HCA’s CON puts W.Va. at a disadvantage

Ever wonder why so many Parkersburg doctors are moving to Belpre? Ever wonder why the Marietta Memorial Hospital is establishing a branch in Belpre? The answer is that a very restrictive medical Certificate of Need is required by West Virginia but not in Ohio.

What is a Certificate of Need? In 1974 a federal law required that all states have structures involving the submission of proposals and to obtain approval from a state health planning agency before beginning any major building expansion or ordering new high tech devices. This new law was, in my opinion, fostered and promoted by the American Hospital Association to limit competition outside a hospital environment.

Until 1986 the federal government required all states to have CON programs to receive federal Medicaid funding. The CON required a designated state agency’s approval of the expansion of new medical facilities or equipment in excess of a certain dollar amount. In West Virginia this state agency is the Health Care Authority. The agency was originated in 1977. The stated purpose of the agency is to control health care cost, improve efficiency in the health care system and develop health care delivery that will benefit all residents of the state. No CON is issued unless the state determines a public need for the project, service or equipment.

Many health care providers object to the restrictive nature of the CON. It has become a fight between hospitals, which have the financial resources to comply with mandates of the Health Care Authority, and small health care providers, which seek to meet these standards.

In 2007, the West Virginia Legislature was involved in debate over whether or not to loosen the restrictive CON requirements. In the Senate the debate became one between a doctor with a small rural practice and a doctor who worked at the large Charleston Area Medical Hospital. This debate resulted in little change in the CON requirements. In a more recent legislative session, House members were told, “Cumbersome CONs were contributing to a shortage of in-home personal care providers.”

Evan Jenkins, a state senator and executive director of the West Virginia State Medical Association, has said, “West Virginia has one of the most restrictive CON laws in the country. West Virginia is out of step because of our restrictive environment. We should become more like other states and do away with or reduce our CON oversight.”

West Virginia is not alone in finding fault with CON. In Virginia a group of physicians are challenging a court ruling for throwing out a constitutional challenge to Virginia’s Certificate of Need. Virginia’s CON program has been in existence for over 30 years and, like West Virginia, requires owners and sponsors of medical facility projects to secure state approval before initiating any new projects. The physicians claim the CON mandates amounts to economic protectionism and it violates the commerce clause of the U.S. Constitution. If the plaintiffs are successful, it would have a significant impact on CON in West Virginia.

Movement of health care facilities and providers from West Virginia to Ohio has been a real boon to Belpre. Belpre’s mayor, Mike Lorentz, was quoted as saying, “I have lived here all of my life and cannot remember something of such a large magnitude taking place.”

EDITOR’S NOTE: Frank Deem is a former member of the West Virginia Legislature, serving in both the House of Delegates and the state Senate.