Certificate of need changes welcome

While we don’t believe the state should completely eliminate its oversight of new hospitals and other medical facilities, we welcome efforts by the Legislature to overhaul the current certificate of need program.

A House committee, chaired by state Rep. Murrell Smith, R-Sumter, has met for the past nine months to debate whether the certificate of need program should remain in place, be streamlined or be eliminated altogether. There were outspoken advocates for all three options.

But on April 26, the full House gave key approval to a bill that would make it easier to build and expand hospitals and other medical facilities. The bill also would end the state’s oversight entirely at the start of 2018.

The bill, which passed 103-1, would let existing hospitals, medical centers and nursing homes add beds within a mile of their sites. It also would allow hospitals to expand services that already are approved under the program and remove the need to seek permission to buy costly equipment such as X-ray machines or MRI scanners.

The change would not affect the ongoing legal dispute between Piedmont Medical Center and Carolinas HealthCare System over who gets to build a hospital in Fort Mill. That will have to be resolved under the existing rules.

But the Fort Mill hospital battle is a perfect example of what is wrong with the certificate of need program. The two hospital systems have been mired in a legal dispute for nearly a decade with no end clearly in sight.

The current rules requiring an extended review process by the state Department of Health and Environmental Control, followed by the appeals process through the Administrative Law Court, is ridiculously unwieldy. Two years is too long to get an appealed case through the system, and the two hospital systems battling to build a new hospital in Fort Mill have been at it for nearly 10 years – and counting.

We like the proposal in the House bill to make it easier for medical centers and nursing homes to expand and to add new equipment. But we hesitate to endorse the proposal to phase out state oversight altogether in 2018 unless it is replaced by a streamlined plan.

There are good reasons not to simply allow the free market to dictate how health care is dispersed in the state. With no regulation, we likely would see rapid expansion in urban areas and the abandonment of rural, less populated parts of the state.

Investors inevitably would rush to build high-profit facilities, such as heart care centers, at the expanse of other needs. We likely would see an abundance of MRI facilities with low-quality equipment providing inferior services. And nursing homes of questionable quality could sprout up everywhere.

Nonetheless, the regulatory changes proposed in this bill would be welcome if they shorten the review process. The current system isn’t working.

The bill now moves to the Senate. In the end, we hope lawmakers strike a balance between radically changing the process and eliminating it altogether.

In summary

A change in the certificate of need program is desperately needed, but state should retain some oversight.