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Hospitals and medical society support raising CON thresholds; stakeholders ask for proportionality and contract clarifications
Summary
Hospital association and medical society representatives told the board they back proposals to raise certificate-of-need thresholds, urged proportionality for academic medical centers and asked for clearer language to exempt state-budgeted projects from CON requirements.
Representatives of Vermont hospitals and the Vermont Medical Society told the Green Mountain Care Board they back raising certificate-of-need (CON) jurisdictional thresholds and simplifying the CON process, while requesting clarifications to preserve access and account for academic medical centers.
Devon Green of the Vermont Association of Hospitals and Health Systems said hospitals support increasing jurisdictional thresholds in the proposed changes and suggested considering proportionality for academic tertiary centers that face higher per-user costs for projects such as electronic medical records. "So, hospitals are in support of increasing the thresholds, the jurisdictional thresholds for a certificate of need," Green said.
Green said members also favored provisions in S-10 that would exempt emergency and non-emergency ground transport (but not helicopters) and supported a depreciation-related exemption described in the bill. On contracted projects that are budgeted by the state — for example, an adolescent psychiatric inpatient unit — Green asked for language changes because some contracts have not yet been awarded and the current draft could unintentionally catch state-approved, budgeted projects in the CON process.
Board members asked about making exemptions retroactive for projects already in state budgeting or contract review, and Green said the association would supply suggested wording. Green also discussed a contemplated arrangement where UVM Health Network could provide Epic access to North Country Hospital to address electronic health record challenges; she said she would follow up with details.
Jessica Barnard, executive director of the Vermont Medical Society, said physicians and physician assistants support the concept of raising thresholds and reducing instances where CON applies but deferred on precise dollar amounts and specific thresholds to other stakeholders with more direct facility-level expertise. "We support the concept of raising the thresholds and simplifying the the CON process or at least the number of instances in which it applies," she said.
No formal vote was taken. Stakeholders asked the board and legislative counsel to refine statutory language to avoid unintended consequences for state-approved projects and to consider proportional thresholds for academic medical centers with larger-scale implementation costs.
Follow-up items include stakeholder-submitted drafting language for exemptions and more detailed proposals addressing proportionality for academic medical centers.
