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Lawmakers weigh possible changes to certificate of need law

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mississippitoday.org – Gwen Dilworth – 2024-08-20 15:40:00

A new committee convened this week at the Capitol to discuss changes to the state’s law requiring medical facilities to seek state approval before offering new or expanded services.  

Health leaders said there is room to strengthen the law with reforms but cautioned against doing away with it entirely.

The law, which requires medical facilities to apply for a “certificate of need,” aims to lower costs and increase the accessibility and quality of health care in the state by avoiding duplication of services. 

Critics argue that the law stifles competition in the state’s already sparse health care ecosystem and does little to decrease costs. Advocates say it ensures that communities have access to a range of services, not just those that are profitable for providers. 

Nationwide, the laws have not accomplished much of what they were intended to, like increase quality or reduce costs, State Health Officer Dr. Daniel Edney told committee members on Monday. 

But the law has been “extremely” successful at preventing health care companies from choosing only to offer only the most profitable services to patients, he said. 

“When we’re looking at a very fragile health care framework, especially in rural areas of the state, cherry-picking can be disastrous,” he said. “It can be catastrophic.” 

When health centers choose to offer only services with a high-profit margin, he explained, it can draw business away from hospitals that provide services at a loss, like inpatient and emergency care. He said this applies in both rural and urban areas. 

Rural hospitals in Mississippi are struggling to stay afloat. Over half are at risk of closing, and 64% are operating with losses on services. More than half of Mississippi residents live in a rural area. 

Richard Roberson, the incoming president and CEO of the Mississippi Hospital Association, said he believes it is unlikely that removing certificate of need requirements will incentivize investment in areas of the state with the highest need for new health care services.

“What I suspect is you’re going to see an overproliferation of services in more commercially insured areas,” he said. “And if you’re talking about folks coming in and investing money, that’s where they’re going to put it, where they can make their money back.” 

Gov. Tate Reeves has advocated for abolishing certificate of need laws in the state, arguing that it will allow more competition and innovative health care services to flourish.

Last session, a bill sponsored by Sen. Angela Burks Hill, R-Picayune, sought to repeal the state’s certificate of need law, but it died in committee. 

Bills seeking to repeal or reform the law have become run-of-the-mill in the statehouse. Last year, over two dozen bills sought to modify the state’s certificate of need law. 

Legislators in 2016 made several changes to the law, including shortening application review timelines and increasing capital expenditure thresholds.

States were first required to implement certificate of need laws in 1974 in order to receive funding for certain federal programs. Today, 35 states operate certificate of need programs, and 12 have repealed their laws entirely, according to the National Conference of State Legislatures. 

Laurin St. Pé, CEO of the nonprofit Singing River Health System, said that without the certificate of need law, private equity-backed companies could open health centers near existing hospitals, drawing away patients with insurance. 

Hospitals with emergency departments are required to provide emergency care to patients regardless of insurance status under the Emergency Medical Treatment and Labor Act. These hospitals depend on providing services to patients with insurance to offset losses from uncompensated care.

“If they siphon (insured patients) off, we’re not going to be able to take care of those with the most need,” he said. 

Over 10 percent of Mississippians do not have health insurance, according to data from KFF. 

Edney said that Medicaid expansion could offset risks associated with repealing the certificate of need law by lowering the rate of people in the state without insurance in response to a question from House Medicaid Chair Missy McGee, R-Hattiesburg. 

McGee authored the Medicaid expansion bill that died earlier this year. Mississippi remains one of 10 states in the country not to have expanded Medicaid.

Rep. Hank Zuber, R-Ocean Springs, is the co-chair of the committee on the certificate of need law. Credit: Mississippi House

“As we close the coverage gap, that does create more revenue into the system that flows to the hospitals,” Edney said. 

Keith Norman, vice president and chief government affairs officer for Baptist Memorial Health Care, agreed. 

“I believe expansion goes hand in hand with this conversation,” he said. 

Though Edney and Roberson cautioned lawmakers of the impacts of repealing certificate of need law, they agreed that reforms could improve the program. 

Roberson suggested that allowing hospitals to offer dialysis services without a certificate of need would reduce patient transfers to other hospitals. Many small hospitals do not have their own dialysis centers. 

He also proposed allowing hospitals to operate home health services, which would reduce rates of readmission to the hospital. The Centers for Medicare and Medicaid Services penalizes hospitals when readmissions top the national average. Hospitals in the Delta have in the past faced high penalty rates for readmissions. 

Edney added psychiatric and perinatal care to the list of services he believed should not have to undergo the review process due to the state’s dearth of such care. 

The application itself should also be reformed to prevent long, costly appeals, said Edney. 

Last year, an applicant vying to provide “much-needed” ambulatory care in the Delta – a region of the state with limited health care services – withdrew its application after its certificate of need approval was contested. He said the hospital did not have the resources to sustain a potentially years-long legal struggle. 

“We go through these long battles that are very costly, just to get to the same ruling,” Edney said.

The State Department of Health approves 95% of certificate of need applications, he said. 

Edney also suggested that lawmakers consider more vigorous enforcement of existing certificates of need, noting that some health care facilities do not follow through on the commitments made in their applications. 

“We’re lacking accountability and transparency in the CON world,” he said.

Rep. Henry Zuber III, R-Ocean Springs, co-chair of the committee, said the group will explore a range of possibilities for certificate of need reform before drafting any legislation. The group will meet again on Sep.10.

“Everything, everything is on the table,” Zuber said.

This article first appeared on Mississippi Today and is republished here under a Creative Commons license.

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On this day in 1946

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14 hours ago

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December 23, 2024

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mississippitoday.org – Jerry Mitchell – 2024-12-23 07:00:00

Dec. 23, 1946

Chuck Cooper Credit: Wikipedia

University of Tennessee refused to play a basketball game with Duquesne University, because they had a Black player, Chuck Cooper. Despite their refusal, the all-American player and U.S. Navy veteran went on to become the first Black player to participate in a college basketball game south of the Mason-Dixon line. Cooper became the first Black player ever drafted in the NBA — drafted by the Boston Celtics. He went on to be admitted to the Basketball Hall of Fame.

This article first appeared on Mississippi Today and is republished here under a Creative Commons license.

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Mississippi Today

Podcast: Ray Higgins: PERS needs both extra cash and benefit changes for future employees

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December 23, 2024

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mississippitoday.org – Bobby Harrison – 2024-12-23 06:30:00

Mississippi Today’s Bobby Harrison talks with Ray Higgins, executive director of the Mississippi Public Employees Retirement System, about proposed changes in pension benefits for future employees and what is needed to protect the system for current employees and retirees. Higgins also stresses the importance of the massive system to the Mississippi economy.

READ MORE: As lawmakers look to cut taxes, Mississippi mayors and county leaders outline infrastructure needs

This article first appeared on Mississippi Today and is republished here under a Creative Commons license.

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‘Bringing mental health into the spaces where moms already are’: UMMC program takes off

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December 23, 2024

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mississippitoday.org – Sophia Paffenroth – 2024-12-23 06:00:00

A program aimed at increasing access to mental health services for mothers has taken off at the University of Mississippi Medical Center. 

The program, called CHAMP4Moms, is an extension of an existing program called CHAMP – which stands for Child Access to Mental Health and Psychiatry. The goal is to make it easier for moms to reach mental health resources during a phase when some may need it the most and have the least time. 

CHAMP4Moms offers a direct phone line that health providers can call if they are caring for a pregnant woman or new mother they believe may have unaddressed mental health issues. On the line, health providers can speak directly to a reproductive psychiatrist who can guide them on how to screen, diagnose and treat mothers. That means that moms don’t have to go out of their way to find a psychiatrist, and health care providers who don’t have extensive training in psychiatry can still help these women. 

“Basically, we’re trying to bring mental health into the spaces where moms already are,” explained Calandrea Taylor, the program manager. “Because of the low workforce that we have in the state, it’s a lot to try to fill the state with mental health providers. But what we do is bring the mental health practice to you and where mothers are. And we’re hoping that that reduces stigma.”

Launched in 2023, the program has had a slow lift off, Taylor said. But the phone line is up and running, as the team continues to make additions to the program – including a website with resources that Taylor expects will go live next year. 

To fill the role of medical director, UMMC brought in a California-based reproductive psychiatrist, Dr. Emily Dossett. Dossett, who grew up in Mississippi and still has family in the state, says it has been rewarding to come full circle and serve her home state – which suffers a dearth of mental health providers and has no reproductive psychiatrists. 

“I love it. It’s really satisfying to take the experience I’ve been able to pull together over the past 20 years practicing medicine and then apply it to a place I love,” Dossett said. “I feel like I understand the people I work with, I relate to them, I like hearing where they’re from and being able to picture it … That piece of it has really been very much a joy.”

As medical director, Dossett is able to educate maternal health providers on mental health issues. But she’s also an affiliate professor at UMMC, which she says allows her to train up the next generation of psychiatrists on the importance of maternal and reproductive psychiatry – an often-overlooked aspect in the field. 

If people think of reproductive mental health at all, they likely think of postpartum depression, Dossett said. But reproductive psychiatry is far more encompassing than just the postpartum time period – and includes many more conditions than just depression. 

“Most reproductive psychiatrists work with pregnant and postpartum people, but there’s also work to be done around people who have issues connected to their menstrual cycle or perimenopause,” she explained. “… There’s depression, certainly. But we actually see more anxiety, which comes in lots of different forms – it can be panic disorder, general anxiety, OCD.”

Tackling mental health in this population doesn’t just improve people’s quality of life. It can be lifesaving – and has the potential to mitigate some of the state’s worst health metrics.

Mental health disorders are the leading cause of pregnancy-related death, which is defined by the Centers for Disease Control as any death up to a year postpartum that is caused by or worsened by pregnancy. 

In Mississippi, 80% of pregnancy-related deaths between 2016 and 2020 were deemed preventable, according to the latest Mississippi Maternal Mortality Report.

Mississippi is not alone in this, Dossett said. Historically, mental health has not been taken seriously in the western world, for a number of reasons – including stigma and a somewhat arbitrary division between mind and body, Dossett explained.

“You see commercials on TV of happy pregnant ladies. You see magazines of celebrities and their baby bumps, and everybody is super happy. And so, if you don’t feel that way, there’s this tremendous amount of shame … But another part of it is medicine and the way that our health system is set up, it’s just classically divided between physical and mental health.”

Dossett encourages women to tell their doctor about any challenges they’re facing – even if they seem normal.

“There are a lot of people who have significant symptoms, but they think it’s normal,” Dossett said. “They don’t know that there’s a difference between the sort of normal adjustment that people have after having a baby – and it is a huge adjustment – and symptoms that get in the way of their ability to connect or bond with the baby, or their ability to eat or sleep, or take care of their other children or eventually go to work.”

She also encourages health care providers to develop a basic understanding of mental health issues and to ask patients questions about their mood, thoughts and feelings. 

CHAMP4Moms is a resource Dossett hopes providers will take advantage of – but she also hopes they will shape and inform the program in its inaugural year. 

“We’re available, we’re open for calls, we’re open for feedback and suggestions, we’re open for collaboration,” she said. “We want this to be something that can hopefully really move the needle on perinatal mental health and substance use in the state – and I think it can.”

Providers can call the CHAMP main line at 601-984-2080 for resources and referral options throughout the state. 

This article first appeared on Mississippi Today and is republished here under a Creative Commons license.

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