Surgery Center vs. GMCB Illustrates How Bad CON Laws Really Are

December 12, 2018

by Rob Roper

The Burlington Free Press just ran an excellent article on the legal dispute between the Green Mountain Surgery Center and the Green Mountain Care Board (GMCB), the six member panel appointed by the governor to oversee healthcare in the state. At the heart of this particular kerfuffle is a “Certificate of Need” (CON), which is essentially a permission slip from the government to operate a health-oriented business or service.

GMBC’s purpose is to “contain costs, and make sure everyone has access to high-quality health care services in Vermont.” It supposedly does this by “prevent[ing] unnecessary duplication of health care facilities and services.” In other words, it eliminates competition, and, if you’ve been paying attention to your health insurance premiums lately, you know exactly how well this approach works.

This is a case of the Surgery Center, after spending two years and a bucket of money to go through the CON processes and, after thinking it had its CON, investing another $11 million in their new facility, the GMCB now saying not so fast. The Surgery Center argues the GMBC is going back on its word, and GMBC says that it never agreed to allow what the Center is now attempting to do. All in all, a colossal waste of time and money that could have been spent treating patients.

But the big question here is why should doctors need to get permission at all from a half a dozen bureaucrats, most of whom have no real experience in the healthcare business, to treat patients who, by all accounts, are desirous of being treated? These doctors are clearly addressing a “need” – patients waiting for service in their communities. The Center believes (and has evidence to show) that they can provide equal or better service for a lower cost to the patient. The bureaucrats, perched in Montpelier, say there is no need, so you’re prohibited from providing the service (that, if there were no need, there would be no occasion to provide). Yes, that’s how stupid government managed healthcare is.

Why not just let the market work? If there is a need for a service, let these doctors meet it without having to jump through these bureaucratic hoops. If the doctors are right, they will benefit as will their patients. If they are wrong, they close up shop. That’s a risk they voluntarily choose to take.

If the Surgery Center can treat patients for less money and more conveniently than their competitors can, great! GMBC, who’s mission it is to lower cost and improve access, should be all over this, right? But that’s not really their mission. Their mission is to protect politically connected/preferred providers from competition, granting monopolies, which, of course, ultimately drives up costs and restricts access for patients.

Vermont has more areas of healthcare subject to CON laws than any other state, and we have some of the highest healthcare costs. This is not a coincidence. We should get rid of our CON laws, and, while we’re at it, the Green Mountain Care Board.

Rob Roper is president of the Ethan Allen Institute.

{ 3 comments… read them below or add one }

Mike December 14, 2019 at 2:31 pm

The creation of the Green Mountain Care Board was accomplished by a bunch of unqualified well meaning folks who have thrown the baby out with the bath water. If my understanding that the board was created to save money is correct then somewhere along the line the folks didn’t do their due diligence. The board is a train wreck whose collective engineers have never run a train before.


Ray Thomas December 15, 2019 at 3:51 am

Rob l could not have said it better! The Care Board is an unqualified intrusive unneeded counterintuitive approach to health care. Further, they continue to prove our worst fears by making these costly decisions that prevent competition from lowering prices. Just getting rid of the board would save over a half million dollars a year. Come on Phil do your job!!


Dr.C December 21, 2019 at 7:48 pm

Even before the GMCB we tried to for a Surgery Center in Rutland but the legal fees and onerous CON proved too big of a roadblock for us and this was about the same time when Walmart was spending big dollars trying to get a store in Vermont ,the last state on their list. Now the GMCB sets unrealistic revenue caps despite services delivered or number of patients seen that prevent hospitals from reinvesting in their infrastructure ,equipment and people .


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