Certificate of Need
Discussion
Congress enacted the federal health planning program in 1974 to curb unnecessary health facility construction and check the acquisition of major medical equipment. The law required states to develop health planning agencies and establish certificate of need (CON) programs. The federal law was repealed in 1986. Since that time, 14 states have repealed their CON programs while several others have limited their program’s scope.
Certificate of need laws were supposed to help curb rising health care costs by limiting the explosive growth in hospitals, long-term facilities and major medical equipment. Indeed, in those states that repealed their laws in the 1980s and 1990s, many experienced a proliferation of facility development and major medical equipment acquisition. The effects have been mixed. Some have argued that the unregulated health planning environment has led to greater access to health care and greater competition between facilities reducing costs to insurance companies and consumers. Others have argued that the explosive growth in health facilities has simply led to increased utilization of care (resulting in higher health care expenditures) and jeopardized the public’s investment in health care facilities.
Radiology has a long history with CON. Due to the acquisition cost of radiological equipment, many states currently require CON for acquisition of magnetic resonance imaging (MRI), computed tomography (CT), ultrasound and radiation therapy equipment (typically linear accelerators and gamma knives). More recently, positron emission tomography (PET) units have been added to many state CON laws. Some states impose CON’s on the basis of dollar thresholds for capital cost, and others for specific pieces of equipment, regardless of cost.
Through the years, many ACR chapters have opposed repealing CON laws. The reasons vary. However, many have been concerned about the proliferation of diagnostic imaging centers and radiation therapy centers by entrepreneurial interests outside of radiology. Some of these facilities have engaged in self-referral activities. In others, chapters have been concerned about the quality of radiological care being rendered. While hospitals are largely required to have JCAHO accreditation as a pre-condition for Medicare reimbursement, freestanding facilities typically do not have to meet similar quality assurance requirements. Some state chapters have approached the state legislatures and health departments about placing some accreditation requirements (i.e., ACR accreditation programs) on these new facilities. Through the efforts of its state ACR chapter, Connecticut has enacted such legislation.
ACR Position
- The ACR recommends to those governmental agencies responsible for CON that all radiological equipment should be under the direction of a radiologist in order to provide for the highest level of patient care, including radiation protection.
- Many chapters of the ACR have actively supported CON legislation as a way to promote quality and appropriate utilization of imaging.
Contact
For further information on radiation control and patient safety, please contact Eugenia Krimer Brandt at the ACR offices (800) 227-5463 ext. 4398.
