Saturday, October 20, 2012

Is it time?

The dreaded and feared Certificate of Need law appeared at the Mississippi Supreme Court this week. This time the victim is UMC:

"JACKSON — The Mississippi Supreme Court has refused to reconsider its ruling that the University of Mississippi Medical Center must follow the state's certificate-of-need law.

The court today denied requests to revisit its June ruling.

Mississippi's CON law limits where hospitals can locate and expand and what services they can provide.

The court ruled UMMC, as a competitor in the hospital marketplace, must abide by the same CON laws as the other 100-plus hospitals in Mississippi. However, the court said state health officials can determine when UMMC must do so.

UMMC said it was not subject to the CON law. St. Dominic-Jackson Memorial Hospital, Health Management Associates and Mississippi Baptist Medical Center took the view that the laws apply to UMMC as to all hospitals."

Perhaps its time to get signatures and put abolishing the CON law on the ballot.


Anonymous said...

Instead of abolishing the CON perhaps the law should require EVERY hospital in MS (or maybe just within 50 miles of UMC) to contribute an equal percentage of each hospital's GROSS revenue to UMC to support the only medical school in the state as well as their residency programs.

Anonymous said...

If the Second Coming occurs during our lifetime perhaps we will see Christ turning out the money-changers from Baptist and St. Dominic's :-)

Anonymous said...

"This time the victim is UMC."

Incorrect. UMC won the case: the CON Law "applies" to it, but in a remarkable feat of interpretive magic, the MSSC has held that the Department is free to decide that any project is not covered by the CON Law, and never mind the Legislature's list of activities that require a CON. See the op.

"The Legislature, through enactment of Mississippi Code Section 41-7-187, delegated to MSDH the authority to 'adopt by rule and regulation: . . . (b) effective standards to determine when a person, facility or
organization must apply for a certificate of need.'"

So when the CON Law says that "No person shall engage in any of the following activities without obtaining the required certificate of need," it's not "required" if the Department says it's not, even if it's a new hospital or a $10M piece of equipment. Full and complete discretion lies with the Department ... at least, that's how I read the op. If someone reads it differently, then please share.

Anonymous said...

"If the Second Coming occurs during our lifetime perhaps we will see Christ turning out the money-changers from Baptist and St. Dominic's :-)"

Sorry. Aren't they nonprofits?

clintonrebel said...

All the CON system accomplishes is turning the critical care industry into a giant political operation. If you shmooze the right people (ie build soccer fields) you drum up support for your CON. Not to mention all the direct lobbying of our legislature to keep competition out. Kill the CON, and while you are at it, put in some term limits on the legislature.

Anonymous said...

UMMC should be held at the same standards, rules and regulations that every healthcare facility in Mississippi operates under.

At one time the public perception of UMC was patient care first and financial second. Now the perception is financial first and patient care second. UMMC apparently is well funded as evidenced by the number of new construction projects on campus as well as what seems to be a very generous advertising budget.

Anonymous said...

11:46 they claim to be; hence the sarcasm. Sorry if it went over your head.

Anonymous said...

If a hospital can afford it (on their dime not mine) why shoud I care if Madison, Flowood, Clinton, Canton or any where else in the metro each has 1/2/3 hospitals. They won't build it if it can't support what they build.

Competition is good, may the better run hospital win!

My former state ditched something simular to CON and the world did not end just the politics.

Anonymous said...

I cannot believe that anyone is looking to build new hospitals after the poor census at Madison River Oaks.

Tack onto that the penalty for readmission that started hitting all hospitals on October first and I would not want to be involved in introducing a new hospital to any area right now.

Most hospitals are looking at the loss of several $100,000 after the October first readmission penalties.

Anonymous said...

Re: Anonymous @ 10:43

St. Dominc and Baptist already are penalized to support UMC. Each of them pays in excess of $1 million/year (check) because each of them is not a level II trauma center. Of course it makes absolutely zero sense to require three level I/II trauma centers within a mile of each other but that is state law.

Anonymous said...

934. They don't pay the money to support UMMC, they pay the money to the state trauma system (check) because they opted to. It is THEIR choice to pay or play. Would you have UMMC treat all the trauma patients with no hope of keeping the lights on so that Baptist/St.D/HMA can continue to attempt to cherry pick the rest of the healthcare delivery system?

It also makes absolutely zero sense to require UMMC to treat most of the indigent care patients within a mile of each other, but that is the way the not-for-profit church/hospitals want it. So much for "Christian" charity when you apparentl want a "state" charity system.

Anonymous said...

The CON laws apply to more than hospitals - take dialysis centers. Go look at the dialysis mortality rates of the states around MS. The 2 with the CON laws - MS and AL - are better. You don't want fly-by-night owners or some doctor owners (when $ is on the line, they compromise). In addition, there is limited trained staff - look into the Memphis or New Orleans markets where some staff show zero loyalty. With CON protection, patient care or new processes/equipment are discussed each day instead of strategic advantages.

Anonymous said...

Will the CON laws prevent Physician Owned Distributors from operating in hospitals?

Will it stop doctors from implanting devices made by companies they own thus profiting from the surgeries they perform? It was clearly detailed in last year's WSJ article.

If so, someone should put St Dominics on notice.... Or the OIG

Anonymous said...

The CON was a Federal requirement that has gone away but Miss. kept it. Most state did not keep it..

clintonrebel said...

The CON process has absolutely nothing to do with mortality rates at dialysis centers. Not even remotely related.

Anonymous said...

"With CON protection, patient care or new processes/equipment are discussed each day instead of strategic advantages."

Thanks for the chuckle. If you think that after a CON is granted and a facility built the workers discuss "each day" blah blah blah you are delusional. Once it's granted it's done - they're not going to come knock down the building once it's up and running.

Anderson said...

I'm probably not competent to discuss whether the CON Law is a good thing or not, but I don't think it's properly criticized on "free market" grounds.

We don't have a pure free market in health care, thanks primarily to Medicare and its effects on the market.

Nor is it necessarily a good thing if an area already has 5 gadgets, has demonstrable need for 4 or 5 gadgets, but someone wants to buy a 6th gadget just to compete with the other 5 and maybe drive one or two of them out of business. How does that help things?

So, the necessity of the CON Law is something I'd want a good bit of data to look at before I could decide either way. Of course, now that the Department can set aside the CON Law as it likes, the point may be moot.

Kingfish said...

who are you to decide what the market is?

Anderson said...

"who are you to decide what the market is?"

??? If this is directed to my saying we don't have a free market in healthcare, I think that's obvious.

Otherwise, where did I "decide what the market is"?
Obviously, a lot of the cost of gadgets, hospitals, etc. is borne by the taxpayers. So it's not just a "market" issue, it's a policy issue.

Anonymous said...

I just wish a CON was required for development of shopping centers & residential subdivisions and check cashing facilities.

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