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Vidant Community Hospitals President Jay Briley speaks to Joint Legislative Oversight Committee on Health and Human Services

February 13, 2020 posted by Vidant Health News

IMG_0038(854).jpgJay Briley, president of Vidant Community Hospitals, speaks to The Joint Legislative Oversight Committee on Health and Human Services.

Jay Briley, president of Vidant Community Hospitals, spoke with state legislators about the role Certificate of Need (CON) laws play in preserving rural health care. Briley did his part to Stand Up For ENC before the Joint Legislative Oversight Committee on Health and Human Services, defending CON laws along with hospital representatives across North Carolina.

Below is Jay Briley's speech to the committee

"Good morning and thank you Chairwoman Krawiec, Chairman Dobson, Chairman Lambeth, and distinguished Members of the Subcommittee for allowing Vidant Health to speak at today’s meeting. I am Jay Briley, President of Vidant Community Hospitals, part of Vidant Health, a health system guided by its mission to improve the health and well-being of eastern North Carolina, a geographic region the size of the state of Maryland that 1.5 million people call home — including the district of the subcommittee Representative Farmer-Butterfield, Representative Jones, and Senator Perry. As a native of Lenoir County, now having lived in Pasquotank, Duplin, and Pitt counties, with deep eastern North Carolina roots, it is also a region I care deeply about — just like so many of you.

For that reason, I am honored to speak to you today about the importance of Certificate of Need laws within the context of rural health care and how they support the people and communities we all serve, using the thoughtful, objective processes already outlined today.

Vidant Health consists of nine hospitals and 100 practice sites across 29 counties in rural eastern North Carolina. Vidant Medical Center, located in Greenville, is one of four academic medical centers in our state and is the only Level I Trauma Center on the Eastern seaboard between Norfolk and Charleston.  

Each year, like many of our health system colleagues across the state, while providing the high quality of care our patients expect and deserve, Vidant reaches well outside of its walls to meet people where they are, helping and funding communities with social, economic, and environmental factors that influence health. From chronic condition support, to food banks, to school health programs, and many other initiatives, we’re making a difference. Just last year, we partnered with 159 different programs across the East, contributing nearly $2 million in grants to social service organizations, serving more than half a million of our neighbors.

(Below, Jay Briley, right, stands with Representative Perrin Jones) 

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This connects to Certificate of Need because we can only do these things when we are able to balance our governmental, ethical and social obligations. This includes providing an array of high-quality health care to anyone that needs it, regardless of their ability to pay. 

That commitment to mission translates to more than $200 million in uncompensated care costs annually for Vidant Health. This includes charity care, bad debt and shortfalls from government programs.

There is often a notion that we should let the free market drive matters that CON laws intend to address. The reality is that free market health care does not work in rural and lower populated areas. In these areas, Certificate of Need laws provide the difference between essential health care services available for all that need them and severely compromising the sustainability of rural providers and health systems due to syphoning off profitable business and patients.

No one is challenging Certificate of Need applications to build behavioral health facilities, emergency departments or general medicine facilities in socioeconomically depressed communities. CON challenges do, however, center on diagnostic testing and ambulatory surgery, profitable services that will make or break health systems.

This is particularly true for the more vulnerable rural communities in our state already facing significant challenges.

Eastern North Carolina has certainly had its share of challenges; in fact, 23 of our 29 counties were designated this year as Tier 1 by the Dept of Commerce; this includes eight of the nine counties that are home to a Vidant hospital.

As is often the case, these economic indicators overlap with numerous health challenges, including a high burden of disease, an underserved population, and a growing number of patients relying on Medicare and Medicaid.

Approximately 70 percent of all patients within Vidant Health have a governmental payor. In other words, 70 percent of care is reimbursed at a fixed governmental rate. The remainder of care is either unreimbursed or provided by private insurers — who often quickly follow in the steps of Medicare when they, too, see a more profitable path. 

In an environment where the overwhelming majority of payment is governmentally set, governmentally inspired, or not reimbursed at all, it is difficult — if not impossible — to consider health care to function in any way close to free-market. This is compounded further when considering the moral and legal obligation that hospitals — and only hospitals — have to care for all who enter our doors 24 hours a day, 7 days a week, 365 days a year.

Non-hospital health care entities do not have such an obligation to your family or mine. In this lack of free market, those without such obligation take profitable services from the safety net organizations that need them the most. This action directly impacts a hospital or health system’s ability to care for the 2 a.m. car accident victim on Interstate-40, to treat an uninsured farmer or pastor’s pneumonia, to develop that new program or service in rural communities, or to care for the many behavioral health patients who know that in our state, a hospital’s emergency department is the door always open to them when no other resource seems to be.

The last presentation referenced a Wallet Hub ranking of North Carolina as 50th in the nation in terms of cost, accessibility and outcomes. We can look at several other studies that rank North Carolina in the mid-30s, including United Health Foundation, US News, and the Commonwealth Fund. Regardless of ranking, we have significant challenges in health care across our state. But, let’s look at what went into the Wallet Hub assessment. Contributing to the high cost estimate, it concluded that we rank 45th for the average cost of monthly health insurance premiums, 40th in percent of uninsured (speaking to the ongoing debate in North Carolina around the need for Medicaid expansion), and 35th in terms of physicians accepting Medicare. This low acceptance of Medicare certainly includes providers practicing in ambulatory surgery facilities. If we already have challenges with access to care for Medicare patients, we should all have significant concerns around access to care for the uninsured and Medicaid population.

I know these issues are complex or, as someone said earlier, “terribly complex,” and I understand you have many factors to consider. Please consider that we have a rural health care crisis across North Carolina and our nation — you see it in the closing of labor and delivery services and hospitals. The elimination of, or otherwise diminishing certificate of need laws will not help, but instead will further aggravate the already complicated environment that currently exists. 

Thank you for letting me talk about rural health, the communities we serve, and the vital need North Carolinians have for your support."

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