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Can David and Goliath co-exist? Georgia Senate mulls options to create more medical centers
At Dr. Byron Colley’s practice, children with severe dental problems wait nearly eight months for surgery due to a shortage of availability in the local hospital’s operating rooms. Yet, current state law bans the Savannah pediatric dentist from opening a surgical center because he offers multiple medical specialties.
“A lot of times we're seeing kids for their six-month checkup before we can see them in the hospital to do their dental treatment,” Colley told State Affairs.
Katie Chubb tried to open a birth center in Augusta in 2021 but was denied by the state because she couldn’t work out a transfer agreement with a local hospital. In the meantime, women are leaving the state in search of such services. Chubb is suing Georgia saying the regulatory process for issuing certificates for new medical facilities is unconstitutional.
“Because of the lack of options for birth in our area, I still have to send women to local hospitals despite them opposing me,” Chubb told the Senate Study Committee on Certificate of Need Reform. “Because we don't have a viable option for alternative birth, women are traveling to South Carolina to use birth centers because the three Georgia locations are too far.”
Colley and Chubb are just two of many who say they are having difficulty opening or providing medical services because of Georgia’s Certificate of Need law.
The law was created 44 years ago to control health care costs and cut duplication of services and unnecessary expansions. It determines when, where and if hospitals or other medical facilities need to be built. The law has proved so contentious that Georgia lawmakers are trying to decide whether to keep it, tweak it or get rid of it entirely.
Critics say the law allows existing hospitals to block new facilities, thus creating monopolies. The law’s impact is harshest on rural Georgians who often live in medical deserts. A sudden, severe illness or routine checkups can mean traveling hours and miles to a hospital.
On Monday, The Georgia Hospital Association, a trade group of 145 hospitals in the state, weighed in at the Senate Study Commission meeting with 14 recommendations, including rewriting parts of the law to make it easier to understand.
“Our current position is to streamline and simplify. Before, it was to protect CON,” Anna Adams, the association’s executive vice president of external affairs, told the committee, which met in Savannah.
“It’s actually the first time that the hospitals have tried to be part of the process instead of just fighting about it,” committee member Sen. Kay Kirkpatrick told State Affairs. “So I think that's a positive move but I think we’ve got a long way to go. I think that's just the place to start.”
The committee heard nearly three hours of presentations and testimony about one of the state’s most contentious public policy issues.
The hospital association’s recommendations included:
- Updating the state health plan at least once every five years. Many of the plans are over 20 years old.
- Ending the Certificate of Need appeals process. The group suggested moving those hearings to the Office of State Administrative Hearings.
- Increasing access to pre and postnatal care in Georgia's maternity care deserts. “So increased financial support for obstetricians, certified nurse midwives and family medicine practitioners is an important piece of this recommendation,” Adams said.
During Monday’s hearing, committee member Sen. Ben Watson, addressed the elephant in the room.
“Why do we really care whether someone wants to put up a new hospital or add more beds?” he asked Adams.
“Well, in many cases, it's very beneficial to those community members who want to make sure they have access to those care services,” Adams answered. “We also want to ensure that there's not an adverse enough impact to existing facilities so that certain services within the community that the new facility may not be offering would be terminated.”
To which Watson responded: “That’s sort of monopolistic and anti-competitive, right? So you have a new hospital versus an old hospital, and yet you want to protect that from a governmental standpoint. Texas and Florida don't have that and I think they're doing pretty well for their health care. South Carolina just did away with [Certificate of Need]. Why does the government want to be involved in regulating something like that?”
“I think if there's a need within the community, it shouldn't be an issue,” said Adam.
“And that's the issue,” replied Watson. “I presume the folks that are doing the new hospital, they've done the numbers. They may be investors or it's another governmental entity that's doing that. I would hope they wouldn't put something in there that is not a need. I mean, competition makes us all healthier. So I'm just struggling with why the governmental regulation here?”
Some speakers called for repealing the law.
“A better idea is probably to just eliminate most or all of the Certificate of Need requirements,” said Jaimie Cavanaugh, an attorney and legislative counsel at the Institute for Justice, an Arlington, Va.-based national nonprofit that is challenging Certificate of Need laws nationwide.
She suggested the committee look at how other states decide on new facilities.
“The committee would do well to follow states like Indiana, Louisiana, Michigan, Nebraska, New York and New Jersey,” Cavanaugh said. “Those states have very robust Certificate of Need programs but they review applications without giving the opposition the chance to intervene or appeal a decision that they don't like.”
Monday’s meeting, the committee's third since June, drew the attendance of Lt. Gov. Burt Jones.
“I think it was telling that the lieutenant governor was there,” Kirkpatrick said. “This issue is very important to him because someone was trying to open a new hospital in his county and wasn't able to do it because of CON. So that made him very unhappy. I think he's trying to fix that.”
Kirkpatrick said she was “encouraged” by the hospital group’s recommendations but added “they’re still not where we need to get as far as what they have to offer.”
The committee is set to meet again at a later date.
A study committee of Georgia senators took a decisive step Tuesday toward ending a longstanding and contentious law that regulates how and where new medical facilities are located in the state.
The committee’s decision centers on the 44-year-old Certificate of Need law. It was created to control health care costs and cut down on duplication of services and unnecessary expansions. It determines when, where and if hospitals need to be built. Opponents have said the law prevents competition and enables big hospitals to have a monopoly, often shutting out small and private medical outlets.
On Tuesday, the Senate Study Committee on Certificate of Need Reform effectively said the law needs to be repealed. The committee approved, in a 6-2 vote, nine recommendations.
“Based upon the testimony, research presented, and information received, the Study Committee on Certificate of Need Reform has found that the problem Georgia’s CON law was intended to combat no longer exists,” the report said.
However, the head of the Georgia Alliance of Community Hospitals said Tuesday that repealing the law would be a bad idea.
“It would have a devastating financial impact on hospitals and the quality and access to health care,” Monty Veazey, the alliance’s chief executive, told State Affairs.
Veazey said he has not seen the recommendations yet but his organization has sent its own set of recommendations to the senate and house study committees.
“We believe that the certificate of need really does need some modernization and we look forward to working with the committee to work through those recommendations and see if we can reach a compromise position during the upcoming legislative session,” Veazey said. “We still want to see what the House committee recommends before moving forward.”
Here’s what the senate study committee recommends, according to a draft:
- Repeal CON requirements for obstetrics services, neonatal intensive care, birth centers and all services related to maternal and neonatal care across Georgia.
- End requirements for hospital-based CON on Jan. 1, 2025.
- Reform CON laws to eliminate CON review for new and expanded inpatient psychiatric services and beds that serve Medicaid patients and the uninsured.
- Repeal all cost expenditure triggers for CON.
- All medical and surgery specialties should be considered a single specialty, including cardiology and general surgery.
- Multi-specialty centers should be allowed, particularly in rural areas.
- Remove CON for hospital bed expansion.
- Revise freestanding emergency department requirements such that they must be within 35 miles of an affiliated hospital.
- Remove CON for research centers.
The committee will present its recommendations to the Georgia General Assembly when it reconvenes in January.
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ATLANTA — The first step in the 2023 electoral redistricting process occurred Monday when Sen. Shelly Echols, R-Gainesville, chair of the Senate Reapportionment and Redistricting Committee, released a draft proposal of new Senate district maps.
Last month, U.S. District Judge Steve Jones ordered Georgia to redraw its state House, Senate and congressional district maps, adopted in 2021 by a majority-Republican-led Legislature, after finding they violated the Votings Rights Act by diluting the power of Black voters. The Georgia General Assembly is charged with submitting new maps to comply with Jones’ order by Dec. 8, and will be meeting in an eight-day special legislative session to do so, starting on Wednesday.
The proposed Senate maps would create two Black-majority voting districts while eliminating two white majority districts in metro Atlanta now represented by Democrats. The districts of state Sen. Elena Parent, chair of the Senate Democratic caucus, and Democratic Sen. Jason Esteves, a freshman, would become majority-Black if the redrawn maps make it through the redistricting process, a change that could invite considerably more primary challenges.
The proposed maps do not significantly alter the district lines for Sen. Valencia Seay, D-Riverdale, and Sen. Marty Harbin, R-Tyrone, whose districts Jones ruled did not comply with the Voting Rights Act. It will be up to Jones to decide if the new maps pass muster.
As it stands, the proposed Senate map will leave Republicans with a 33-23 advantage in the Senate.
On Wednesday legislators will plunge into their redistricting work during a special session at the Capitol. In addition to the state Senate maps, lawmakers must also redraw electoral maps to create Black majorities in one additional congressional district in west-metro Atlanta, and in five additional state House districts in Atlanta and the Macon-Bibb County area.
The proposed Senate maps (and all proposed maps to be submitted by legislators) are available on the Legislative and Congressional Reapportionment Office’s website. Written comments can be submitted (and viewed) by the public through the portal available on the Georgia General Assembly website. Most of the reapportionment and redistricting committee’s hearings are open to the public; the daily legislative schedule is available here.
“The committee encourages public participation and values the input of the community in this vital democratic process,” Echols said in a statement released on Monday.
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