Crist budget surprise: Abolish hospital certificate-of-need

By Christine Jordan Sexton
2/1/2008 © Florida Health News
TALLAHASSEE -- Tucked inside the $70-billion budget that Gov. Charlie Crist unveiled on Thursday is a controversial plan to eliminate the certificate-of-need process for the construction of new hospitals.
Crist made the recommendation as part of his economic stimulus package, which he contends will help the state at a time when housing has slumped and sapped tax collections. But his proposal will draw opposition from the health-care community, which views CON as a necessary tool to control duplication and wasteful spending.
“I can’t imagine what they mean by economic stimulus,” Tallahassee CON consultant Gene Nelson said. “It’s hard to see how the mere fact of building more hospitals is going to help the economy.”
Crist didn’t mention the proposal during his 30-minute press conference, but while campaigning for governor he promised to “minimiz(e) red tape in the building of new health facilities.”
Florida is one of 37 states with certificate of need requirements. Agency for Health Care Administration Deputy Secretary Liz Dudek has said that Florida’s CON requirements are considered “moderate.” For example, Florida no longer requires a CON for capital expenditures or for new beds at an existing hospital, which some states do.
The state does, however, require a CON for new hospital construction.
The proposal, which would require approval from the Legislature, may run into heavy opposition. Rep. Ed Homan, a physician and Tampa Republican,  has urged members of a House health care panel to "think long and hard about relaxing the CON process."
Florida Hospital Association Senior Vice President Ralph Glatfelter said eliminating CON for new hospital construction would encourage the development of what he called “limited service hospitals” or small, seven and 10-bed facilities that, he said, will cater to the “very healthy and best-insured patients.”
Florida already has banned so-called “boutique” cardiac and orthopedic hospitals but hasn’t outlawed limited service hospitals, Glatfelter said.
“They are high cost and inefficient, and they will force existing hospitals to raise their rates,” Glatfelter said. “It won’t help the economy and it won’t increase access to health care. In fact, it will do just the opposite.”
Glatfelter said that “every single hospital and health care system in the state will oppose this change.”