CON Reform Something For Everyone

    LANSING — Gov. John Engler plans to sign legislation reforming Michigan’s certificate of need program, ending a year-long process triggered by Metropolitan Hospital’s request to relocate.

    The CON reform bill, passed Dec. 13 during the last day of the legislative session, accomplishes Engler’s goal of streamlining the program and making it more effective and accountable.

    “The governor thinks it’s a good bill,” said Engler’s spokesman, Matt Resch. “Reform was needed in the system and he believes this bill will accomplish that.”

    The bill, a compromise that passed following a final rewrite by a House-Senate conference committee, alters the composition of the commission that establishes CON review standards, provides flexibility for health systems seeking to relocate licensed hospital beds to a sister facility within the same market, makes it easier for care providers in some counties to obtain an MRI, creates more legislative oversight to the program and seeks to streamline the application process.

    “I feel very good about it,” said state Rep. Barbara VanderVeen, an Allendale Republican who led efforts in the House to examine and reform CON. “We got some history-making revisions that should make certificate of need much more responsive and applicable to today’s health care system.”

    The Michigan State Medical Society, a staunch proponent of CON repeal, can live with the reform package passed this month, although it remains committed to the ultimate elimination of the program.

    “Obviously we would have liked to go a lot further,” said Colin Ford, the medical society’s manager of state government affairs. “We still have a long ways to go before we’re completely satisfied.”

    The effects of the CON reform package are hard to tell at this point, Ford said.

    “We’ll have to wait and see if it addresses all of the problems,” Ford said. “Looking into the crystal ball, I don’t know what the answer will be.”

    Under the package that passed, the CON Commission will expand from five to 11 members and consist of representation from varying health care and business interests. Two seats dedicated for representative businesses, one from a business that’s self-insured and one that’s not, as well as language that gives the commission discretion on whether to appoint an advisory committee or take up changes in CON standards on its own, helped earn the backing of business groups.

    “These get to cost containment and access issues that employers care about,” said Rusty Merchant, vice president of public policy and government affairs for the Grand Rapids Area Chamber of Commerce. “I’m really comfortable with the fact that there are some really good changes in there.”

    The bill requires the CON Commission to examine and, if needed, alter review standards every three years. It also establishes a six-month timeframe to complete standard rewrites. The measure also creates a six-member joint House-Senate committee to oversee the program, as well as requires the Department of Community Health to dedicate a minimum of two full-time staff members and additional support staff to administer CON.

    Backers of CON had complained that many of the problems were due to the department not adequately staffing the program and intentionally allowing it to languish.

    “The department was trying to dismantle this from the inside out,” VanderVeen said.

    MRIs fall under new provisions that automatically allow a minimum of two units in counties with a population of 160,000 without a care provider having to go through the CON process.

    In a move to satisfy two Detroit-area hospitals, lawmakers created provisions that allow a health system to relocate hospital beds within a given market to another hospital or outpatient surgical center with a 24-hour emergency room that it owns.  

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