Hospitals compete against each other all the time. Even in a small town in Maine I have been a part of that for the past 12 years. Competition is healthy and breaks up monopolies. Controlling the healthcare dollar is a very powerful thing. I always felt the CON or Certificate Of Need that hospitals apply for was part of that competition. A new article in the AMNews, however, has opened my eyes. The CON require "physicians and hospitals to demonstrate a community need for new projects and services before receiving state approval to offer them". It can cost upwards of $80K to work the legal system and get it passed. For a hospital, that is nothing. For a physician, that is a lot. As it turns out, hospitals actually love the CON. I never would have thought that after all the controversies and debate I have seen in Maine as different hospitals try to expand. They have to go through hurdle after hurdle which they whine about all the time. It turns out I was wrong. As the article points out, with an example of a nephrologist trying to open a dialysis center, hospitals use the CON to keep him out of the game. So hospitals may not like the CON but they dislike physicians getting power even more. The enemy of my enemy is my friend, I guess.
If you think I am exaggerating too much on this point, check out what Howard Peters, the Illinois Hospital Assn.'s senior vice president of government relations, said:
"Profiteers can come in and cherry-pick by engaging in only those services where people can pay using private insurance. That leaves community hospitals with the burden of covering indigent and uncompensated care, and it can undercut hospitals' ability to subsidize emergency or charity services."
You don't have to read between the lines to realize that the biggest fear for hospitals is for physicians get power and gain control over the healthcare system again. It turns out that managed care companies have that same fear. Now if only the doctors would just realize this and work together? I know, I know...I'm dreaming again.
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