Building new hospitals, covering rural healthcare, and addressing the needs of an aging population are being discussed in a series of meetings by a Georgia House of Representatives committee. Today’s topic was suggestions of how best to modernize the state’s Certificate of Need (CON) process for CSRA healthcare.
The CON process, administered by the Georgia Department of Community Health, determines that a new or expanded healthcare service or facility is needed. Included on the list of healthcare facilities and services are the construction of new hospitals, new and expanding nursing homes, and many ambulatory care facilities. The Georgia legislature established the CON program in 1979.
“With the changes that have occurred in healthcare over the last 40 years, I think it’s time that we look at it again to see if we need to make some changes to bring us more in step with what the times are,” explained committee chairman, Rep. Butch Parrish (R-Swainsboro). “What we’re trying to do is approach this with an open mind, nothing is off the table.”
Dr. Mark Newton, who is also the elected representative for Georgia House District 127, is a member of the committee. He said one of the goals is to find the right balance to protect vulnerable rural hospitals, while opening the door to innovation.
“We got to see someone today who’s passionate about improving care and one particular subset of health care, but there are others that have not been able to get to that point who may want to do it in their communities across Georgia,” he said. “We know the deterrent it must be to put that much time and effort into it, to have it not supported. And then, even worse, if they were given a certificate and then someone appealed it, and appealed it and appealed it, you know, that would be devastating.”
Newton is very familiar with the impact the appeal process can have on a healthcare project. His district includes Columbia County that is finally seeing construction of the county’s first hospital, but it was a seven-year battle.
In 2014, Augusta University Medical Center (then called Georgia Regents Medical Center), University Hospital, and Doctors Hospital all filed CONs with proposals to build a hospital in Columbia County. GRMC’s CON was approved, but University Hospital and Doctors Hospital both appealed the decision. University Hospital ultimately dropped its appeal, but Doctors Hospital continued until 2021, when the Georgia Supreme Court declined to hear the case, effectively upholding DCH’s initial ruling.
The 100-bed, 260,000-square-foot hospital will include an emergency department, trauma center, intensive care rooms, and six operating rooms.
Columbia County will cover about 20% of the $150 million facility. The county commissioners recently created a hospital authority and approved a contract to shepherd the project.
Construction is finally underway at the site at Exit 190 off Interstate 20. Rick Plummer, AVP of Marketing and Branding at AUMC, released a statement saying, “We are pleased to announce that we have started the construction process and are continuing to assess the community’s healthcare needs for additional opportunities. We look forward to sharing additional information and opportunities to speak in the coming months.”
Research provided to the committee by the Georgia Public Policy Foundation, an Atlanta-based nonprofit organization that researches and analyzes public policy issues, showed the appeal process can lead to substantial delays for the project.
Chris Denson, Director of Policy and Research, said they researched nearly 380 CON applications from 2017 to 2022.
“We found that when there is an objection to a certificate of need application at the state level, the odds of denial more than doubled from 20% to about 50%. In some cases, when you have opposition, you’ll see an application that increases the odds of denial by roughly 11%. And opposition that’s filed adds 234 days to the wait time. But if it’s specifically a competitor opposition, that adds 520 days to the wait time and each additional party on top of that adds another 129 days.”
South Carolina’s legislature this year partially did away with CON requirements. New hospitals, nursing homes, and home health agencies must still file a CON. However, it is no longer required for a number of other healthcare facilities including free-standing emergency rooms, ambulatory surgical facilities, and hospice facilities.
Newton said that is something the committee is reviewing, but it comes with its own set of challenges.
“I have heard from others and other states that transferring patients who need to be admitted, like Florida, where there’s a lot of freestanding emergency rooms, that’s one of the things we need to think about, do we have a robust transport system for every time a patient needs to be admitted? Do we have the EMS infrastructure? Are we willing to support the EMS infrastructure for that many new transports? So, there’s a lot of things to think about,” he said.
The meeting in Augusta was the second of a planned four stops around the state to get public input. The hope is to be able to find a workable plan to present to the 2024 Georgia Legislative Session.