Certificate of need: A thorn in Virginia’s side for decades

Certificate of need: A thorn in Virginia’s side for decades
The certificate is a regulation meant to control the number of medical facilities and services available in designated regions.

Some lawmakers already sported wry smiles as Sarah Stanton, a staff member with the Division of Legislative Services, walked to a lectern in late November to deliver a presentation on Virginia’s Certificate of Public Need, or COPN, program.

“Everybody’s favorite topic,” she said sarcastically, and both the crowd behind her and lawmakers on the Joint Subcommittee for Health and Human Resources Oversight laughed.

The certificate is a regulation meant to control the number of medical facilities and services available in designated regions. Providers must receive approval from the state certifying that there is a need before they can do things like open a freestanding emergency room or add new hospital beds.

The process is cumbersome and it can take years — and thousands of dollars — to complete.

And it’s been haunting Virginia’s legislature for decades. It started in 1973, and just a little over a decade later the first attempt at reform began. The effort has gone through some stops and starts since then, but like clockwork it presents itself as a puzzle that the General Assembly attempts to solve every few years.

In Virginia’s health care community and among legislators, the program is seen as both hotly contested and an exhausting dispute worthy of an eye-roll. Some consider it to be vitally important, while others view it as a wart on an already ugly and convoluted health care system — and nobody can agree whether it should be cut off.

But to most everyone else, it’s a confusing acronym that they sometimes see in headlines during the General Assembly session and then forget during the rest of the year, unaware of the parade of work groups and studies that have been held on the program every few years over the past three decades.

This year, some legislators have indicated they don’t want to make revisions to the program because they need time to see how Medicaid expansion changes Virginia’s health care landscape.