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There's Something Worth Cheering in Florida. It's Not the CON Law's Repeal.

Analysis  |  By John Couris  
   July 11, 2019

We at Tampa General Hospital compete every day, and I am a proponent of free market principles. But, unlike one of my peers, I'm not cheering the repeal of Florida's Certificate of Need law. I have another policy in mind.

Editor's note: John D. Couris is president and CEO of Tampa General Hospital.

Cleveland Clinic Florida CEO Wael Barsoum reacted positively to the repeal of Florida's Certificate of Need (CON) law, which took effect on July 1, as HealthLeaders recently reported.

In "Florida Repeals CON Law, and One Hospital CEO Cheers," Barsoum is quoted as saying, "I'm glad it's gone. … It's better for our communities and better for our patients. Competition is a good thing. It drives lower costs and it drives better quality."

While I'm a strong proponent of the free market and while I have great respect for Barsoum, I'm certainly not cheering the repeal of CON. I understand that healthy competition can be good for business and consumers. We compete every single day at Tampa General Hospital, and that's true of hospitals across Florida. But free-market principles are sometimes a poor fit when you try to apply them to the complexity of delivering quality healthcare to patients. Healthcare is not a commodity. Unlike in other industries, the majority of our reimbursement is set by the government and governmental agencies. We also can't turn patients (consumers) away based on their inability to pay for care or services.

The reality is that in healthcare, particularly when it comes to highly specialized care, like transplants, NICU procedures or open-heart surgery, procedure volume is critical in order to have positive patient outcomes. Research continues to demonstrate that the more times a hospital performs a surgery or other procedures, the better the outcomes, the better the patient care and the lower the cost. High-volume thresholds ensure proficiency in skill by the physicians, which, in return, reduces the amount of medical errors. Without CON in place, we are now more likely to experience an increase in hospitals where providers perform complex procedures less often, maybe only a handful of times.  

Barsoum continues to argue that access to specialized care will be improved by removing CON restrictions and that he doesn't see any downsides to repealing the CON laws "when I look at it from a patient's perspective." So, without CON on the books, does this mean that Cleveland Clinic will now reduce the number of their complex cases they transfer from their other hospitals to the main campus in Ohio? They do this because they know what has been well-documented in the hospital industry: the more times a hospital performs a complex procedure, the better they get at it, resulting in better outcomes for the patient and lower cost. In fact, quoting from a Cleveland Clinic outcomes publication, "a relationship has been demonstrated between volume and improved outcomes for many treatments, particularly those involving surgical and procedural techniques."

With CON no longer the law of the land here in Florida, how can we ensure that all Floridians will have access to high-quality care in the Sunshine State? By insisting that the Florida Agency for Health Care Administration (AHCA) set high-volume thresholds as a condition of medical licensing for tertiary services. This, in turn, will contribute to better patient outcomes and a higher level of care. And that is something I believe is worth cheering about.

Related: Why Cleveland Clinic Florida's CEO Cheers the CON Law's Repeal

Related: Trump HHS Manifesto Seeks More Competition, Looser Regulation

Related: Feds Urge Repeal of Alaska Law on Healthcare Competition

Related: Henry Ford Health System's Hospital Plans Trip Over CON Law

Care to share your view? HealthLeaders accepts original thought leadership articles from healthcare industry leaders in active executive roles at payer and provider organizations. These may include case studies, research, and guest editorials. We neither accept payment nor offer compensation for contributed content. Send questions and submissions to Erika Randall, content manager,

“High-volume thresholds ensure proficiency in skill by the physicians, which, in return, reduces the amount of medical errors.”

John D. Couris, MS, is president and CEO of Tampa General Hospital in Florida. He blogs at

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