Can My Practice Benefit From CON Regulations?
April 5th, 2023 | Private Medical Practice
Certificate of Need (CON) regulations are in place for ambulatory surgery centers (ASC) in about 20 states. For most physicians, these regulations stop them from forming their own ASC due to the high cost and complexity of coming into compliance. We want to ask: are CON regulations protecting hospitals from lower-cost competitors (ASCs) and, in the process, contributing to higher health care costs?
Unlocking Opportunities for Physicians: Office-Based Procedures as a Solution to High Healthcare Costs
Health insurance companies in some CON states have realized that CON is working to the advantage of hospitals and to the detriment of patients and employers who pay the bills. There are ways in which physicians can benefit from having the ability to set up their offices for office-based surgery or endoscopy procedures.
Common high-volume procedures such as colonoscopies, upper endoscopies, balloon sinuplasty procedures, epidural injections, etc. are well suited for office settings provided that the practice has space for the procedure room, recovery areas, and decontamination room (1,000-2,000sq ft). Additionally, the physicians and staff must be trained and equipped to provide sedation in their office setting, or they should bring in anesthesiologists or CRNA’s.
Health Insurers Can Encourage Physicians to Set Up Office-Based Procedures
Even the health insurance companies have a role to play in this situation as they can encourage specialty practices – such as gastroenterologists, ENT’s, OB/GYN’s, urologists, pain management specialists, etc.–to set up their offices for procedures, get accredited by one of the national healthcare accreditation companies, and provide a safe and convenient setting for their patients.
For the health insurers who have realized that office-based procedures can provide safe, cost-effective solutions to higher volume outpatient procedures, they implement fee schedules to encourage practices to take advantage of this approach. Instead of seeing CON as an obstacle, the insurers have provided practices with incentives to make the investment to convert their practice into office-based surgery/endoscopy suites.
Transforming Healthcare: The Success of Office-Based Procedures with Rockett Healthcare Strategies
Rockett Healthcare Strategies has initiated these programs with the health insurers in several states and provided practices with the tools and know-how to benefit from them. Now there are gastroenterologists, urologists, pain management specialists, and podiatrists, to name a few, providing convenient high-quality patient care in their offices and benefitting financially from this arrangement.