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Proposal Takes Aim At Hospital ‘Certificates Of Need’

Leon County Judge John Cooper on June 30, 2022, in a screen grab from The Florida Channel.
Taber Andrew Bain, via Flickr Creative Commons
The Florida Channel
Leon County Judge John Cooper on June 30, 2022, in a screen grab from The Florida Channel.

A Florida panel may be on the verge of ending the state's contentious certificate-of-need process for hospitals.

Such a move could be a victory for Gov. Rick Scott and other Republicans who have been unable to win support for the deregulation of the hospital industry in the GOP-controlled Legislature.

The Constitution Revision Commission is expected Tuesday to consider a proposal that would ask Florida voters to tie new hospital growth to hospital-acquired infection rates.

Commission member Frank Kruppenbacher initially proposed a constitutional amendment (Proposal 54) that would have prevented the state from limiting hospitals, nursing homes, hospices or intermediate-care facilities for individuals with intellectual disabilities through the granting of certificates of need. The proposed amendment was subsequently altered to make clear that while the so-called CON laws would be repealed, laws that restrict or limit the ownership of facilities would remain in effect.

Kruppenbacher is now offering a revision, under the description “access to quality healthcare.” Under it, the state could not prevent hospitals from entering counties if any existing hospitals in those counties have infection rates higher than the statewide average.

The CON program is a regulatory process that has long required hospitals, nursing homes and other health providers to get state approval before adding new facilities or offering expanded services. Scott and House Republican leaders have wanted to eliminate the program, arguing it is a barrier to free enterprise and helps existing health-care facilities avoid competition.

The Constitution Revision Commission meets every 20 years and has the power to place proposed constitutional amendments directly on the November ballot. It is meeting this week in Tallahassee to try to narrow a list of ballot proposals. Ultimately, 60 percent of voters would have to approve any constitutional amendments.

When asked about the certificate-of-need proposal, Kerri Wyland, a Scott spokeswoman, said the governor “looks forward to seeing the CRC’s ideas on how to eliminate restrictions on the availability of health care services to increase access and quality of health care for Florida patients.”

There are 310 licensed hospitals across the state, located in most of Florida’s 67 counties. While more than a dozen small rural counties have no hospitals, other areas are flush in facilities, including Miami-Dade, Broward and Hillsborough counties which have 35, 23 and 16 hospitals, respectively.

Kruppenbacher’s new revision would not include nursing homes, which means the certificate-of-need program would continue to apply for new long-term care beds. Since 2014, the state Agency for Health Care Administration approved roughly 4,000 new nursing home beds, and upward of 40 new long-term care facilities are being built, said Florida Health Care Association lobbyist Bob Asztalos.

Asztalos said his association, which represents hundreds of nursing homes, supports Kruppenbacher’s revision. He said the certificate-of-need program keeps occupancy rates at Florida nursing homes high, which makes financial sense for taxpayers who foot much of the costs of long-term care through the Medicaid program.

Kruppenbacher’s new proposal would use infection rates as a measuring stick. But it does not define statewide average and does not specify the infection rates it would measure or how it would determine the rates.

Bryan Anderson, vice president of public relations at HCA, said his hospital company wasn’t behind Kruppenbacher’s initial version or the proposed revision and isn’t taking a position on the certificate-of-need issue.

Lindy Kennedy, executive vice president of the Safety Net Hospital Alliance of Florida, urged members of the Constitution Revision Commission on Monday to reject the proposed constitutional amendment and the potential change, saying it would hurt hospitals that provide residency programs to future physicians and provide highly specialized medical care.

“Proposal 54 would be extremely detrimental to safety net hospitals caring for the state’s neediest patients with critical, complex needs,” she said.

Florida Department of Health spokeswoman Mara Gambineri said the state currently sends hospital acquired-infection information to the federal Centers for Disease Control and Prevention, which publishes a standardized infection ratio.

In a 2015 report, Florida acute-care hospitals had higher standardized infection ratios than the national standard for infections spread by contaminated hands, ventilators or large tubes that are inserted into large veins.

But Florida hospitals scored better than national average for two other infection categories: infections from catheters and bacterial infections that cause deadly diarrhea.