Certificate of need

So that, in a way, is a check that I think makes this stark law.

uh superfluous but so that's a big one of stark law um certificate of need which you had mentioned which is in about 35 states they have laws saying that you can't open a new health care facility uh without getting approval from the government the governing body which gives out these certificates often that governing body is staffed by local health cares so it's like if you want to open a hamburger stand you need to get a permission from mcdonald's so that makes it Very difficult.

Montana just recently overturned their certificate of need law and saw a huge influx in the amount of healthcare facilities that have opened.

Those are a couple of big ones.

And then there's these revenue streams that are only available to hospitals and not to independent doctors.

So the only way direct primary care doctors can do that is by fully dropping out of Medicare, which again, has a lot of downstream consequences and is burdensome.

Yeah.

So I was wondering, because you said you have friends and physicians who are able to drop out of Medicare and what makes it possible and what are kind of maybe the treatment or specialty areas where it's feasible and where could it be feasible if some other US states like Montana or New Hampshire or what have you, are improving the state law part for independent practice? For example, scrapping certificate of needs.

Both companies earlier this week filed motions asking the court to pause the lawsuit and compel arbitration based on the mandatory arbitration clause in the subcontract.

in the event of arbitration the award rendered by the arbitrator or arbitrators shall be final and judgment may be entered upon it in accordance with applicable law in any court having jurisdiction according to the motion After clearing multiple hurdles in getting the project off the ground, including an initial 2021 denial of its Certificate of Need from the State Health Facilities Council concerned about its cost, lack of collaboration, and potential to harm community providers, the university broke ground on its North Liberty Hospital in October of 2021.

At that time, the project was slated to cost $395 million, but officials in 2022 sought Board of Regents and state approval to increase the budget to $525.6 million as a worst-case scenario.

In the university's application for a budget increase, officials said the construction manager at risk model would insulate it from future upward fluctuation once all agreements are signed.

Um, so I was in practice from 1985 on, and during my career there was, there were always some sort of limits on physician ownerships of, of facilities.

In my state there were state regulations that many states had called Certificate of Need laws that also limited it.

However, having said that, the Stark Law followed by the ACA provisions, uh, set in stone that physicians could not own hospitals e- even in rural areas where they needed them.

But also, uh, it did grandfather in physician-owned hospitals that already existed, but prohibited them from expanding their services, adding beds, et cetera, from that point on.

Uh, that's the stop point right now that's the most critical.

Each state has its own regulations and rules about who can own healthcare facilities.

Uh, some states still have something called a certificate of need law that, uh, even to acquire a piece of radiology equipment above a certain cost requires to go before, uh, a state commission, and often appear at hearings where you're opposed by the hospital association in that quest.

Uh, that's not true all over the country.