Here are three things for ASC leaders and physicians to know about the current certificate-of-need landscape:
1. North Carolina, Tennessee and Georgia have each made changes to their CON laws in the last year. Tennessee will repeal its CON laws by 2025, while North Carolina advanced a more staggered approach, repealing CON requirements for ASCs in counties with populations over 125,000 people, effective Nov. 1.
2. While some argue these regulations help control healthcare costs and prevent unnecessary duplication of services, some ASC leaders contend that they increase healthcare costs, limit access and hold back healthy market competition.
Simon Schwartz, associate director of the Colorado Ambulatory Surgery Center Association and COO of Englewood-based Strategic Resources Group Colorado, told Becker’s that the process of obtaining a CON is often influenced by political connections, rather than a standardized system.
“It becomes more about who you know,” he said. “[I]n states without that structure, it becomes incredibly difficult — you have to know the right politicians and the right people. That doesn’t work toward progress or help patients gain access to quality care at a more affordable price. Instead, it makes care more expensive, requires more time and utilizes more resources. In my view, that’s wasted effort.”
3. Cardiology is one specialty particularly impacted by CON laws, as many state laws regarding cardiology practices specifically were written prior to the development of technologies that enable safe, outpatient cardiovascular procedures.
Danielle Martin, administrator and director of physician services at Richmond-based Virginia Cardiovascular Specialists, experienced this firsthand. The group opened the state’s first freestanding, Medicare-approved outpatient cardiac catheterization lab in 2023 only after a lengthy process.
“One of the biggest challenges that we experienced when we were doing the CON was the fact that the state manual for the CON for a cath lab was written, in the ’80s or ’90s, many years ago, when outpatient cath labs were just not a thing,” Danielle Martin, an administrator and director of physician services at VCS,” told Becker’s.
Though VCS ultimately secured approval in January 2024, Martin said the outdated framework was a “big hurdle.”
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