Almost half a century ago, the nation — starting in New York — embraced a sweeping regulatory strategy as the solution to rising health care costs.
The approach was to keep costs down by controlling hospital beds and equipment. Before expanding or buying expensive new equipment, providers had to prove “need.”
Mostly the rigidly anti-competitive regulatory system didn’t work and, under President Reagan, the federal requirement for a “certificate of need” (CON) was repealed. But just as American taxpayers still, under New Deal regulation, pay wealthy farmers not to grow crops, the remnants of failed health care cost containment persist today.
Just ask Dr. Manfred Sandler, chief of cardiology at Gwinnett Medical Center. Or state Sen. Renee Unterman of Buford. Both are furious at a legacy regulatory system that continues to make Gwinnett — population 814,215, up 350 percent between 1980 and 2000 — the largest county in the nation without a hospital with a license to perform open-heart surgery.
In January 2008, GMC applied to the state for CON permission to provide open heart surgery. Permission was granted in June. Three hospitals appealed: Piedmont, Emory and Emory Crawford Long. A hearing officer for the Certificate of Need Appeal Panel this week denied Gwinnett Medical permission to build. Hence the anger expressed by Sandler and Unterman.
“I am disgusted and disappointed,” said Sandler. Unterman’s anger is more sweeping. “It’s a way for lawyers to make money and, meanwhile, you have people out in Gwinnett County who are having heart attacks and dying,” said Unterman, who fought to repeal or at least reform the law in the General Assembly two years ago.
If you read the hearing officer’s decision — which, importantly, should be overturned by the Department of Community Health commissioner by July 17 — you get a sense of a regulatory process that is virtually insurmountable.
It notes, for example, that Athens Regional Medical Center in Clarke County “has been struggling to provide at least 300 procedures per year,” the number needed to maintain a high-quality heart surgery program.
In 2007, of the 506 Gwinnett residents requiring open heart surgery, four ventured to Athens. The hospital most affected — St. Joseph’s, just inside I-285, where 71 percent of Gwinnett residents go for open-heart surgery — agreed in April 2008 to partner with GMC in Gwinnett Cardiovascular Services.
The three hospitals that object served 119 residents, or 24 percent of Gwinnett’s patients.
The rejection is based on speculation that Emory’s medical training could be negatively affected and on good health outcomes for Gwinnett patients who travel out of county. It does not, however, note that the health outcomes don’t take into account an increasing number of cardiac-related deaths at GMC’s emergency room, which rose from 149 in 2006 to 181 in 2007. And, the hospital appeal notes, “in-hospital acute myocardial infarction mortality rates were significantly greater at GMC than at other metropolitan Atlanta open heart surgery providers .” For the elderly, those over 65, it was 150 percent greater; for those 55-64, it was 200 percent greater.
It is a regulatory outrage that GMC is denied the opportunity to serve the obvious needs of a rapidly growing county. The outrage is not for the hospital, but for sick people and their families.