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House Panel Will Weigh CON Reforms
A panel of state legislators, preferring to take a fix-it rather than kill-it view of the process, wants to see what changes are needed in the program that regulates the development of health care services and facilities in Michigan.
The subcommittee of the House Health Policy Committee could begin holding hearings as early as next month on the state Certificate of Need program. The effort is expected to lead to legislative action next year to reform CON, a regulatory process established in 1972 to provide a checks and balances over health care cost, quality and access issues, and to ensure the development of only those medical services and facilities where they are needed and supported by market demand.
The panel’s first task is to decide whether the CON program needs changing – a question that many within the state’s health care industry answer with an emphatic “yes,” claiming the process is far too cumbersome and costly.
After answering that question of whether to change CON, and in the process establishing a comparative basis on which to judge the status quo against suggested changes, the panel will move on to examining and determining the precise reforms to make, said Rep. Barbara Vander Veen, an Allendale Republican who chairs the subcommittee.
“The premise is to study whether to change, but you can’t look at whether to change it without looking at what to change,” Vader Veen said.
Vander Veen’s subcommittee was formed earlier this year to examine ways to reduce the cost of health care. During hearings across the state last summer, complaints were often voiced about the current CON process, she said. Among the findings included in an upcoming report from the subcommittee is a call to either reform or repeal CON.
The concerns voiced about the process led lawmakers to seek and win approval from state House Speaker Rick Johnson for the subcommittee to take an in-depth look at CON, Vander Veen said.
The review comes as legislation is pending in the state Senate to repeal CON by removing all references to it from the Michigan public health code, although the legislation’s main sponsor, Sen. Glenn Steil of Grand Rapids, earlier indicated that he’s willing to look at other options.
“I don’t mind revising it if someone has a better idea,” Steil said. “I’m willing to look at all other alternatives.”
Even those who support CON say it could use revisions that make it more flexible and work better. Among the ideas mentioned is to build more flexibility into CON standards used to review heath care projects, or to regionalize the program with different standards for different markets across the state.
“Perhaps there are some reform opportunities,” said Roger Spoelman, president and CEO of Mercy General Health Partners in Muskegon.
Spoelman likes the checks and balances and public input provisions that CON provides over health care investments, but considers the process laborious and time-consuming.
“It has a definite plus-minus thing,” Spoelman said.
Grand Rapids area lawmakers speaking at a legislative forum last week on health care issues said they hope to find alternatives to the current process and for now prefer to look first at reforming CON rather than repealing it.
“At this point, I’m willing to say we need to go in and reform it,” said Rep. Mark Jansen, R-Gaines Township and a recently added member of the subcommittee.
Jansen believes that CON, while well intended, has strayed from its original goals and has not kept up with the rapidly changing health care industry, particularly the development of new medical technologies.
“Some way we need to figure out what works and pass something that meets our goals,” Jansen said.
To Rep. Jerry Kooiman, the question isn’t one of whether to change, but how far to go.
“The question is do you do a wholesale wipe out of the system and find something to replace, or do you do some major surgery and retain the system so that it works?” said Kooiman, R-Grand Rapids. I’m not ready to ‘do we just wipe it out?’ but I’m not going to be satisfied just to do polishing around the edges.”