CON Regulation of "Enhanced Physician Practices" Is Considered By the NYS Public Health and Health Planning Council

Health Law Bulletin

CON Regulation of "Enhanced Physician Practices" Is Considered
By the NYS Public Health and Health Planning Council

October 11, 2013

At the behest of New York Governor Cuomo and Health Commissioner Shah, the state Public Health and Health Planning Council ("PHHPC") and its Committee on Health Planning ("CHP") have held meetings, commissioned white papers, and solicited stakeholder comments to help analyze ambulatory care service arrangements in the state and develop detailed recommendations to the Governor and Health Commissioner, including possible extension of the Certificate of Need ("CON") process to certain "Enhanced Physician Practices."  Enhanced Physician Practices include private physician practices that utilize highly sophisticated equipment and facilities, often employ larger numbers of physicians and furnish (1) surgery, (2) advanced diagnostic imaging, (3) urgent care, and/or (4) radiation therapy services, yet operate in the state with limited regulation as private physicians' offices.  Participating stakeholders have included hospitals and other Article 28 facilities, physician organizations, regional and community organizations, insurance/managed care companies, and interested government agencies.

Improving Healthcare Delivery

PHHPC cites mounting evidence that a substantial portion of our nation's health care expenditures is squandered due to waste and inefficiencies.  The NYS Department of Health ("DOH") believes that weaknesses in the state's health care delivery system contributes to those wasted dollars.  To help attain the "Triple Aim" of better care, better health and lower costs, Governor Cuomo and Commissioner Shah believe immediate steps must be taken to improve the state's health care delivery system, and their goal includes: (1) streamlining and improving the CON process, and (2) developing a regulatory and health planning framework that drives health system improvement and population health.

Importantly, as part of these goals, CHP is likely to make specific policy recommendations to the full PHHPC as early as November 2013 that could result in significant policy changes for certain Enhanced Physician Practices, including requiring CON approval (possibly applied retroactively), registration, and/or mandates to serve Medicaid and other underserved populations.

Influencing the Dialogue

At this juncture, policy alternatives are being developed by CHP.  CHP has also enlisted the assistance of Dr. Dave Chokshi, a primary care physician, who was a White House Fellow, Rhodes Scholar and internal medicine resident at Harvard Medical School, and is currently completing a "vision paper" for CHP.  From our close observation of the deliberations at CHP's numerous Special Meetings this fall and past summer, CHP appears most interested in recommending effective policy mechanisms to PHHPC, and PHHPC will make recommendations to the Governor and Commissioner by December 2013.  The next Special Meeting of CHP is scheduled for November 20, 2013.

Please contact Gary Fields at 516-944-8200 or if you would like to discuss these efforts of CHP and PHHPC and ways to effectively influence the deliberations.

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