Death of CON due to multiple blows

Several factors cited in defeat of hospital planning overboard

ATLANTA - When Rep. Mickey Channell last week effectively killed a bid to overhaul Georgia's law governing the construction of hospitals and other health care facilities, he cited the hour and the complexity of the issue.

It was after 9 p.m. on "Crossover Day," the deadline for bills to pass the legislative chamber where they originated, and tired House members had been in session for more than 11 hours.

Lawmakers had just passed an annexation reform bill after a lengthy debate. Legislation making a significant change in the state's Certificate of Need process - which controls what health care services can be offered in a community - was likely to generate another long discussion.

"CON deserves a healthy floor debate," said Rep. Austin Scott, R-Tifton, one of the Legislature's strongest supporters of reforming the law. "I don't think people were up for a healthy debate at 9:30 at night."

But a lot more than timing went into thwarting action on one of the most heavily lobbied issues to hit the General Assembly this session.

Lawmakers and lobbyists on both sides also blamed the defeat of CON reform on a widespread desire for a comprehensive bill rather than piecemeal solutions, a late change of heart that sank a compromise between groups representing hospitals and general surgeons and rumors that changing the law would lead to an outbreak of abortion clinics.

"Certainly, there was far from any consensus among the people most affected," said Channell, R-Greensboro, whose motion to send the only CON bill to reach the House floor back to the Rules Committee prevailed 112-52.

"We need to have something both hospitals and physicians can live with."

Two-year process

It took two years for the push to overhaul the CON law to reach the House floor last Tuesday night.

The General Assembly created a commission in 2005 made up mostly of health care professionals to consider whether the state's CON restrictions should be weakened or scrapped altogether.

The panel also included two lawmakers, Scott and Sen. Don Balfour, R-Snellville.

The driving force behind the campaign for change was doctors who wanted to open freestanding centers for outpatient surgery or imaging and found the state-approval process cumbersome to navigate.

The commission issued a 200-page report just before the start of this year's legislative session with 52 recommendations for updating the 28-year-old CON law.

The panel approved more than 40 of those suggestions unanimously, including changes aimed at streamlining the approval process and accelerating appeals filed by applicants denied a CON.

But what occupied most of the debate once lawmakers convened were recommendations the commission adopted on divided votes, notably a change that would exempt freestanding outpatient centers operated by general surgeons from CON.

The discussion was further complicated by the introduction of a bill on behalf of Illinois-based Cancer Treatment Centers of America, looking to open a small hospital in Georgia featuring its approach to cancer treatment.

That proposal hadn't come up during any of the meetings held by the commission.

Reacting to a flurry of CON-related bills introduced in late January, House Speaker Glenn Richardson, R-Hiram, created a special committee to focus solely on those measures.

Three finalists

During hours of meetings held by the committee, three major players emerged: the cancer center bill, legislation exempting general surgery from the CON law and a more comprehensive measure introduced on behalf of Gov. Sonny Perdue.

The governor's bill also called for exempting general surgeons wishing to open outpatient centers from CON requirements. In return, they would have to pay "civic rent" by committing a small percentage of their revenues to indigent care.

The major fear of hospitals in giving doctors carte blanche to open freestanding outpatient centers is that they wouldn't be required to serve non-paying patients - as hospitals must do by law - putting hospitals at a competitive disadvantage.

When Perdue's bill first appeared, many of his Republican legislative allies rallied around it as the comprehensive approach they had been looking for.

But it was also more than 100 pages long, and the special committee never seemed to get a firm grasp on it.

With Crossover Day fast approaching, the panel settled for the much narrower cancer center and general surgery bills.

Of those two measures, however, only the one dealing with general surgery made it to the House floor.

While addressing the concerns of general surgeons was one of the key issues driving the debate, the bill still ran into opposition from lawmakers who wanted comprehensive legislation.

"It's all so interrelated," Channell said. "My opinion was we should deal with the whole thing."

Compromise offered

Despite that sentiment, the bill appeared to have a good chance of passing because of a compromise hammered out by rural hospitals and general surgeons.

Administrators from rural hospitals, perennially operating on shaky ground financially, see freestanding outpatient-surgical centers as even more of a threat than officials from urban and suburban hospitals.

To allay their fears, the general surgeons agreed to require that physician-owned outpatient centers in rural counties be operated jointly with local hospitals.

"We thought we had an agreement with rural hospitals on that language," said Kathy Browning, executive director of the Georgia Society of General Surgeons. "Then, they decided they hadn't read it carefully enough."

Jimmy Lewis, CEO of HomeTown Health Care, which represents rural hospitals, said they liked the language at first but, upon closer examination, saw unintended consequences that would hurt rural areas.

He said forcing general surgeons in rural counties to enter into joint ventures with hospitals, when they wouldn't have to elsewhere, would simply cause them to move to more populated areas.

"The language was well intentioned, but it would have caused a migration of surgeons," Lewis said.

If that wasn't enough to shoot down the bill during the waning hours of Crossover Day, Browning said false rumors began circulating that easing restrictions on freestanding outpatient-surgical centers would make it easier for abortion clinics to set up shop in Georgia.

"I don't know which hospital lobbyist put that out, but it really caused problems on the floor," she said.

Kevin Bloye, spokesman for the Georgia Hospital Association, said late last week that he hadn't heard of anyone spreading such rumors before Tuesday night's vote.

"That issue has never come into play from our perspective," he said.

Reactions mixed

While hospital officials were pleased with the outcome, general surgeons were disappointed.

Browning said her group was unhappy with some lawmakers' insistence upon a comprehensive bill when addressing general surgeons' concerns would have been a major step.

"Saying you want to do something in a comprehensive way or do nothing is a way to stall," she said. "This is such a narrowly drawn change. It is not a fundamental change to the CON law."

Balfour said the legislature at least should have adopted the commission's unanimous recommendations.

"These things needed to be done," he said. "It would have streamlined the process."

One thing all sides agree on is that the debate isn't over.

Scott said he's confident the parties will work during the summer to develop a comprehensive bill for consideration next year.

Lewis isn't even convinced that CON has been put to rest for this session.

Although Crossover Day has come and gone, intrepid lawmakers can find a way to attach dead bills to related legislation that is still alive.

"I learned a long time ago, in the last days of the session, to never say never," he said.