James Jan-Feb 2024 web - Flipbook - Page 71
G E O R G I A’ S C E RT I F I C AT E O F N E E D
CON Works
A Repeal Would Hurt Healthcare
BY M O N T Y V E A Z E Y
N
early half of Georgia counties are
classified as “maternity care deserts” by the March
of Dimes, meaning expectant
mothers in these largely rural
areas face long drives to receive
prenatal and birth care. Patients
cite distance as a top reason they
skip care, especially routine and
preventative care, and that lack
of local access plays a major role
in Georgia suffering one of the
worst rates of maternal mortality
in the nation.
Two factors help explain
the lack of doctors and other
healthcare professionals in these
counties: a payor mix that makes
it hard for healthcare institutions
to keep their doors open and
low reimbursement rates from
government payors, specifically
Medicare and Medicaid.
Maternity offers but one
example of a healthcare access
crisis that affects many parts of
the state. But not all “solutions”
offered would actually help. A
proposal by the Georgia Senate
Study Committee on Certificate
of Need Reform, for instance,
would worsen the problem. The
panel recommended repeal of the
state’s Certificate of Need (CON)
program, which protects patient
safety, provides quality controls,
helps lower healthcare costs, and
promotes access to healthcare,
especially in emergencies, by promoting the financial stability of
Georgia’s hospitals.
The Georgia Alliance of Community Hospitals opposes the
repeal of CON because it would
reduce the availability of healthcare across Georgia, and most
acutely in rural Georgia.
The Senate committee based
its conclusions largely on the research of a Virginia-based policy
advocate, Thomas Strathmann,
Ph.D., who claims to have compared Georgia to similar states
and found that CON does not
save money for patients and payors. But Strathmann’s research
has glaring shortcomings, including his failure to account for
whether states have implemented full expansion of Medicaid
under the Affordable Care Act,
which Georgia has not done.
The nationally renowned
Cleverley & Associates healthcare finance firm compared Georgia with Arizona, Colorado and
Texas, all non-CON states, and
found that Georgia patients pay
significantly less for emergency
department visits, inpatient care,
and routine room rates. Georgia
hospitals had lower markups,
lower net revenues per patient,
and lower operating margins
than in the non-CON states.
Comparing Georgia to other
states with CON and without
CON, and considering Medicaid
expansion, Cleverley found that
Medicaid expansion is associated with lower hospital charges
and higher operating margins,
an important measure of financial health.
Medicaid expansion— which
more than 40 states have implemented— would benefit providers
by greatly reducing the number
of uninsured patients, perhaps by
hundreds of thousands. Medicaid
and Medicare (government insurance for low-income Americans
and seniors, respectively) reimburse providers 86 cents on the
dollar of the actual cost of care.
While less than desirable, it’s far
better than uncompensated care.
Hospitals usually receive about
5 cents on the dollar from uninsured patients.
A 2018 survey of more than
90 healthcare systems in Georgia
revealed that nearly two-thirds
of patients were covered by
Medicaid or Medicare. Add in
those who pay little to nothing—
because by law, hospitals must
treat whoever shows up— and
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