Op-ed: Eliminating Certificate of Need would devastate West Virginia hospices

Certain people inside and outside the West Virginia Legislature believe this year is the right time to eliminate the state’s certificate of need law. But they’re wrong.

Eliminating the certificate of need law, which has been in effect since 1977, would be devastating for many health care providers in West Virginia. That especially includes hospices, those orgnizations that provide care and comfort to terminally ill patients in the final months of their lives. That’s a situation any of us could find ourselves in sometime in the future, so we all have a stake in the outcome of this legislative battle.

Those who are behind the elimination effort contend that it would promote competition, make health care more accessible, and reverse the current shortage in nurses and other health care professionals. That might sound alluring, but it’s a siren song that could cause some health care providers to crash on the rocks.

In the case of hospices, having more providers would not necessarily improve access, but it likely would reduce the quality of care. Eliminating certificate of need requirements might encourage large for-profit entities to enter the market. In some industries, such competition could help lower costs without decreasing quality, but not with hospices because they don’t operate in the same type of free market that other industries do. About 93% of hospice patients in West Virginia are covered by Medicare or Medicaid, so reimbursement rates are fixed, meaning patients would experience no cost savings. However, in such a situation, the only way for-profit entities could preserve their bottom line would be by reducing the quality of services.

West Virginia has 18 hospice agencies and eight hospice inpatient facilities, which serve patients from all 55 counties. By law, they are mandated to provide at least 5% of direct care by using volunteers. In the face of competition from for-profit entities, they could find it much harder to find volunteers, especially in rural areas. Instead of increasing access to hospice, the competition might force current hospices to lose revenue and patients, which might force them to withdraw service from more costly rural areas. For-profit entities would not have incentive to serve those rural areas, so some rural counties could be left with no hospice services.

Likewise, elimination of certificate of need would not reverse the shortage of nurses and other health care professionals. Instead, it could encourage the duplication of services, which would make it more difficult for hospices to recruit and retain highly skilled palliative care professionals, including those needed to serve as hospice medical directors.

West Virginia’s hospices exist because of substantial investments – through donations, volunteerism and other means – by communities into their facilities, including rural satellite offices. The history of hospice development in West Virginia demonstrates that rural counties require support from larger, urban hospices. Certificate of need helps protect those investments and ensure that all West Virginians are served by hospices.

We know West Virginia’s hospices provide a high level of quality because Medicare’s Care Compare, using 2020 data, ranked the state as sixth best in the nation based on patient care and family satisfaction. Why would we want to jeopardize that?

By contrast, a recent federal report found that California, which repealed the certificate of need law it once had, leads the nation in serious complaints and inspection concerns about subpar care at hospices. The wellbeing of California’s hospice patients is threatened by fraud, malpractice, unchecked growth and lack of effective oversight from state and federal authorities. In 2021, California’s governor signed into law two bills meant to address those problems, but maybe the problems could have been avoided if the state still had its certificate of need law.

Why would West Virginia want to be like California? We already have a good law on certificate of need that ensures that thousands of West Virginians each year can get high-quality hospice care. This is a good time to invoke the wisdom of that old saying: “If it ain’t broke, don’t fix it.’


Janett Green is chief executive officer of Hospice of Southern West Virginia, based in Beckley, and secretary of the Hospice Council of West Virginia.


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