State standards restrict lifesaving services, critics charge

By TRACEY GLAZENER
Capital News Service
LANSING — Opponents of the state’s health care cost-control program say Michigan citizens are paying the ultimate price — limited access to lifesaving services and technologies.
Sen. Glenn Steil, R-Grand Rapids, is leading the battle against Michigan’s Certificate of Need program, which requires that health care facilities get permission from the state before making major expenditures for equipment or expanded facilities.
CON standards are determined by a five-member government-appointed commission, and applications are reviewed for endorsement by the Michigan Alliance for Health and the Michigan Department of Community Health.
Many states repealed CON programs when federal funding for such health care cost control strategies ceased in 1986, but Steil says special interest groups keep Michigan’s law in place for their own benefit. The result is what CON opponents are calling an unfair rationing of health care.
According to a petition submitted to a House subcommittee on health care costs, 96 of the state’s some 150 nonprofit hospitals disagree.
John Liston, vice president of planning and business development at Mount Clemens General Hospital, said CON is necessary to keep hospitals and other nonprofit health care providers in business.
“We and other hospitals of the Michigan Hospital Association are unequivocally in support of CON,” he said. “We are willing to play by the rules to protect our ability to serve the patients — that’s why we’re here.”
Liston said the proliferation of for-profit health care facilities would place an unfair burden on non-profit hospitals to care for the indigent population.
“For-profit health care providers do not typically set up shop in low-income neighborhoods, so we are left to care for those who can’t pay for health care,” Liston said. “On top of that, they keep limited hours, while we must staff the hospital 24 hours a day, seven days a week.”
Robert Marquardt, president of Memorial Medical Center in Ludington, said he doesn’t support the repeal of CON, but he described it as a “byzantine process” that often caters to the whims of special-interest groups.
“The process needs to be revised and made less open to the influence of special-interest groups,” he said. “The hoops you have to jump through to justify your case are entirely unreasonable.”
Marquardt said the hospital would like to offer megavoltage radiation therapy, which is useful for treating cancers of internal organs while minimizing radiation damage to the skin, but CON is standing in the way.
Patients currently needing such therapy — which typically requires daily treatments for at least a month — must travel as far as Muskegon to receive it.
“I don’t understand how the state can say that it is reasonable for someone to drive 60 miles one way to get radiation therapy,” Marquardt said. “It’s a crime.”
Liston argues that by consolidating resources and reducing the instance of duplicative services, CON ensures that patients receive quality health care.
“People don’t want to get major heart surgery at a place that has only performed six heart surgeries,” he said. “They want to go where hundreds of surgeries are performed all the time, and I think people are willing to travel to get that kind of service.”
Meanwhile, many physicians recently testified before House and Senate committees on health policy that the interests of Michigan consumers and patients have been grossly overlooked.
While testifying before the Senate committee, West Bloomfield radiologist Dr. Michael Sandler, said, “Something is fundamentally wrong if Michigan citizens can’t get quick access to necessary health care.”
He said citizens in West Michigan typically wait six to eight weeks for an available magnetic resonance image scanner, which is useful in the early detection of soft-tissue abnormalities.
In urgent cases, Sandler said, patients are often referred for treatment to Ohio, where CON laws were repealed in 1997.
Despite compelling testimony, committee member and physician John Schwarz, R-Battle Creek, said that total elimination of CON is probably not possible or advisable.
“The reality is we probably can’t get rid of it, and it’s probably not a good idea to get rid of it,” he said. “We’re sure as heck going to try to fix it, but we’re not going to get rid of it.”
Sen. Diane Byrum, D-Onondaga, added that the committee is taking the issue seriously, and any future changes to CON law will reflect that.
“It is not our intent to fix it around the edges,” Byrum said. “If we go in and are successful in passing legislation dealing with CON, it would be a major overhaul.”
Some of the suggestions frequently cited by those testifying before the House and Senate committees include:
Allow CON applications to be submitted electronically, and offer updated key information online.
Relax CON standards for acquiring high-technology equipment.
Improve CON staffing structure to ensure efficiency.
© 2002, Capital News Service, Michigan State University School of Journalism