Albany physicians continue fight for CON reform

ALBANY — As the state legislature grapples with a decision on reform or outright repeal of Georgia’s certificate of need (CON) law, an involved process that requires oversight and approval — a “proof” of need — by the state’s Department of Community Health (DCH) before expansion or construction of health care facilities are permitted, two Albany physicians have been deeply involved in the fight to exact change.

Surgeon Dr. Price Corr, a principle owner of Albany Surgical P.C., and Dr. Joe Stubbs, an internist with Albany Internal Medicine, have testified before Senate panels discussing what has turned into a controversial bit of legislation.

DCH says the state’s certificate of need program is intended to achieve three goals: (1) to measure and define need, (2) to control costs, and (3) to guarantee access to health care services. Georgia started reviewing health care projects in 1975 under Section 1122 of the 1972 Social Security Act Amendments, and Georgia’s CON program was established by the General Assembly in 1979.

Stubbs, Corr and other physicians in the state have argued before legislative panels that CON is an outdated concept that is no longer needed. Large health care providers in the state argue that CON is a way of managing costs so that new facilities aren’t brought into an area to “cherry-pick” patients with insurance coverage or most likely to pay their bills, leaving the hospitals to absorb a growing amount of indigent care.

Stubbs, who along with Corr came to Albany in 1982 to work at Phoebe Putney Memorial Hospital, said the original intent and need for CON no longer exist.

“CON was designed to assure that the poor could afford health care,” Stubbs said. “But what’s happened in practice is that CON allows monopolies to exist. The federal government saw that and in 1987 repealed the law. Since then, 37 states and D.C. have revised their CON laws or repealed them altogether.

“Georgia, however, has one of the most restrictive CON laws in the country.”

That, Corr says, leaves single specialty centers like Albany Surgical looking for help from the legislature.

“What we want is a level playing field,” he said. “It’s absurd to think that there is a need or the funding to support hospitals in many rural areas of the state, but specialty centers could provide the vital care that would improve the quality of life of the people in those areas.

“Under CON, Albany Surgical or any other facility providing a single specialty, cannot join with, say, an ENT physician, an ophthalmologist, someone who does gynecological procedures … under CON, it’s illegal for us to provide services outside our specialty area. There are even certain insurance companies that will not pay one penny to a surgical center like ours.”

Larger hospitals crying poverty, which is the primary reason CON continues to exist in its current capacity, does not, Corr said, make sense.

“There will always be a need for the larger hospitals and health care centers,” he said. “Many of them claim that they alone will be left to take care of the poor. But that’s not the case. All health care facilities are charged with indigent care. We have requirements at our facility.

“This is, I think, their primary concern. When we finally got approval to exist as an ambulatory surgical center and started doing colonoscopies, the price for doing colonoscopies in the region dropped dramatically. A while back, people said Phoebe, which was considered the ‘city hospital,’ was going to die because of HCA Palmyra hospital, which was the larger of the two at the time. But Phoebe actually blossomed, adding its cardiovascular and cancer centers. The competition stimulated Phoebe to create and provide better services.”

State Rep. Gerald Greene, R-Cuthbert, said the CON issue is very much alive in the legislature, but he admitted that time is running out to take action during the current session.

“Trust me, both the House and the Senate are still looking into CON, trying to come up with a solution that will satisfy everyone … which we both know is not likely to happen,” Greene said Friday morning. “I’ve been talking with the CEOs of hometown hospitals, and my colleagues are all looking into this issue.

“I can’t say we’re leaning one way or another right now, but trust me when I say this is still a vital issue for this session. We’ve just got to come up with something soon. Crossover Day (a time by which legislation must be put up for a vote by one of the two bodies to be considered during the session) is coming up, so we’re really starting to focus in on issues like CON and tort reform.”

Stubbs notes that CON reform would be a lot more palatable for all health care providers in the state if Georgia expanded Medicaid coverage.

“A lot of the answers to rural and indigent care would be solved, I think, if the state expanded Medicaid,” he said. “If more people have health care coverage, I think that definitely would change the course of many hospitals’ angst.

“No one knows the future, but it certainly doesn’t make sense to think you could build and operate 159 hospitals in all of Georgia’s counties. But I do know this: One way to cut the costs of health care in the state is to alter or alleviate CON altogether. CON as it now exists in Georgia is designed to allow monopolies to exist. And that’s only going to allow the cost of health care to continue to skyrocket.”

File Photo: Carlton Fletcher