NKY legislators file legislation to challenge St. Elizabeth’s dominant healthcare provider status

Mark Payne
Mark Payne
Mark Payne is the government and politics reporter for LINK nky. Email him at [email protected].

More by....

Several Northern Kentucky legislators filed legislation Wednesday in both chambers of the Kentucky legislature to challenge St. Elizabeth’s perch as the leading healthcare provider in the region. 

House Bill 312 would allow any healthcare provider to operate in the three northernmost counties — Boone, Campbell, and Kenton — without first requiring a certificate of need. 

A certificate of need is required under Kentucky law for healthcare providers to open up a new facility, acquire major medical equipment, make substantial changes to a facility or project, or “Alter a geographical area or alter a specific location which has been designated on a certificate of need or license.”

“What I’m looking to do is reduce the amount of services that are regulated by the certificate of need,” said Rep. Marianne Proctor (R-Union), the bill’s primary sponsor. “In Kentucky, we have 23 regulations that require permission from the state to open such as ambulatory care services, dialysis centers, substance abuse, mental health services.” 

According to Kentucky’s state health plan, certificates are issued by the Kentucky Cabinet for Health and Family Services, and there are currently 21 medical services that require certificates of need. 

In Boone, Campbell, and Kenton counties, there are 109 certificates of need, and St. Elizabeth holds nine of them. 

Regarding hospitals, they hold four of the NKY counties’ seven total certificates, with St. Elizabeth Florence, St. Elizabeth Ft. Thomas, St. Elizabeth Edgewood, and St. Elizabeth Covington.

But, some have argued that St. Elizabeth has a healthcare monopoly. 

“For too long, the CON process has erected a barrier around Northern Kentucky that has kept out competition, improved health care services, and patient choice for our residents,” wrote former Campbell County Commissioner Charlie Coleman in a 2016 op-ed. “The time has come to end the government-controlled healthcare monopoly in our state and our community.” 

Proctor’s concern is that the region, specifically Boone County, is growing at a rapid pace, and there needs to be more than one healthcare provider available to the community. 

More news:  Thomas More working to revamp theatre program

“It can take a long time to get to see a doctor, to have adequate facilities for our growing population,” Proctor said. “So what I would like to see is other places be allowed to come in and compete.” 

The last hospital group to challenge St. Elizabeth was Christ Hospital in 2017 — Christ sought to open a $24 million ambulatory facility on the old Drawbridge Inn site in Fort Mitchell. 

The Kentucky Court of Appeals issued a 2019 decision that upheld a lower court decision saying Christ didn’t present enough of a “need” to develop the site for ambulatory services. 

No healthcare providers are currently working with Proctor’s legislation, though she said she’s open to the idea. 

In the Senate, Sen. Gex Williams (R-Verona) filed two pieces of legislation — the first is Senate Bill 146, which would allow local governments to provide an exemption to the certificate of need to a healthcare facility. 

The bill has an emergency clause, meaning that it will go into effect immediately if it passes. 

The second bill Williams filed — Senate Bill 26 — would repeal the Kentucky statute certificate of need in the state. 

Williams thinks he will get blowback on both bills but understands that he has the support of his constituents. 

“I do not believe you can afford to simply look at the bottom line in medicine,” Williams said. “We have got to put physicians back in charge of our healthcare; that’s who I want, telling me yea or nay. Not some bean counter at the top.”

Williams noted that the push for certificate of need started in the 1970s when the federal government heavily encroached into Medicaid and Medicare. 

More news:  Christmas Past: Historic photos show what the holidays used to be like in NKY

The government required that by 1982, any state that took Medicaid or Medicare had to have a certificate of need in place, according to Williams, and the goal was to improve quality and reduce cost. 

“In the free market, that doesn’t work, but their goal was limiting access, which is what certificate of need does,” Williams said. “That’s how the federal government reduced costs back in the 80s.” 

In 1987, the government overturned that decision, but 36 states, including Kentucky, still require certificates of need. 

That’s what Willams and Proctor, along with several other legislators — Steve Rawlings (R-Burlington), Steve Doan (R-Erlanger), Mark Hart (R-Falmouth), Savannah Maddox (R-Dry Ridge), Candy Massaroni (R-Bardstown) and Felicia Rabourn (R-Pendleton) also sponsored HB 312 — are looking to challenge in the state and specifically northern Kentucky.

“I would like to know, on behalf of the people, why does one large nonprofit organization get to control healthcare in all of our region,” Rawlings said. “For example, people see Ohio, they can go over the river to Cincinnati, and they’ve got choices over there. They’ve got choices in Indiana. They’ve got choices in Lexington and Louisville.” 

But, the CEO of St. Elizabeth, Garren Colvin, said that folks in the region do have choices. 

“I would say, first of all, that everybody in Northern Kentucky and Greater Cincinnati has a choice today,” Colvin said. “They are not limited, so if someone wants to go to someone not named St. Elizabeth, they have the ability to do it.” 

Colvin pointed out that 70% of St. Elizabeth’s business comes from Medicaid and Medicare. Both programs have a reciprocation agreement with Cincinnati Children’s Hospital Medical Center through something called “Hospitals with Border Status for Medicaid.” 

Further, without a certificate of need process in place, St. Elizabeth believes other providers would enter the market and “cherry-pick” commercial patients. They argue that this causes an “uneven playing field and a greater burden of charity care and Medicaid for safety net providers.” 

More news:  Land purchase moves Boone County Water Rescue closer to the river

In Hamilton County, there’s a healthcare tax levy that provides support to the two safety net hospitals, according to information from St. Elizabeth. This levied tax allows other Cincinnati hospitals to transfer to these two hospitals. 

“So the fact that Cincinnati has that tax allows it to designate where the indigent and Medicaid are positioned for health care in Cincinnati,” Colvin said. 

Northern Kentucky doesn’t have that tax, and officials from St. Elizabeth said they absorb these costs. 

While there will likely be further discussion, it’s unclear if the legislation filed this session will gain any traction in either the Senate or House. 

Speaking to a group from Leadership Northern Kentucky at the statehouse in early February, Senate Majority Floor Leader Damon Thayer (R-Georgetown) said it’s unlikely any certificate of need legislation will be considered this session. 

“Frankly, it’s not a topic we’ve dealt with here recently, so we’re not going to move fast on something like that,” Thayer said. “There seems to be a lot of concerns about what it could do to rural hospitals, and so during a short session like this, we’re certainly not looking to move forward on anything related to that issue at this time.”

House Majority Floor Leader Steven Rudy (R-Paducah) said he’s open to have conversations about the legislation but wouldn’t comment on the likelihood of the bill moving through the legislature.

While legislative leadership indicates they are unlikely to budge on this session, all parties seem open to discussion of the legislation during the interim session — committee meetings that occur between legislative sessions — this summer. 

More articles

More by...

Latest articles

In Case You Missed It