Patients win when independent doctors open stores. More choice means better service and lower costs for everyone. But states often step in to stop the competition in healthcare.
Virginia Regulatory Authority I was blocked When Maryland-based radiologist Mark Monteferrante sought to expand his independent practice beyond state lines.alabama regulator Stop family physician Nancy White as she attempted to provide home medication at a 16-bed facility. 20 years When he tried to open an ambulatory surgery center next to his office.
There was no government interference with health or safety concerns. A licensed physician would have provided medical care using state-of-the-art equipment and technology in all three cases. objected to working for me.
The consolidation of independent practices has continued for decades, milestone In 2018, the number of employed doctors surpassed the number of self-employed doctors for the first time in U.S. history. Many factors contribute to trends. acceleration during the COVID-19 pandemic.
For example, regulatory compliance and medical billing are becoming more complex. But Monteferrante, White and Birchanski’s obstacles were something else. It was a tool that made a monopoly called a “Certificate of Need” or “CON”.
Overall, 38 states and Washington, DC have CON laws or similar laws in force.
Before healthcare providers can begin or expand their services in these jurisdictions, they must first prove to the government’s satisfaction that a need exists. Often this means having to prove that you’re not poaching talent or getting revenue from an established provider.
To further maintain the status quo, many states allow existing providers to participate in the CON process. This ensures that you receive government permits while denying potential rivals.
Something similar would happen if the state allowed Home Depot to block family-owned hardware stores from opening nearby. Innovation would suffer. But CON proponents argue that governments need to do a favor for healthcare to prevent extra investment and keep costs down. For example, he argues that too many MRI machines and surgery centers in the same area waste money, raise prices, and reverse the principle of supply and demand.
Such arguments suggest that the usual laws of economics do not apply to healthcare.stealthAcquisition of private equity. But they weaken their case when they defend the CON Act, which is all about money.
As expected, the promised benefits of CON never materialize.academic research, federal review, and decades of real-world experience have revealed the CON Act to be a failed experiment.Antitrust Division of the U.S. Department of Justice and Federal Trade Commission sounded the alarm As far back as 2008, “CON Act, by its very nature, presents a barrier to entry and expansion, detrimental to healthcare competition and consumers.”
Many governors have acknowledged the damage done in the early weeks of the COVID-19 pandemic. “maneuver the competition, a nationwide review of CON laws by our public interest law firm, the Institute of Justice, found that 24 states and Washington, D.C., have suspended CON enforcement in 2020. This has enabled healthcare providers to respond more quickly to crises. Despite the evidence, many states embrace protectionism anyway.
Ophthalmologist Jay Singleton knows firsthand. He owns a vision center near Fayetteville, North Carolina, where he can treat patients for thousands of dollars less than the big hospitals.but the state don’t let him Use spaces for most of the steps he takes. He doesn’t have his CON, so he has to drive to a competitor’s facility two miles away.
Costs rise, scheduling options dwindle, and patients suffer.
New Hampshire finally had enough and repealed its CON laws in 2016, joining California, Texas, and nine other CON-free states that account for about 40% of the US population. The next battlefield for CON reform is South Carolina.Since then, Palmetto legislators have debated a full repeal. at least 2015 and renewed their efforts in 2023 Senate Bill 164.
Independent doctors will benefit from the end of protectionism. So do consumers. No one benefits when government officials intervene between licensed doctors and their patients.
Jamie Kavanaugh I am a lawyer. Darryl James I’m a writer.
