Albany area health care could be impacted by CON clash

ALBANY — In 2022 the Phoebe Putney Health System provided $61 million in free health care, according to system president and CEO Scott Steiner, and the money generated to fund that charity care came from procedures that generated higher profit margins.

Phoebe serves more than 500,000 residents in 41 counties throughout southwest Georgia, and many of those can’t afford the costs of an emergency room visit or other life-saving care.

“We are required to take care of people 24 hours a day, seven days a week, coming into the ER, and we have to provide care by law,” Steiner said. “I can’t think of any other business that has to do that.”

Georgia, along with 33 other states and the District of Columbia, has a certificate of need (CON) program that governs the provision of medical care. It is intended to measure and define need, control costs and govern access.

Established by the Georgia General Assembly in 1979, it has also drawn critics who claim it prevents competition that could lower costs for health care services.

Lawmakers could examine the existing system during the Legislative Session this year, but what kind of proposals could emerge is not yet known, state Rep. Gerald Greene, a Cuthbert Republican whose district includes part of Dougherty County, said.

“I think you’re going to see health care is a big issue, both mental health and CON,” he said. “We’re going to hear about it.

“Of course, it affects our area with Phoebe, so we want to be very careful about what happens. It depends on if they want to do away with certificate of need.”

While Steiner says he does not disfavor competition, the danger for Phoebe lies in where that competition comes from.

Providers looking to move in seek to perform the most profitable procedures, draining money that Phoebe uses to fund care for those who can’t afford it, the health system CEO said. Emergency care is the most expensive to provide, and an area where many who come in are underinsured or uninsured.

“Nobody’s going to come in and provide emergency services,” Steiner said. “In the end, if that happens, who will provide the services that are not profitable? Either the community will have to pay or we’ll have to reduce services.

“Health care, whether you believe it is a right or whatever you believe it to be, we all deserve to be cared for at the most vulnerable moment in our lives. It’s different in southwest Georgia than it is for the people of Atlanta or Savannah or Douglas County.”

The hospital administrator said he would be happy to see a provider come in to Cuthbert, whose hospital authority closed the facility in fall 2020 after more than 60 years in operation.

“They can do that today,” Steiner said. “We need more psychiatric care here. If there’s someone who wants to open a psychiatric care hospital in Albany, hell, I’ll come help them find land for it.”

In addition to the indigent care provided each year, Phoebe currently has two construction projects under way that will help improve care in southwest Georgia. Those include a new emergency room and critical care unit and a training center across the street from Phoebe Putney Memorial Hospital, where nursing students can live and learn, with a total price tag of about $200 million for both.

A discussion of the certificate of need program could be fruitful, Steiner said, but its elimination would not be a formula for improving health care in rural areas. Having a choice of health care providers is a good thing, but will not positively impact those who would not be able to afford the service, he said.

“I believe in reality that would restrict access,” Steiner said. “Georgians will have less access. Giving somebody without health insurance choice A or B does not increase access to them.

“It’s certainly going to be an interesting discussion. We’re not opposed to having a discussion about it. Let’s really talk about what we’re doing here, what the intent is and what the consequences are, whether intended or unintended. We just want to keep having that conversation.”

During the 2023 legislative session, the Senate Study Committee on Certificate of Need Reform was formed, and Freddie Powell Sims, D-Dawson, was one of seven senators appointed along with five non-legislative appointees.

“Certificate of need has been around for a very long time,” she said. “The purpose was to make sure that medical services were delivered in an equitable manner across all sectors of medicine. There are many who feel it has become outdated, that it needs to be updated or eliminated altogether.”

The committee’s recommendations will be passed on to the House and Senate, and lawmakers will likely come up with legislation on the issue, although Sims said she was not sure what that legislation will entail.

After meetings and visits to medical facilities, one thing Sims wants to make clear is that health care is vastly different in a rural setting than in an urban environment.

“It is very much considerate as to how we are going to handle providers who serve large, rural populations, not only those populations but those municipalities that have a very low-income work force that doesn’t have health care insurance or has insurance that does not cover a lot of their needed medical services,” she said. “Phoebe was always at the forefront when we thought about certificate of need.

“There has been concern that if certificate of need is eliminated, it would add to the number of indigent (patients) rural hospitals are already having to take care of.”

Phoebe has invested millions of dollars into the community, the senator said, not just in indigent care but for equipment, and in many cases that equipment is quickly outdated and must be replaced.

Sims said she expects Medicaid expansion to be a part of the conversation this year.

Georgia is one of the 10 states that has not adopted Medicaid expansion under the Affordable Care Act. As Sims sees it, that means Georgians are subsidizing health care through federal taxes for other states without its residents receiving any benefit.

“We lose millions of dollars every year sending those dollars to other states,” she said. “That is not a partisan issue. If the people understood this issue better, then they would demand that we do something about Medicaid expansion.

“If we do away with certificate of need, if we refuse to expand Medicaid, what will that mean for our hospitals?”

In addition to the closing of the hospital in Cuthbert three years ago, Fort Gaines’ hospital closed in 1983 and Steward Webster Hospital in Richland closed its doors in 2013.

“We’re talking about the working-class poor, people who are going to work every day who barely afford their bills and don’t have health insurance because they can’t afford it,” Sims said. “These are not people who are lazy. They want a better quality of life, but for whatever reason they can’t afford health insurance. If you have a large population who can’t afford health care, it bleeds into the rest of the population.”

File PhotoFile Photo

File Photo

Special Photo: Phoebe