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Health care: Hospitals want state to restore certificates of need

By Charles Swenson
Coastal Observer

The future of angioplasty in Georgetown Memorial and rehabilitation beds at Waccamaw Community Hospital are among $86 million worth of health care projects in the state that are on hold because a state agency says it doesn’t have the money to operate the program that allocates medical resources.

The two hospitals are among a dozen providers that petitioned the state Supreme Court last week to force the state Department of Health and Environmental Control to restore its Certificate of Need program.

“We’re in a state of limbo where we have a law on the books and no funding to support the process,” said Rick Kaylor, vice president of system development for the Georgetown Hospital System.

State law requires providers to get a certificate of need before building new facilities or offering new services. The certificates are based on criteria in the State Health Plan to “promote cost containment, prevent unnecessary duplication of healthcare facilities and services, guide the establishment of health facilities and services which will best serve public needs, and ensure that high quality services are provided.”

In June, Gov. Nikki Haley vetoed $1.4 million for the certificates of need and other programs in the DHEC budget. “The Certificate of Need Program is an intensely political one through which bureaucratic policy makers deny healthcare providers from offering treatment. We should allow the market to work rather than politics,” Haley wrote in her veto message.

The House of Representatives sustained the veto and two days later Catherine Templeton, the DHEC director, notified health care providers that “the veto completely suspends the program for the upcoming fiscal year.” The agency won’t review any new applications or act on any pending ones, she said.

If funds are restored, “the department will not be inclined to take enforcement actions under Certificate of Need for activity that occurs during the program’s suspension, unless instructed otherwise by the General Assembly,” Templeton wrote.

Georgetown Memorial has applied for a certificate that will allow doctors to perform percutaneous coronary intervention, better known as angioplasty, without having staff to perform open heart surgery as a backup. “Doctors now go to MUSC to perform procedures we can do here,” Kaylor said.

The hospital applied for the certificate last year after the State Health Plan was changed and hoped to start offering the procedure this year.

Waccamaw Community Hospital has applied for a certificate of need for 17 additional beds in its 43-bed rehabilitation unit. Based on Templeton’s letter, the hospitals could simply move forward. “It would be very risky to move forward in the current climate,” Kaylor said, not knowing whether the state would retroactively require a certificate or if another provider would implement the same services without a certificate.

“I hope no one takes advantage of the situation to develop a new facility,” he said.

The hospital system has also received a certificate to move a linear accelerator from its cancer treatment center in Georgetown to its imaging center in Murrells Inlet. A certificate for another device in Murrells Inlet was also issued to 21st Century Oncology and the hospital system appealed to the Administrative Law Court.

That appeal is still pending, but Kaylor said the process shows the value of the Certificate of Need Program. “It’s a lot better than being allowed to build anything anywhere,” he said.

With Georgetown County located between two larger counties, the certificates ensure that a provider can’t just focus on services with the highest financial return. “We’re mandated to take care of all the community,” Kaylor said. “We rely on all services to support that. Providers who provide only the more lucrative services would hurt us.”

In their petition to the Supreme Court, the providers argue that DHEC can’t repeal the Certificate of Need law by claiming a lack of funding. They point out that the program collects fees from applicants in excess of the cost of running the program and note that other programs affected by Haley’s veto, such as inspections, continue to operate because DHEC shifted funds in its budget.

The petitioners also point to a statement issued by the chairman of the House Ways and Means Committee stating the intent of upholding the veto was not to eliminate the Certificate of Need Program. “The House believes there are a number of ways for the CON Program to retain its function and purpose,” Rep. Brian White said.

The petitioners ask that the court declare that the governor’s veto does not repeal or suspend the Certificate of Need Act and that DHEC is required to administer it. If the agency lacks the funds, they ask the court to require it to devise a funding plan with the state Budget and Control Board or seek a supplemental appropriation from the legislature.

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