Letter to the Editor: Don't change Iowa's Certificate of Need health care review system

(In Iowa, hospitals, nursing homes and other health care providers must receive a "Certificate of Need" from the State before offering or developing a new or changed health care service.  The State of Iowa developed the system so it could make sure there was a need for a service and to prevent duplication.

Iowa Hospital Association VP of Communications Scott McIntyre says his organization expects a challenge in 2017 to the existing Certificate of Need rules. There is no bill being presented at this moment and no formal debate going on, but IHA advocates who talk with legislators and staff daily believe that something may be in the works.

Winneshiek Medical Center Chief Administrative Officer Lisa Radtke has submitted this Letter to the Editor about the Certificate of Need 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 management of institutional health care services through the Certificate of Need law.

Iowa's Certificate of Need regulations were first enacted in 1977 to provide for the orderly and economical development of health care services, to avoid unnecessary duplication of services, to control the growth of overall health care costs and ensure 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 expertise among medical staff and ensure high-quality care. The same applies to existing facilities. Without Certificate of Need, new, for-profit facilities would spring up all over the state and reduce patient volumes across the board.

Not only would this compromise the quality of care for everyone, but these new facilities would target profitable 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 set up a different review process that is highly debated.

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, bringing 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."