The status quo isn't optimal while full repeal of the certificate of need law isn't feasible, writes Andrew McNeill of KYFREE. "Every stakeholder in the CON conversation ought to be open to the idea that finding common ground is not only possible, but desirable. Greater access to quality health care for our families and loved ones should motivate our best effort to get there."
Meaningful reform on controversial issues takes time and hard work. Passions run high.? Sharp elbows get thrown. Nuance can contradict ideology, requiring compromise.
Which brings me to Kentucky’s certificate of need (CON) laws.
CON regulates investment in our state’s health care sector. Before opening certain types of facilities, an entrepreneur or health care provider must demonstrate there is a “need” for the services. The process is complex, it can be expensive and, at the end of the day, there’s no guarantee an applicant will get the go-ahead to move forward.
What to know about the certificate of need debate in Kentucky
Giving the government a veto on whether someone can open a business is the antithesis of free enterprise. Then again, health care is unlike any other sector of the economy.
During the 2023 interim, the General Assembly appointed a task force to evaluate the issue.? Legislation to reform CON was filed in the ’24 session but didn’t get traction. In June, the Licensing & Occupations Interim Committee dedicated their first meeting to the topic.
Smart people from all sides have debated what steps, if any, lawmakers should take to modify our certificate of need program. The gap between the positions is wide but that doesn’t mean it’s insurmountable.
Here are four guidelines to reset the conversation around sensible steps for CON reform:
Call it “CON reform” or “CON modernization,” the goal should be the same. Changes to CON must make it easier to invest in facilities and technology that provide health care services to Kentuckians. This will mean new entrants in certain areas but must also mean streamlining the red tape that hinders existing providers from expanding access.
Recognizing the differences between the state’s urban and rural health care settings is crucial to evaluating the policy options to reform CON. Nearly half of Kentucky’s acute care hospital beds are located in only five counties. Specialized in-patient services (cardiac, psychiatric, neonatal, etc.) are mainly — though not exclusively — concentrated in Lexington, Louisville and Northern Kentucky. On the flip side, we also have 25 rural hospitals —which provide essential care to thousands of our fellow Kentuckians — that have 25 or fewer beds.
The connection between Kentucky’s smaller communities and their local hospital is more than a transaction. Knowing care can be provided close to home is a great comfort to patients and their families. Rural legislators are unlikely to support anything that risks a hospital closing in their district, no matter how small that risk might be.
In 2018, a CON reform exempting several outpatient categories of care passed the legislature with broad support. Pragmatic changes can move the needle if the give-and-take of the legislative process works properly.
A family member recently developed a health condition that required a short hospital stay in Maysville, my hometown. I spent three days in that setting watching the nurses and doctors provide excellent care. The experience provided me with greater clarity on the CON debate than any report I’ve read or testimony I’ve listened to.
The status quo isn’t optimal while full CON-repeal isn’t feasible. Every stakeholder in the CON conversation ought to be open to the idea that finding common ground is not only possible, but desirable. Greater access to quality health care for our families and loved ones should motivate our best effort to get there.
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