From Marcia Hendricks RN, MHA, FACHE
CEO of Adair County Health System
Iowa has one of the highest quality, lowest cost health care systems in the United States. And at the heart of that system are 118 community hospitals that stand ready, day and night, to serve everyone, regardless of their ability to pay. A significant reason for health care excellence in Iowa has been state oversight of institutional health care services through the Certificate of Need law.
Iowa’s Certificate of Need regulations were first enacted in 1977 for the express purpose of providing for the orderly and economical development of health care services, thereby avoiding unnecessary duplication of services, controlling the growth of overall health care costs and ensuring the stability of community hospitals. Since that time, these regulations have been re-examined multiple times and each time the same conclusion was reached: Iowa needs Certificate of Need.
As the name implies, Certificate of Need ensures that new medical services are truly needed at the community level. This is important because new facilities, including nursing homes, ambulatory surgical centers and hospitals, among others, must have sufficient patient volumes to support proficiency among medical staff and ensure high-quality care. The same applies to existing facilities, yet without Certificate of Need, new, for-profit facilities would spring up all over the state and deplete patient volumes across the board.
Not only would this compromise the quality of care for everyone, but these new facilities would target lucrative lines of medical service while not providing emergency care, charity care and other unprofitable services that are at the core of the community hospital mission. If Iowa’s community hospitals are left with only unprofitable services and only care for complicated patients who are on Medicaid or uninsured, their ability to survive and continue providing high-quality, community-focused care to everyone will be jeopardized.
In fact, repeal of the law in other states has led to hospitals closing. Furthermore, nearly all of these states have instituted a different review process that is highly politicized.
One of Iowa’s greatest strengths is its health care system. Not only do Iowa’s health care providers deliver excellent, accessible and efficient care, but health care employs more than 200,000 people, injecting some $11 billion into the state’s economy. More than 71,000 of these workers are employed by hospitals, which alone have an economic impact of $4.3 billion.
Certificate of Need, which exists in 36 states, not only ensures the stability of these major employers and economic engines, but it also supports the collaborative spirit that fosters communication and cooperation among Iowa health care providers, which, again, leads to better health care for everyone.
Today, with the uncertainties surrounding the future of the Affordable Care Act (Obamacare), Iowa’s Medicaid program and even Medicare, the constancy of Certificate of Need is more important than ever. During this time of significant change in the health care industry, the stability provided by this law allows hospitals to more confidently plan and respond to the needs of the communities they serve.
In all parts of the state, Iowans depend on their community hospitals being there all day, every day. That level of access and preparedness is jeopardized by those who would significantly change or repeal Certificate of Need.