Turmoil during the sale of Manchester, Rockville and Waterbury hospitals from Prospect Medical Holdings to Yale New Haven Health has prompted conversation about the state's ‘certificate of need’ program — and whether or not it’s needed.
WSHU’s Ebong Udoma spoke with CT Mirror’s Jenna Carlesso to discuss her article written with Katy Golvala, “Fix or nix? CT’s ‘certificate of need’ law under scrutiny,” as part of the collaborative podcast Long Story Short.
WSHU: Hello, Jenna. Let's start with Connecticut’s certificate of need law, and why it's become an issue in Yale New Haven Health’s purchase of three struggling hospitals owned by the private company Prospect Medical Holdings. What is the certificate of need law?
JC: So the certificate of need program is a regulatory program that requires state approval for different types of transactions in the health care industry. So if you're a hospital and you want to purchase another hospital, or if you're a health system and you want to purchase another health system, or merger, you'd have to get state approval for that. And even for sometimes things as simple as certain types of medical equipment; if you want to acquire a PET scanner, you may need state approval for that.
WSHU: Now, why has that been an issue in purchasing the three struggling hospitals?
JC: So this law or this oversight program has been around for decades, and Connecticut launched its own in the 70s. But there's a real spotlight on it right now, because Yale New Haven Health wants to purchase three facilities, three hospitals owned by Prospect Medical Holdings, and they had applied for a certificate of need through the state to get approval for that. That process took about 16 months. The approval did come through recently.
WSHU: Well, why did it take so long? 16 months, that is quite a bit of time.
JC: So there's a lot of reasons the state's Office of Health Strategy has talked about why things might take longer. The Office of Health Strategy oversees the certificate of need program. It can be that an application doesn't have enough records, it could be that a public hearing needs to happen and the date gets changed. But in the case of Prospect, that office has said that it's a very complicated transaction. It involves the purchase of three hospitals versus, say, one health system purchasing a single hospital. All of that has been added to the timeline.
WSHU: But lawmakers are concerned about this process and they're trying to do something about it. You say there are four different proposals on the table this session?
JC: Yes. Several legislators are concerned about the process possibly limiting competition. Others say it creates unnecessary delays in patient care. Some people are concerned about how enforcement is done. So right now, the legislators are considering at least four bills. One of the ones that has gotten the most attention is the shorter time frames; one of the bills would shorten the time frame for a review and decision on an application to 30 days down from 90, and it would also tighten up some other time frames. So if there's an intervener, like a member of the public, they would have to request a hearing within 10 days versus 30 to move the process along more quickly.
WSHU: And this is backed by the co-chair of the Public Health Committee, Senator Saud Anwar (D-East Hartford), who is a doctor. So what's his take on this?
JC: So the Public Health Committee has actually advanced all four of the bills. They put their support behind it to move them forward. And there are some other steps they have to go through before coming up for a vote. Senator Anwar has definitely chatted about wanting tighter timeframes. And he's also mentioned wanting to see more clinical staff overseeing the process versus people in the legal field.
WSHU: And some are saying there's no need for a certificate of need. What's their argument?
JC: So some folks feel the process should go away altogether. They argue the programs in states across the country have failed to limit spending or improve quality and access. Some of them describe it as red tape that increases consolidation and increases health care costs.
WSHU: Any idea of which of these bills will be able to make it into law this year?
JC: So right now, the legislators who are supporting the bills are having conversations with the Office of Health Strategy to fine-tune the language. The issue this session really is the budget constraints and whether, you know, additional personnel could be brought on at the Office of Health Strategy to help move this process along more quickly. If not, an alternative is to increase exemptions. So fewer things would have to go through a certificate of need, in order to be approved, they would just be approved without a certificate of need. That's all up in the air right now.
WSHU: It seems as if we will probably have more consolidations of the health care system, and more scrutiny over those purchases going forward.
JC: In recent years, particularly, we've seen more and more consolidation.
