It's meant to cut costs and make sure that communities have access to healthcare. It's called a Certificate of Need.
Hospitals have to apply for one from the state before they decide to make big decisions like shut down a service like labor and delivery that could be losing money, or other big decisions that could impact public health.
But some hospital chains, and even some lawmakers, say it is time for the Certificate of Need regulation to either be amended or eliminated altogether.
Senator Saud Anwar is chair of the Public Health Committee. He's shedding some light on the debate.
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Mike Hydeck: Thanks for joining us. First up three hospitals, Waterbury, Rockville and Manchester had mountains of debt. They were up for sale to Yale New Haven Health. The state needed to approve the deal, but it took nearly two years to do that. Is that too long when the debt continues to pile up? And what should we do?
Saud Anwar: Thank you so much, Mike, for having me, and also having a conversation on this important topic. It clearly took a long time. And there were multiple reasons for this long time. But it was a three-way deal. And there was conversations that were happening between the two parties, but the state was part of that conversation. And between the time of the application, the application being completed about some of the research that was required to look at what impact it would have on the health and wellbeing of the community, if you pile all of those timelines, it took a long, long time to be able to get to at least where we are in the first phase.
Mike Hydeck: So you're a doctor, medical doctor, and you're on the front lines as well. So you know when there is need in place, and it could affect patients. How does this particular process get sped up? Or should it be sped up, in your opinion?
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Saud Anwar: It absolutely needs to be sped up. And I think this is what we are having frank conversations with the Office of Health Strategies, the Connecticut Hospital Association, with the governor's office, all the legislators. We have had four bills, and then more as well with some of the other components. But we have had bills dedicated to trying to look at how can we streamline this process? What can be done to improve this process so that individuals, there's no barrier to entry into the state of Connecticut's healthcare market. And then there's a safety for the patients as well. If somebody is going to have an acquisition or a merger, the process should go somewhat more smoothly and efficiently. And so we are having the conversations to improve that process in our bills right now.
Mike Hydeck: So as far as improving the process, you mentioned, this was a three-way deal to begin with. Looking over the financials of so many different organizations has got to be a painstaking process, which needs to be done so it's an equitable deal all the way around, right? So how would you speed up the financial paperwork? That sounds like it's complicated as it could be.
Saud Anwar: So I think that's part of the details of this entire long process, because Office of Health Strategies were taking their time, but actually, the applications were not being completed by the various stakeholders. And they were also using this as a negotiating way to try and reduce the value of the entire transaction. So between all of these conversations that were happening at multiple levels, the process was slowed down because of the applications and new information that we were getting and that you're hearing about. And I think that's where it's important to have a process where at least the Office of Health Strategies can set up some timelines and guidelines and make sure that people have good reasons if they are going to slow that down.
Mike Hydeck: You're a medical doctor with privileges at Rockville and Manchester, you understand what it's like to have the equipment you need to do your job. One of the things that's involved in this Certificate of Need is if a hospital wants to buy a big piece of equipment that's very expensive, like a PET scan, or maybe an MRI machine, they have to go through this Certificate of Need process, too. Should that equipment be maybe dealt with in another way? Or should that be still in the Certificate of Need, in your mind?
Saud Anwar: Mike, you're absolutely right. This is again, another conversation we are having. This should be an expedited process. This should be a fast lane for some of the simple things. Obviously, we need to do due diligence on many of the areas, but for some of the common sense things, it should be a fast process. And Office of Health Strategies is willing to have this conversation and ready to look at ways to be able to expedite some of these processes, too.
Mike Hydeck: So some lawmakers say, 'look, let's just get rid of it.' New Hampshire got rid of theirs. They seem to be doing just fine as far as their numbers are concerned. Where do you stand - amend or get rid of it?
Saud Anwar: Amend, and I'll tell you why. If you notice in the last many years, many of the healthcare centers across the state have left some of the communities. That has left women's health in dangerous, unacceptable form in our state where maternity units have been closed and the hospitals have wrapped up that part of the business and moved away. If there was an Office of Health Strategies working on CON focused on trying to make sure that some of the most underserved populations are protected, this would be beneficial. So there's use of this, we can actually improve this whole process. And I know that there's a willingness from everyone in this, between the governor's office, between the Office of Health Strategies, the legislators, as well as the hospital association, we are going to be working together to have a bill, which is going to get us to a far better place than where we are right now.
Mike Hydeck: Last question. I have about 30 seconds. One last thing, when they tried to close labor and delivery, a lot of people protested at certain hospitals that tried this. Should there be an appeals process involved in this Certificate of Need moving forward as well?
Saud Anwar: Absolutely. I think there already is an appeals process, but I think the community involvement is going to be critical, so that there is a public hearing so people get to be able to say what's going to happen to their wellbeing when any healthcare system moves out or closes any sort of services in the community. Especially our rural parts of our state are suffering in some respects. So we need to have that protection.
