Surely, emergency health care should be neither restricted nor rationed by law, and emergency facilities should not be banned. Yet, certificate of need (CON) laws do exactly that, by allowing central planners to decide which, where, and how many healthcare practices may legally exist within their jurisdiction.
Even when used as intended, CON programs prevent market demand cues from quickly indicating where needs arise and providers from efficiently filling them. But, in Alaska, where the health department invites competitors to give their opinions on potential new business rivals, the laws serve as an easy way for current providers to eliminate competition.
History shows this is indeed how CON functions in practice, and no more obvious example exists than the current battle between Providence Alaska Medical Center and Alaska Regional Hospital in Anchorage, where Providence has repeatedly sought to prevent Alaska Regional from opening a freestanding emergency department (FSED), which would be the first in the state.
No Need?
As the CON program purportedly exists to determine community need, the relevant question is whether Anchorage needs additional emergency care. Providence does not want Alaska Regional to open another emergency facility, but Providence’s wait times for patients to be seen, taken to a room, admitted, and sent home are greater than both the state and federal averages, and its percentage of patients who leave without being seen is twice that of the state average.
These numbers stand as an indictment of its inability to manage the care of Anchorage patients in crisis. Clearly, the area has a need for another facility.
FSED: Lifesaver Or Danger?
Because Providence can hardly claim a lack of need in the area, it has focused its protest on the specific type of emergency facility Alaska Regional is trying to open. An FSED, according to Providence, brings drawbacks and even dangers, and Anchorage residents would supposedly do well to avoid such a place.
Ironically, Providence itself operates these very types of facilities in other states, and its Kadlec website in Washington enthusiastically touts their numerous benefits.
According to Providence in Washington, “Because the facility is freestanding, all equipment, lab and imaging services are dedicated to your needs. (In a hospital-based ER, those services would all be shared with other departments.)”
Yet, Providence in Anchorage turns this benefit into a drawback, ominously warning that a freestanding unit is “not connected to a full hospital campus” in case of transfer need. They neglect to mention that Alaska Regional transfers patients to a regular hospital free of charge, whereas Providence sometimes charges for transfer service. And Providence indeed has to transfer patients, because even their full hospital in Alaska is only a Level II trauma facility, which is not equipped to handle some emergencies.
In Washington, Providence assures patients that both “hospital and stand-alone ERs are set up to focus on emergencies,” specifically including heart attack, chest pain, difficulty breathing, or head trauma.
In Anchorage, Providence warns that heart attack, chest pain, difficulty breathing, or head trauma should be addressed at a hospital, not a stand-alone ER.
However, in Washington, Providence simply celebrates the “convenience” of an FSED without mentioning these symptoms, and with no mention of cost or alternatives.
In Anchorage, Providence warns that although an FSED may provide more convenience “for some patients,” they should look into primary care clinics (such as the ones Providence operates) when possible, due to cost concerns.
The list of such contradictions is far too long to complete here, but Providence appears to oppose Alaska Regional’s proposed FSED purely because it would be owned by Alaska Regional, not Providence. And the CON board opposes the proposed FSED in part because they can’t compare it to others in the state, since there are none.
Anchorage needs more emergency care than Providence offers, and Alaska Regional stands ready to provide it. The health department must stop protecting Providence’s bottom line at the expense of Anchorage patients, who need the adequate health care that Providence is surreptitiously trying to deny.