Why The Certificate Of Need Issue Is Bigger Than The Cancer Treatment Centers Of America Debate

Auntie P / flickr

The Certificate of Need process faces continued legislative scrutiny this session.

New Hampshire legislators are proposing a law that would do away with the Certificate of Need process. This is a state requirement for hospitals and other healthcare facilities that want to expand or establish new medical facilities. The aim of CON is to keep redundant healthcare out of the system.

Recently, the CON process has faced legislative scrutiny in another House bill as the for-profit Cancer Treatment Centers of America pushes to build a facility in the Granite State.  At the heart of that debate is two questions: Does New Hampshire actually need a specialty cancer treatment center? (Cancer Treatment Center representatives say that CON, the answer is “no.”)  And if the CON process is abandoned, would the center live up to its promises to bring more jobs and money into the state’s economy?

But the Cancer Treatment Centers of America proposal is only a piece of the larger economic debate swirling around CON.

Rep. Cindy Rosenwald, D-Nashua, opposes this latest bill which would do away with the CON process. She says without controls placed on new medical services, costs will rise. She cites studies that show healthcare costs are higher in regions where more care is offered. “The more capacity you have simply the more care that will be delivered,” says Rosenwald.

Supporters of the bill say the CON process is outdated and actually contributes to higher medical costs. Nick Vailas, who is CEO of Ambulatory Surgical Services and head of the CON board, says the process needs a complete overhaul. He says the system is not designed to address the rising costs of healthcare and that’s a problem. “If someone were to come before the CON board and they would prove that they would drop the cost of care by 50 percent, they still would not get their CON,” he says. “The people in the system would say we are already providing the care even if though we charge twice as much or five times as much.”


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