but even seemingly benign changes like deregulating operating rooms can have significant ripple effects across the healthcare system potentially harming hospitals and patients. CON law needs to be thoughtfully modified, preserving access to healthcare for all.