EP444: Two State Healthcare Laws Often Don't Go as Planned: CON and COPA, With Ann Kempski

Jul 11, 2024

Healthcare consultant Ann Kempski discusses the unintended consequences of state healthcare laws CON and COPA. They explore issues with market consolidation, impact on costs, and potential monopolies. The episode highlights the need for vigilant oversight and diverse stakeholder involvement in regulatory terrain.

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INSIGHT

CONs Often Increase Costs Not Lower Them

Certificate of Need (CON) laws aimed to limit supply-driven demand but often backfire by empowering incumbents.
The result can be higher prices and consolidation rather than lower total cost of care.

ANECDOTE

Remembering Suzanne Delbanco's Legacy

Ann Kempski recalls Suzanne Delbanco as a kindred spirit who founded Leapfrog and Catalyst for Payment Reform.
Kempski credits Delbanco with empowering purchasers to be more effective in the healthcare marketplace.

INSIGHT

Origins Of Certificate Of Need Laws

CON laws were created during Medicare/Medicaid's early years to control costs under cost-based reimbursement.
States and the federal government initially encouraged certificates of need to avoid duplicative facilities and spending.

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In Episode 444 of Relentless Health Value, Stacey Richter speaks with healthcare consultant Ann Kempski about two state healthcare laws with unintended consequences: the Certificate of Need (CON) and the Certificate of Public Advantage (COPA) laws. They delve into the original intentions behind these laws, the ways in which they have often failed, and their impact on the competitive landscape.

The discussion also explores how CON laws have led to increased costs and market consolidation, while COPA laws have allowed potentially monopolistic mergers under state oversight. The episode sheds light on complex regulatory terrain and highlights the importance of vigilant oversight and diverse stakeholder involvement.

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00:00 Introduction

02:08 Understanding Certificate of Need (CON) Laws

02:57 Problems with CON Laws

04:02 Exploring Certificate of Public Advantage (COPA) Laws

05:25 Guest Introduction: Ann Kempski

06:05 In Memoriam: Suzanne Delbanco

06:20 Ann remembers Suzanne Delbanco.

06:55 EP224 with Suzanne Delbanco.

07:40 What are state Certificate of Need laws?

08:44 Why are states getting rid of these CON laws?

13:26 Why CON laws are created.

15:43 EP437 with Brian Klepper, PhD.

16:09 What are the conflicts of interest and problems that arise when CON laws are created?

20:55 What happens when states get rid of these CON laws?

24:10 How are Certificate of Public Advantage laws different from CON laws?

27:58 Why does the research show that COPAs don't usually accomplish their goals?

31:34 What encouraging current events are happening in the realm of COPA laws?

32:08 Gloria Sachdev, PharmD, of Employers' Forum of Indiana.