Op–Ed submitted by Todd Rehm


Georgia is suffering a wave of overdoses as new forms of extremely potent and often deadly drugs make their way into our communities. In fact, a new report by the Agency for Healthcare Research and Quality shows that opioid-related hospital admissions nearly doubled between 2009 and 2014 –  the highest rate of the 43 states examined.  The Georgia Alliance of Community Hospitals and our 86 members across the state are proud to be part of the first-line of response to these sobering tragedies.

These illegal drugs, which know no geographic, demographic or economic bounds, have changed the way that overdoses come into our hospital emergency rooms and demonstrate the importance of having a robust and resilient network of hospital emergency departments.

Increasingly, overdoses come in clusters of multiple incidences within a short time.  The impact on an emergency room can be paralyzing, even for a large Metro Atlanta hospital, much less a smaller facility in a rural market.  The impact can also be lasting, as stabilized patients often require prolonged medical support, including intensive care and services from a number of different departments.

On top of this growing epidemic, emergency rooms are also experiencing increased visits related to behavioral or mental health, which have have skyrocketed nearly 60% over the same period.  This is in addition to the heart attacks, accidents and other life threatening situations that bring patients through their doors and require a hospital’s full capabilities to treat.  This week, Becker’s Hospital Review ranked the emergency rooms with the most visits per year, placing two Metro Atlanta facilities in the top ten nationwide.

As hospitals deal with the strain of increasing admissions, the existence of a strong network of neighboring hospitals helps distribute the patient load and ensure timely access to care.  But today, as hospitals across Georgia struggle under the pressure of financial challenges caused by factors including changing demographics, growing numbers of underinsured and uninsured patients, and declining populations – that network is at risk.

For example, it is estimated that Georgia hospitals performed $1.7 billion dollars worth of uncompensated care in 2015 alone, which is simply unsustainable.  In addition, potential cuts in Medicare and Medicaid are being discussed in Washington, DC, that would force more hospitals to close their doors, as 7 in Georgia and 80 across the nation have been forced to do since 2010.

One of the keys to the stability of Georgia’s network of care is the state’s Certificate of Need (CON) program.  This critical tool helps the state manage the availability and financial survival of safety net hospitals while ensuring access to emergency departments, advanced treatment, and routine healthcare needs.   Despite the tenuous status of our current healthcare system, CON continues to come under attack, largely by out-of-state corporate chains whose priorities place financial gain before patient care.

At least five legislative proposals were brought forth during this year’s session of the General Assembly that sought to weaken or repeal the CON laws that protect our healthcare system. Since that time, the Georgia Department of Community Health  has considered an additional proposal, but voted to retain the current rules.

Many of the arguments for repealing or weakening CON hinge on the idea that more facilities, offering limited services, will enhance patient choice. But experience proves that these new facilities often choose to offer only the most-lucrative procedures, to the most well-insured patients. This occurs at the expense of existing hospitals, which then lose the benefit of offering profitable services that help cover the cost of much-needed but costly services, such as emergency rooms and trauma centers.

Healthcare markets are different from most “free” markets for goods and services. Consumers often do not understand the true costs of care, nor do they have sufficient information to compare services by different providers or in different facilities.

Simply having more facilities does not equate to greater access for patients. As existing hospitals are weakened financially, sometimes closing as a result, patient choice is actually reduced, while unneeded facilities proliferate in lucrative markets.

Expert testimony recently commissioned by the Georgia Attorney General’s office demonstrated that CON programs can reduce healthcare costs, improve the quality of healthcare services, and expand access to care.  Conversely, if existing hospitals are weakened financially, sometimes closing as a result, patient choice is ultimately reduced.

Georgia’s hospital system faces serious challenges, from the rise of opioid overdose clusters and spread of infectious diseases like the Zika virus, to the political and financial challenges emanating from Washington, DC.  Preserving and strengthening our front line of healthcare response is vital not only to our health, but to our continuing prosperity as a state. The time could not be worse for weakening protections for our hospital system, which would come at the unquestionable risk of reducing access to healthcare and emergency services.

Monty Veazey is President of the Georgia Alliance of Community Hospitals, a statewide organization of not-for-profit hospitals. He served in the Georgia House of Representatives from 1977 to 1983.

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