Ideologies not always best for patients

Recently, The Palm Beach Post published a thoughtful commentary arguing that the elimination of Florida’s Certificate of Need (CON) program would foster competition and in return, result in improved access to medical care and controlled costs.

I have the greatest respect for the author of that piece, my colleague Wael Barsoum, president of Cleveland Clinic

Florida, but I believe the issue at hand is not about deregulation versus regulation. It’s about finding the right balance to achieve appropriate regulation that benefits patients and consumers in our state.

I am a strong believer in the free-market system and understand that healthy competition can be good for business and consumers. We compete every single day at Jupiter Medical Center, and that’s true of hospitals across Florida. But free-market principles are sometimes a poor fit when you try to apply them to the complexity of delivering quality health care to patients.

To illustrate that point, let’s look at one of the examples cited in Barsoum’s commentary. He argues that access to specialized care such as organ transplants could be improved by removing CON restrictions. Yet the Cleveland Clinic itself transfers many of their complex cases from their other hospitals to the main campus in Ohio. They do this because they know what has been well documented in the hospital industry: that the more times a hospital performs a complex procedure, the better they get at it, resulting in better outcomes for the patient.

In fact, quoting from a Cleveland Clinic outcomes publication, “a relationship has been demonstrated between volume and improved outcomes for many treatments, particularly those involving surgical and procedural techniques.”

Without CON, more providers can move in to offer highly specialized procedures, which means that each facility in Florida will be performing fewer of them, jeopardizing quality.

As often happens with issues in the public arena, there are peer-reviewed academic studies to support both sides of the argument about the impacts of CON deregulation. Barsoum points to some studies that reported that states without CON have lower health-care costs.

I would point to research done by Michael Rosko, a business professor at Widener University in Pennsylvania, which found that healthcare facilities in states with CON regulations were more cost efficient. He found that the regulations helped to avoid unnecessary duplication of facilities and keep hospital occupancy rates high enough to spread their fixed costs most efficiently.

Dueling research studies can’t decide this issue. Ultimately, we Floridians must look at the realities before us and decide what makes plain common sense. From my experience, I am convinced that eliminating CON would reduce quality, increase costs and make it harder for our patients to obtain necessary services.

Well-meaning people can disagree about this issue, but I believe we need to put aside ideology and focus in a collaborative way on what appropriate level of regulation will deliver the best health outcomes for the people of our state.