Andy Miller and Sam Whitehead
ATLANTA — At the shuttered Atlanta Medical Center, a “Stronger Together” mural sends a hopeful message close to a summer time spray of hydrangeas. The campus was largely quiet on a current weekend, since AMC closed almost two years ago. A lone safety automobile sat behind a chain-link fence, and pedestrians handed by with out even a look.
In the city of Cuthbert, some 160 miles away, the Southwest Georgia Regional Medical Center additionally stays shut after closing 4 years in the past, one other Southern hospital casualty in a area dotted with them. Even a smaller facility changing the previous Cuthbert hospital “would be tremendous for the county,” stated Steve Whatley, chair of the Randolph County Hospital Authority.
The two hospitals — one inner-city, the opposite rural — confronted a number of the similar monetary pressures, together with not having sufficient sufferers with non-public insurance coverage.
This yr, in addition they shared the eye of a few of Georgia’s strongest lawmakers. Legislation signed in April by Gov. Brian Kemp, a Republican, included a provision pushed by U.S. Sen. Jon Ossoff, a Democrat.
The regulation amends the state’s “certificate of need” system, which permits current hospitals and different well being services to dam would-be rivals’ plans to broaden by arguing there’s inadequate want for his or her companies.
Certificate of want legal guidelines exist in 35 states and Washington D.C., in line with the National Conference of State Legislatures. The hospital trade, particularly nonprofit services, typically assist the principles, and have argued they cut back well being care prices and protect entry to high quality medical companies. Under CON necessities, well being suppliers should receive approval from the state earlier than providing some new companies or earlier than constructing or increasing services.
Whether the legal guidelines enhance care or cut back prices is questionable, researchers have discovered, and critics say extra competitors would lower spending by insurers and customers. In 2018, the Trump administration issued a report recommending that states repeal or revise their certificates of want necessities, arguing they enhance well being care prices.
“The evidence is pretty darn overwhelming that CON laws don’t achieve the initially stated goals of increasing access, lowering costs, and improving quality,” stated Matthew Mitchell, a senior analysis fellow at West Virginia University.
Dan Sullivan, a Georgia-based marketing consultant who typically helps hospitals and different medical suppliers of their effort to protect the legal guidelines, stated that by limiting the variety of suppliers providing very specialised well being companies, resembling organ transplants, states can higher keep top quality of care.
Certificate of want legal guidelines can cut back fraud, Sullivan stated. Florida repealed its certificates of want necessities for hospitals and lots of different well being suppliers following the Trump administration’s advice. Fraud accelerated within the state after rules had been phased out, he stated.
“At least when you file a CON, there’s at least a minimum of investigation,” Sullivan stated.
He argued one other good thing about the legal guidelines is that they incessantly mandate a baseline stage of charity care.
Other Southern states not too long ago peeled again their certificates of want legal guidelines. Tennessee’s legislature handed a invoice this yr exempting extra medical suppliers from needing to use for a certificates. North Carolina rolled again some restrictions in an overhaul that paved the way in which for Medicaid growth final yr. South Carolina made a big change to its guidelines final yr.
This yr, Republicans in Georgia’s legislature tried to repeal the state’s certificates of want guidelines. The effort fell quick within the face of fervent hospital opposition.
The narrower laws that Kemp signed would as a substitute ease the rules for building rural hospitals and exempts a possible new hospital that might accomplice with Morehouse School of Medicine, one of many nation’s few traditionally Black medical colleges.
That might doubtlessly fill a lot of the hole left by Atlanta Medical Center’s closing.
Hospital trade officers stated Morehouse would most likely want a well-heeled accomplice, and Atrium Health, a part of Charlotte, North Carolina-based Advocate Health, could also be a logical match. The growth-oriented nonprofit well being system has partnered with Morehouse Healthcare to run a clinic in East Point, south of Atlanta, and has a rising presence within the state. Both Morehouse and Atrium declined to debate a possible hospital partnership with KFF Health News.
The shuttered AMC primary campus, in the meantime, is ensnared in a moratorium the town imposed on redeveloping the location — a response to the jolting resolution by its proprietor, Wellstar Health System, to shut the hospital.
In 2022, Mayor Andre Dickens issued an executive order quickly halting any new growth on the location. He has criticized the “unusually abrupt closure of one of Atlanta’s most important medical centers.”
Atlanta’s metropolis council prolonged the ban one other 120 days in June.
A brand new inner-city hospital “would be a heavy lift financially,” stated Josh Berlin, CEO of rule of three, an Atlanta-based well being care consulting agency. That’s as a result of it will draw largely from the realm’s excessive stage of uninsured and Medicaid sufferers. Georgia is one of 10 states that haven’t absolutely expanded Medicaid, and thus has a excessive price of uninsured sufferers.
“You’ve got a community that is struggling to find care in the wake of the Atlanta Medical Center closure,” he stated.
Grady Memorial Hospital and different Atlanta services have seen a bump in affected person quantity for the reason that closure of AMC. Grady is usually deemed “dangerously overcrowded” in one state dashboard.
The have to deal with extra sufferers has sped up growth plans for Grady, together with including greater than 150 beds, stated its chief technique officer, Shannon Sale. “We knew that was going to be needed over time. The Atlanta Medical Center closure sped up that process,” she stated.
In southwestern Georgia, plans are extra modest.
Community leaders, together with Whatley, are awaiting the outcomes of a feasibility research that’s anticipated to suggest a downsized “rural emergency hospital,” a brand new federal designation that directs additional funding to eligible services.
The program ensures hospitals in rural communities additional Medicare funds and an extra fee of about $3.2 million a yr in the event that they shut expensive inpatient companies and provide solely emergency and outpatient care.
Ossoff gained virtually $12 million in three completely different appropriations payments to assist a rural emergency hospital in Cuthbert. He stated he met with state leaders to safe the supply within the Georgia certificates of want invoice that might permit it to reopen. Southwest Georgia Regional Medical Center would additionally should get an exemption from federal officers to qualify for a rural emergency hospital due to its cut-off date.
“This is a very challenging thing to do, and we’ve still got significant hurdles to clear,” Ossoff informed KFF Health News.
Even if it reopens, the Cuthbert facility will face the identical pressures that led to its shuttering within the first place — what Ossoff referred to as “failures of state policy.” At the time, he cited Georgia’s resolution to not absolutely broaden Medicaid within the wake of the closure.
Brenda Clark, who works in a wellness middle throughout the road from the closed Cuthbert hospital, stated some locals are skeptical in regards to the facility reopening.
“It’s much needed. People are hoping and praying we get it back,” she stated. But “there are some people who say, ‘We’ll believe it when we see it.’”
KFF Health News is a nationwide newsroom that produces in-depth journalism about well being points and is among the core working applications at KFF—an impartial supply of well being coverage analysis, polling, and journalism. Learn extra about KFF.
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