Proponents of Certificate of Need (CON) argue that it helps preserve healthcare infrastructure, especially in rural areas. They contend, for example, that repealing the law could lead to a greater concentration of ambulatory surgery centers (ASCs) in more urbanized areas, which would lead to rural patients traveling there for treatment and put community hospitals at risk.
But to the extent that market forces can operate under CON, patients are already migrating to access ambulatory surgical care outside of their counties of residence.
While CON is supposed to effectively allocate healthcare resources across different geographic areas within North Carolina, the data illustrate a different story. The data on outpatient surgery patient migration patterns presented above was collected from 2014 hospital and ASC license renewal applications.
These applications must be submitted annually to the Division of Health Service Regulation, an arm of the state’s Department of Health and Human Services. With this data, the Division documents a statewide inventory of the varying types of healthcare entities, assets, equipment, and services offered.
As previously mentioned, this inventory is used to calculate what healthcare resources are “needed” and is published in the annual state medical facilities plan. It should be noted that the number of outpatient surgery cases is self-reported.
The six highlighted counties are mostly rural and do not have any existing freestanding ASCs.
Anson County, with a population of around 26,000, may not have sufficient volume to support a freestanding ASC, but it does have a high outpatient migration rate of 95 percent.
A majority of these patients are forgoing care at Anson County Hospital and are instead seeking outpatient surgery treatment at the Carolinas Medical Center’s hospital outpatient department.
Others are traveling to freestanding ASCs such as the Eye Surgery Center of the Carolinas in Moore County.
Meanwhile, Onslow County’s population size of 194,000 holds promise for a viable ambulatory surgery center that can certainly help offset its 61 percent patient migration rate to six different counties.
Patients are traveling from 40 miles to either the Surgery Center of Morehead City or Carteret General Hospital in New Hanover County up to 140 miles to the University of North Carolina Medical Center in Orange County.
Without CON, if the market itself determines a demand for more freestanding outpatient surgery centers, they can be built, which will enhance patient access, and also enable patients to enjoy lower healthcare costs. Let’s not forget what’s best for the patient.
Rural healthcare infrastructure is fragile, but evidence suggests that CON does not stabilize medical access in these areas. Other factors have led to the decline of rural healthcare, such as demographic pressures placed on these programs in regions that have a higher percentage of elderly and uninsured.