State regulators are scheduled to weigh the fate of two proposals to build cancer treatment centers on the Seacoast today (Thursday). Two hospitals want to build two separate ? and lucrative ? radiation therapy facilities. The competition highlights the role of the Health Services Planning and Review Board. That?s the regulatory body that approves tens of millions of dollars of bricks-and-mortar healthcare investments each year. NHPR?s Raquel Maria Dillon has more on what?s commonly known as the state?s Certificate of Need Process.
A brief survey conducted by New Hampshire Business magazine last spring found 415 million dollars of construction projects underway at hospitals around the state. Any projects costing more than 1.5 million dollars, had to go through the Certificate of Need process.
The C-O-N Board may soon give the go-ahead to another project. But they have to hear more testimony, deliberate, and choose between two qualified applications.
On the Seacoast, there are two facilities in the works, they?re about six miles apart, both designed to provide the same crucial healthcare service, and they?ll cost approximately the same (give or take a million dollars).
Wentworth-Douglass Hospital in Dover and Portsmouth Regional Hospital have partnered up to propose a collaborative program in a Hampton industrial park.
Portsmouth Regional spokeswoman Leslie Pope says the collaboration wants to provide radiation therapy in an outpatient setting.
POPE :15 If you?re having a 15-minute treatment it should take you a half an hour to find the place. And that?s why we chose the setting we chose. We feel its very convenient because it?s close to Rt. 1, 101 and 95.
The two hospitals say their joint proposal, called the Coastline Cancer Center, would cost five million dollars.
On the other hand, Exeter Hospital says the strength of its proposal is that it would be housed in the hospital?s main facility. Spokesman Ron Goodspeed says Exeter?s oncology program is well-established?
GOODSPEED :17 The biggest difference of course is it?s campus focused, one-stop-shopping, familiar faces. We are accredited as a comprehensive cancer care center. One step higher than what Wentworth-Douglass is rated.
Exeter?s new facility would cost 6 million dollars.
Last year, Exeter made a very similar proposal and the CON Board turned it down.
GOODSPEED :19 the initial application was defeated and then an appeal was defeated on a 3-3 vote. Which in NH is a no vote. So we?re back with an application that?s supported by listening to our patients. They want one-stop shopping, all services in one location.
But what changed between last year and this go-?round? Last year, the staff of the Certificate of Need Board ran the numbers (population and cancer rates). They predicted that there wouldn?t be enough demand for cancer treatment to support another facility on the Seacoast. Steven Marion is the Board Vice Chair:
MARION :18 What?s changed in one year is the pop projections that far in the future weren?t quite there. Now they?re barely there this year. Mathematics of population projections. this year the CON board is ready to approve one application.
Population size is just one of the factors the certificate of need board uses to determine which project gets the go-ahead. Elizabeth Crory chairs New Hampshire?s Health Services Planning and Review Board.
CRORY :14 they both meet many of the criteria of the CON process. The only problem is there?s not enough population in that area to warrant two facilities.
Studies show that in healthcare, volume leads to quality. The more cases a hospital treats with radiation, the better they get at administering the procedure.
Crory says her board also looks at financial feasibility, cost-effectiveness, staffing needs, and location, and the effect of a new facility on existing ones ? in this case, radiation treatment centers in Manchester.
CRORY :11 One of the things that our statute tries to encourage is collaboration between healthcare institutions. It?s not the only issue because all these other factors are weighed in.
So the Coastline partnership might have leg up on Exeter?s proposal.
As the proposals go before the C-O-N Board, each side, Exeter and the Coastline coalition, talks about loyal patients. They find it difficult to drive to a faraway facility for radiation ? when they were sick, and trying to maintain some semblance of normalcy in their lives?
And each proposal uses those stories about living with cancer to lend weight to their proposals.
HELMS :10 I understand it would be convenient and that we could cut down the drive time, but the question we have to ask is what will it do to costs in system.
Ned Helms wrote the state laws that govern new Hampshire?s Certificate of Need process. Now he?s the Director of the New Hampshire Institute for Health Policy and Practice at U-N-H.
HELMS :13 let?s assume for an example, that 2 hospitals side by side both decide to open same piece of expensive diagnostic machinery or open a very complicated procedure.
That?s a very convenient example? Exeter and the Coastline collaborative both want to open very costly ? and very profitable ? radiation treatment centers.
HELMS :28 if there?s only x number of people who need that test or procedure and you duplicate the capital expenditures side by side. It?s not like a free market where one goes out of biz and other survives. Usually what happens in health care is both survive, and cost of care will be higher in both places than it would be if they had more volume.
The Certificate of Need process is supposed to control those growing costs through regulation. At least that?s the theory.
HELMS :25 it would be nice if it were easy, if we put it into the machine and the answer got spit out yes or no. but in addition to the facts and figures there?s a whole lot of subjective judgment that goes into it. 1:16 people don?t come to CON board with half baked ideas, they come with fully cooked ones. If you fully cooked it you think it?s worthy.
Representative Fran Wendelboe says the whole process is half-baked. She says the CON process enables hospitals to maintain their monopoly on healthcare in their communities. She introduced a bill to repeal the CON statute because she doesn?t buy the idea that supply generates more demand in healthcare.
WENDELBOE :22 new services provided the cost comes down. With the Portsmouth W-D Exeter situation, they should both be able to build. maybe they?ll scale it down, better for customer, lower prices.
She says the CON process is unnecessary bureaucracy. In today?s healthcare marketplace, she says, insurance companies effectively regulate costs.
WENDELBOE :30 if that cancer center is there you?re less likely to go to Boston where NH gets none of your healthcare dollar. And you might also have fewer hospitals not doing the Taj Mahal stuff. And believe me if you look at CON process, some projects hospitals do? Fancy lobby atriums? scale back frivolous stuff. To say nothing of the buracracy, you go to a con meeting and the room is full of $250-300/hr lawyers.
Those in favor of regulation make a similar economic argument. They says since employers ultimately pay for healthcare of many Americans, they?ll be reluctant to set up shop in a state where costs are sky high.
Others say the regulatory function of the CON has been co-opted by hospitals eager to protect their own turf. Indeed, the CON Board has rejected only two construction proposals since 1991. And Exeter?s was one of them.
The Certificate of Need process is so contentious that a legislative study committee appointed to look at it bogged down in disagreements and mutual suspicion. In the end, two separate reports were filed and no one can agree on which report sizes up the CON process best.
For NHPR News, I?m RMD.
