ATLANTA - An old battle between Georgia's hospitals and a national cancer treatment chain flared up this fall.
The dispute is rooted in Georgia's "certificate of need" process. The regulatory system used to approve expansion or new construction of hospitals and other health care facilities can have a broad effect on local economies and patient options.
In 2008, lawmakers approved a new category — "destination" hospital — to accommodate Cancer Treatment Centers of America. The chain, headquartered in Florida, operates in four states and is known for its ads describing access to medical care along with spiritual support and alternative remedies.
Lawmakers limited the Georgia facility to 50 beds, and required at least 65 percent of its patients to come from outside the state to blunt the loss of patients with private insurance from existing hospitals.
The company now wants permission from the state's Department of Community Health to apply for a new certificate as a general hospital, allowing the company to ditch the cap on in-state patients and expand in the future. The agency's board gave initial approval and meets in November for a final decision.
Officials with Cancer Treatment Centers said the switch will expand patient options after lawmakers didn't act on the issue during the 2015 session.
"This is another way to help patients in Georgia get the relief they need to be able to come here without restriction," said David Kent, COO of the company's Southeastern Regional Medical Center in Newnan. "In the legislature, there are hundreds of lobbyists and millions of dollars coming in from the other side to keep us from growing."
The effort has inflamed some influential lawmakers. Sen. Renee Unterman, a Buford Republican who chairs the Health and Human Services committee, said lawmakers during the last session didn't pass a proposal to study the regulatory system and rejected bills specifically making the changes that CTCA now seeks from the agency.
"I'd say that's a pretty strong message," she said. "This is about subverting the power of the General Assembly and using the bureaucracy to go around what the intent of the legislature has been."
Georgia's powerful hospital organizations said at a hearing this week that the change would erode the regulatory process when rural hospitals in the state are struggling.
Dozens of hospital representatives wore round buttons reading "Rural Hospitals say NO to CTCA," and warned the company could "cherry-pick" patients with insurance, upsetting the delicate balance of paying customers and those without insurance at their own facilities.
Opponents of the rule change also highlighted records of CTCA's first two years of Medicaid and charity care, arguing the company hasn't kept its 2008 bargain with lawmakers to provide a certain percentage of each.
"They talk about what's right," said Earl Rogers, CEO of the Georgia Hospitals Association. "What is right about not providing service to Medicaid patients, or very few, or very few Medicare patients?"
Kent and other CTCA officials said getting qualified as a Medicaid provider took 18 months.
"Hospitals want to protect their business," Kent said. "They're willing to go to great lengths to do it."
Figures for 2015 will be reported to the state when required, but Medicaid recipients unable to afford travel will never be the bulk of the Georgia facility's patients, he said.
While it's unlikely that the proposed change would affect many people, patients across the state are unknowingly impacted by the regulatory system, said Georgia State University business professor Bill Custer, a specialist in health care financing.
"This whole conversation has to do with which policy changes would raise patient costs or reduce access to care entirely," Custer said. "If a hospital nearby goes under, your ability to get care is undermined, regardless of your ability to pay."
