HLM: Why do these administrative fiats become so burdensome?
Mostashari: One of the things I learned as national coordinator is that there are well-intentioned and dedicated policy makers for whom, through an accumulation of either wanting to be responsive to all constituents or trying to accomplish too much, every measure independently and individually is totally reasonable, but collectively when you put it all together it's insane.
When every regulator is thinking of their domain, they are not thinking about this in a more provider-centric way. Every different group that touches them has their own 'we're only asking for one or two little things. What's the big deal?' And it's not just the federal government, it's the private payers too.
In fact, a lot of the burden is on prior authorizations from private payers, it's from all the one thousand paper cuts that the practices are sustaining.
Gaynor: These burdens grow and grow and practices that would be perfectly efficient are no longer efficient because of these growing burdens, and that leads to consolidation, which then leads to less competition.
Nobody designed or planned or wanted that. But it happens. We're saying step back, take a look at that. You need to listen to people who are actually experiencing these things directly. We need better lines of communication and consideration of the holistic impact of these things, not one-by-one.
HLM: You call for the elimination of the Certificate of Need. Does that create problems, such as cherry picking?
Gaynor: There are no valid arguments. CON was established a long time ago, and we have a number of states that have repealed them. There is a lot of research evidence and it does not support the claims that CON constrains costs or reduce investments. It does not lead to more facilities located in "underserved areas."
CON is well-intended. Nobody designs these regulations thinking they are going to do something bad, but it just hasn't worked out. There is a long track record that shows CONs protect existing firms from competitions and it reifies so you don't get innovation and dynamism. If anything, it serves communities poorly.
John Commins is a content specialist and online news editor for HealthLeaders, a Simplify Compliance brand.