First shots fired in Virginia General Assembly's health care battle

Dec. 22--A Virginia law that some say protects hospitals from cutting vital services and others believe shields hospitals from competition will be a prime target in this year's General Assembly.

Three senior members of the House of Delegates' Republican caucus said they plan to file a slew of bills to do away with much of Virginia's Certificate of Public Necessity (COPN) law.

That's the law that says the state has to approve before a hospital or other acute care, surgical, psychiatric or medical imaging facility can open or expand.

The result of that law, said Del. John O'Bannon, R-Henrico, the GOP caucus' point man on health care issues, is a lack of competition that keeps medical costs higher than they need to be.

Between the federal Affordable Care Act and the state COPN law, "health care is under almost complete government control," said Del. Kathy Byron, R-Lynchburg, who is chair of the General Assembly's Health Insurance Reform Commission.

"It isn't just that we don't have a free market, we effectively have no marketplace at all."

The bills offer an range of options -- from O'Bannon's proposed three-year, phased in repeal of COPN requirements, to outright, immediate repeal of almost all COPN requirements, to repeal of requirements for CT-scan and MRI facilities.

"They laid out a menu of options," House Republican caucus spokesman Matt Moran said, when asked why so many bills were coming and if any represented the GOP caucus stand.

"The speaker is supportive and feels there is a strong appetite for COPN reform in the House," he added. "It is a complicated issue and will have to work its way through the legislative process."

Hospitals generally oppose doing away with COPN, arguing that it exposes them to cherry-picking by facilities going after the most profitable types of care -- care such as imaging or cardiology -- that help support money-losing services like obstetrics and psychiatric care.

"Health care is not a free market enterprise," said Virginia Hospital and Healthcare Association vice president Julian Walker.

The reason is that federal laws requiring hospitals to provide emergency care to all who seek it, and that set rates for Medicare and Medicaid patients below the cost of providing their care, constrain how hospitals manage themselves.

Walker said health care costs in Virginia are lower than in most of the 14 states that eliminated their own COPN programs.

Virginia's issue of certificates usually includes a requirement to provide charity care, as well, hospital officials routinely note.

O'Bannon said his proposal would address the cherry-picking issue by continuing the COPN requirement for tissue transplant, open-heart surgery facilities and nursing homes. He also proposes that facilities that don't hit a target for charity care be required to contribute to a fund to cover costs of charity care elsewhere.

Del. Chris Peace, R-Hanover, who said he's been concerned about COPN regulation ever since the state rejected a proposal for an imaging and stand-alone emergency center in New Kent County, is proposing moving faster than O'Bannon to repeal all COPN requirements except for nursing homes, open-heart surgery and tissue transplant facilities.

As an alternative, he also proposed repealing COPN requirements for physician offices' CT scanning, MRI and other imaging. He is also proposing an immediate repeal.

Byron is proposing three measures: repealing COPN for emergency ambulatory centers; removing COPN requirements for medical equipment; and immediate repeal of all COPN requirements except for rural hospitals and nursing homes.

"This is not an attack on hospitals," Byron said. "Something to strengthen competition is good for society."

Earlier this year, a state work group recommended measures to streamline the process, but did not suggest repealing the requirement.

Ress can be reached by telephone at 757-247-4535.

___

(c)2015 the Daily Press (Newport News, Va.)

Visit the Daily Press (Newport News, Va.) at www.dailypress.com

Distributed by Tribune Content Agency, LLC.