Healthcare

chapter from the publication Guide to the Issues 2022

Overview

We believe that effective healthcare policy should be transparent, equitable and patient-based. 

Healthcare quality depends on an abundance of readily available information that consumers can easily understand. Transparency is as important to healthcare as medication and treatment, and is necessary to achieve better outcomes at lower costs. We believe that economic purchasing power and decision-making should be patient-centered, minimizing third-party reimbursements. 

We believe in security for the sickest and access for all. Reform should be designed to work for the healthy as well as those who are sick or chronically ill. Targeted solutions such as high-risk pools for those with pre-existing conditions and subsidies for low-income individuals are more efficient than top-down solutions. Furthermore, tax policy should be equitable, and should not favor certain methods of financing healthcare over others.

Finally, healthcare reform should combine personal responsibility with financial involvement to incentivize program participation, reward compliance and support better personal health management.

Recommendations

Repeal Certificate of Need

Providers often control healthcare services offered to consumers and exclude competitors through state-issued Certificates of Need (CON). These CONs discourage price transparency by facilitating market dominance for a handful of health systems, limiting competition through local market mergers, reinforcing service line limitations and strengthening territorial advantages.

All players in the healthcare system – insurers, hospitals, doctors and other providers – need to support a competitive free market. Currently, their incentives are not aligned toward this action.

Expand scope of practice

Allowing for expansion of the scope of practice for physician assistants (PAs) and advanced practice registered nurses (APRNs) could help enhance critical access to care and address provider shortages in many areas of Georgia.

In its 2020 report, the Georgia Board of Health Care Workforce found that nine Georgia counties did not have any practicing physicians, 65 counties lacked a pediatrician, 82 did not have an OB/GYN, and 90 lacked a psychiatrist. Increasing opportunities for PAs and APRNs to practice medicine to the full extent of their training will help address these shortages.

Reference-based pricing

Reference-based pricing (RBP) is a cost-containment strategy that should be considered as it pays doctors, hospitals, labs and clinics a market-adjusted percentage of an established benchmark.

The reimbursement rate is typically 120-300% of Medicare pricing for a procedure, adjusted to account for the local market. Reference-based pricing has thus far helped employers mitigate the rising cost of providing health insurance to employees (in addition to reducing premiums and deductibles for plan beneficiaries) and should be considered to reduce costs within the State Health Benefit Plan.

Improved Price Transparency

Starting in January 2021, hospitals were legally required to post their standard charges on a publicly available website. Despite daily financial penalties, less than 20% of hospitals nationally have complied by posting their charges in a readable file and display that is easy for consumers to navigate. 

In June 2022, Northside Hospital Atlanta and Northside Hospital Cherokee became the first hospitals issued financial penalties by the Centers for Medicare and Medicaid Services for noncompliance, totaling over $1 million in fines. Notably, both hospitals are now in compliance and have even been labeled “exemplary” by one price transparency advocate. Penalties for noncompliant hospitals must be pursued and strengthened. 

Curb licensing restrictions that limit the use of alternative and ancillary medical professionals

The generally stated purpose for licensing, and the primary justification, is to ensure quality in services offered to the public. Rarely considered by licensing agencies, however, are shortages of licensed personnel, underutilization of allied personnel and discrimination against minority-group members seeking licensure. Regulatory restrictions should also be consistent with improved technology, such as telemedicine services.