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Review commission to vote on plan to ease government control of health care expansion

September 21, 2005
By: Leslie Yingling
State Capital Bureau

JEFFERSON CITY - Government control over medical-industry expansion would be eased under a plan before Gov. Matt Blunt's government review commission.

The commission is expected to conclude its evaluation of the state's executive branch Thursdsay with votes on 102 proposals, including a suggestion to cut much of Missouri's medical expansion regulation program.

The program regulates health care development by requiring health care companies to get state approval before building new hospitals, expanding services, and purchasing equipment. It was established in Missouri in 1980 in an effort to prevent insurance agencies, the government, and patients from paying for underused medical facilities, technology and equipment.

A commission task force on health and welfare issues proposed to eliminate the program because it "provides little value for the time and costs incurred by the industry and the state."

Lt. Gov. Peter Kinder, who serves on the commission and task force, amended the proposal to exclude hospitals.

"We wanted to keep a portion of Certificate of Need to protect hospitals," said Jerry Dowell, director of policy for the lieutenant governor.

Tom Piper, director of Missouri's Certificate of Need program, said his concern is that without any restrictions new hospitals, particularly specialty hospitals, would provide the most profitable medical services and create competition for 'safety net' hospitals that provide a broader range of medical services and serve the poor.

Elimnating the program completely "would create a very difficult situation that would drain off revenues from full-service hospitals that need them to survive," he said.

Sharn Rohrbach, executive director of the Nurses for Newborns Foundation and a member of the review commission, said only a small percentage of Certificate of Need applications are turned down. If an overwhelming percentage are granted anyway, she said, cutting the program could save the state money.

"But for hospitals it needs to be kept on," Rohrbach said.

Dowell echoed these sentiments. "Pretty much every nursing home that has gone before the panel has gotten Certificate of Need approval," he said. "But hospitals are different."

Piper said he hopes the commission will carefully evaluate the medical expansion restriction program and its benefits.

"For 25 years Certificate of Need has provided a major opportunity for the public to have input into Missouri health care," he said.

"We understand that this is a recommendation of Task Force C, and not from the entire commission," he said.

Dowell said the program might be a policy issue best left to the legislature.

"This might be a case where they decide, 'we're moving a little fast on this,' and leave it for comprehensive review by the General Assembly, whether that means complete reform or complete elimination," he said.

The governor's 20-member appointed commission was charged with conducting a full review of all state departments, looking for ways to restructure and reduce government functions.

"We've each put in well over 100 hours," Rohrbach said. "We've heard public testimony all around the state, and from many departments. I think we're ready."

The commission has until the end of the year to submit its recommendations to the governor, but Rohrbach said the commission is likely to finalize their decisions Thursday.

Commission staff director Ryan Burson said that was expected but not guaranteed.

The commission's proposals could be implented by executive order, legislative approval, or in one case an amendment to the state constitution. Missouri hasn't seen a major government review since 1974.

Voting will begin at noon in a public meeting at Columbia's Holiday Inn Executive Center.