Bills altering Michigan’s certificate-of-need regulations for the health care industry have cleared their first hurdle, although two key reform proposals were held back from action.
The Senate Health and Human Services Committee last week cleared bills that would expand the commission overseeing the state’s CON program from 11 to 13 members, eliminate psychiatric beds and air ambulances from review, and remove a requirement for care providers to obtain approval for capital expenditures of $2.5 million or more.
Left out of the committee’s Feb. 20 votes were bills to eliminate critical-access hospitals and cardiac catheterization procedures from CON rules. The latter change would allow care providers to perform catheterization procedures in an outpatient setting without hospital surgical backup.
Sen. Curtis VanderWall, R-Ludington, the chairman of the Senate Health and Human Services Committee, said both bills would get further consideration as the others move forward.
During legislative hearings, the elimination of cardiac catheterization from CON oversight to allow outpatient procedures drew concerns about safety, particularly in cases where complications occur and a patient needs immediate life-saving emergency surgery.
The bill on cardiac catheterization procedures could become moot if a panel decides to make the same changes within CON rules.
The CON Commission in January authorized formation of a standard advisory committee to look at existing rules for cardiac catheterization procedures, including whether care providers can perform them safely in an outpatient setting outside of a hospital, Commission Chairman James “Chip” Falahee said.
State law requires a review of CON standards every three years. Cardiac catheterization was scheduled for review in 2020, Falahee said.
Standard advisory committees consist of experts in the field. Falahee said he tries to balance the committees by appointing experts on either side of an issue, “so they can have a good discussion back and forth.” With the cardiac catheterization issue, that means trying “to come up with a reasoned decision on what can and what cannot be done in an ambulatory surgery center,” he said.
The bills the Health and Human Services Committee cleared last week now go to the full state Senate for consideration.
VanderWall has been the leading proponent for altering CON regulations.
In moving the bill for psychiatric beds, he hopes to see access improve and begin to address a serious shortage in the state.
“Everyone can agree that we have a major challenge in these areas of mental health and I know this would not solve the issue, but I believe this is one of the steps closer to eliminating a hurdle from the process,” VanderWall said. “If someone has the staff today or the capacity today to make an additional psychiatric bed available, I want it opened. I do not want people to continue to have to wait for service while the government works on their program and process.”
Bed capacity isn’t the only access issue for mental health care in the state.
A severe shortage of professionals exists in Michigan and around the nation, Falahee said. Along with more psych beds, there’s a large need for more psychiatrists, nurses and social workers in mental health care, Falahee said.
“The issue really is getting the people to take care of them in the beds,” he said. “Until you get these professionals, you can’t accept patients.”
Falahee, the senior vice president for legal and legislative affairs at Bronson Healthcare Group in Kalamazoo, suggests that to begin easing the shortage of psychiatrists and mental health care workers, the state could consider some form of medical school debt forgiveness for new doctors who specialize in psychiatry.