D.C. Health Planners OK Organ Transplant Monopoly

Cedit: Olga | Wikimedia CommonsCedit: Olga | Wikimedia CommonsLast month, government health planners in the District of Columbia decided that the city does not need an additional facility that can perform organ transplants. Currently, only two hospitals—both owned by MedStar Health—may legally perform transplants in the District. George Washington University Hospital wants to offer the service, but the State Health Planning and Development Agency (SHPDA) rejected their application.

Back in February, I wrote about the “certificate of need” (CON) process the District of Columbia and other states impose on medical providers whenever they want to offer a new procedure, expand their operations, or purchase new equipment. Hospitals, clinics, nursing homes, outpatient centers, and hospices must apply for permission from a panel of bureaucrats who purport to studiously assess whether a need for change truly exists. In D.C., some providers can’t even move into a new office without the OK from SHPDA.

From the Washington Business Journal:

In its regulatory filings, George Washington highlighted statistics showing that fewer transplants have been performed citywide since Howard University Hospital closed its program in 2010. The declining transplants, a 12 percent drop for kidneys and a 42 percent drop for pancreas, stands at odds with growing incidents of end-stage renal disease, officials said.

Also, George Washington had argued, wait lists are growing at the facilities that still perform transplants….

MedStar opposed George Washington's request, essentially saying a monopoly is in the public interest because medical outcomes are best — and costs are most efficiently managed — in high-volume operations.

In his decision, Amha Selassie, director of the State Health Planning and Development Agency, said George Washington could not prove that there is insufficient hospital capacity.

"It appears that the reason the wait lists continue to grow is not because of a shortage of transplant programs, but because of the shortage of transplantable organs," Selassie wrote. "The applicant has not provided enough evidence to demonstrate that the addition of a new program will be able to substantially increase the number of organs that are needed to establish a new facility."

George Washington, which is appealing the ruling, wants to specialize in kidney transplants. Currently, the hospital's 200-plus renal patients have to go to a MedStar facility or a hospital outside of D.C. if they need a transplant. Research suggests medical outcomes are better at high-volume transplant centers, so it does make sense to centralize operations given the (unnecessary, government-created) shortage of organs.

That said, 30 states do not impose a certificate-of-need requirement on organ transpant facilities. If outcomes are worse in those states, there's no record of it. For open-heart surgeries, outcomes and cost efficiency were actually better in states without CON laws—because competition—according to another study.  

I submit that SHPDA has about as much idea how much transplanting capacity the District needs as I do: none at all. The information necessary to gauge where patients might prefer to get a transplant is not available to planners.  

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  • Scruffy Nerfherder||

    CON is an appropriate acronym for a bureaucratic process that is regularly captured by industry representatives.

  • Scruffy Nerfherder||

    MedStar opposed George Washington's request, essentially saying a monopoly is in the public interest because medical outcomes are best — and costs are most efficiently managed — in high-volume operations.

    And profits are most efficiently maximized when there is no competition.

  • Number 2||

    The CON process is a great example of government bureaucracy and red tape building on itself. At least here in New Jersey, the CONs are justified by the argument that without them, the state would be hit with excessive reimbursement costs from Medicare and Medicaid due to "unnecessary" equipment, treatment, etc. Of course, there would be no "reimbursement costs" at all without the Medicare and Medicaid entitlement programs in the first place...and no one of course ever suspected that anyone would try to pass their equipment and treatment costs onto the government through these entitlement programs, did they?

    But in part because of the CON process, there is a shortage of suppliers of medical services, which in turn drives up the cost of health care, which in turn creates the justification for yet another form of government intervention in the form of Obamacare, which in turn will create more supposedly-unforeseen problems that will create justification for yet more regulation and control....

  • robc||

    "Certificate of Need" sounds like some bullshit Ayn Rand would make up for her novels.

    How can legislatures pass stuff like that with a straight face?

  • JW||

    The **cough** contribution from the AMA helps them sleep at night.

    Who are you going to believe? Your lying eyes and all those sick people waiting to die, or our brave public servants?

  • SweatingGin||

    Maybe they can fix it with a healthcare equalization act or something like that.

  • Archduke Pantsfan||

    Death Panels

  • Chamber Potts||

    Nobody has a heart in D.C. Any way.

  • Pope Jimbo||

    It isn't heart transplants they are performing there. Like you said, the install base isn't big enough to warrant that procedure.

    No, they specialize in hemorrhoid surgeries. Of course it doesn't take much skill to work on assholes as big as those found in the DC area.

  • The Late P Brooks||

    But in part because of the CON process, there is a shortage of suppliers of medical services, which in turn drives up the cost of health care

    That's just crazy talk. If we just let anybody build a hospital anywhere, there would be waste, fraud, and abuse.

  • SweatingGin||

    There'd be hospitals everywhere! They'd be shooting at each other to try to take territory from each other (and thus guaranteeing more customers)

  • JW||

    If it's good enough for food trucks, liquor stores and taxi cabs, it's good enough for our doctors.

  • Ted S.||

    We need a certificate of need system for lawyers. They can't practice in a particular town unless they can prove the town has a need for their services.

  • C. Anacreon||

    The one industry that our government never calls for restrictions on trade or price controls. Wonder why.

  • ||

    What I have the hardest time processing is how the totalitarian cuntstains whose idea such Satanic regulatory frameworks were in the first place convinced enough people of those framworks' justifiability and effectiveness to allow their implementation.

    Are, and were, people really this fucking retarded?

    I'm disgusted to call that shithole the capital of the Union. Fuck DC straight to Hell itself.

  • Irish||

    OT: Bill Maher: I trust Barack Obama to use NSA spies, but don't know if I'd trust Ted Cruz.

    Does Bill Maher live in an alternate universe with a completely different Barack Obama and Ted Cruz than live in our world? Like in Maher's world, is Barack Obama a truthful defender of justice while Ted Cruz is a vile authoritarian?

    He doesn't realize the last 5 years have happened, does he?

  • ||

    When he first started talking, I wanted to give him the benefit of the doubt that he was just arguing that "even though you like this guy, do you want ANY president to be able to do this" but then he kept talking.

  • DK||

    It looks like Maher's Fistpuppet (aka Shrike, PB) has some new talking points.

    I've been seeing a lot of proggy derision against Cruz lately - more so than Rand Paul.

  • Irish||

    Prog attacks on Cruz and Paul are basically an admission that they don't care about civil rights. It must eat them up that the best people in congress in regards to civil rights are Ron Wyden and a half dozen Republicans.

  • DK||

    I admittedly don't know a lot about Cruz other than his recent attacks on several statist Republicans and Democrats, but I just read his Wikipedia page. Is this whole President Cruz thing a talking point since he was born in Canada (to an American mother)? Are they trying to get a hypocrisy thing going with the Birthers?

  • Irish||

    I don't know. The Obama and Cruz birther arguments are both ridiculous since both of them WERE natural born citizens regardless of where they were born. Each of them was born to an American mother and thus had citizenship at birth.

    That's what natural born citizen means. It's irrelevant where you were born.

    I hope Cruz doesn't disappoint me on civil liberties issues, but he's gotten into such big fights with statist Republicans that I'm willing to give him the benefit of the doubt. He doesn't just attack Democrats over this stuff.

  • DK||

    It's irrelevant where you were born.

    When has irrelevance ever dissuaded Team talking points.

    Yes, it will be interesting to see how Cruz continues to vote. Having a choice between Paul and Cruz would be great for libertarians.

  • Adam330||

    Recall that McCain was born in the pans Canal Zone.

  • The Late P Brooks||

    "The applicant has not provided enough evidence to demonstrate that the addition of a new program will be able to substantially increase the number of organs that are needed to establish a new facility."

    If only there were some way to incentivize the donation of transplantable organs.

    *Fuck you guys, I'm not going to be parted out. It's all coming with me into the big furnace.

  • Archduke Pantsfan||

    Furnace?
    I'm having a mausoleum built to have my fully intact body put on permanent display.
    Preferably on some land which is now wasted as wetlands.

  • ||

    That's so old school Pantsfan. Resomation is the corpse disposal method of the future.

  • Archduke Pantsfan||

    you lost me at ecologically favorable

  • ||

    Pft, that's just marketing fluff. They've professionalized mob body disposal.

  • Heroic Mulatto||

    I'm having a mausoleum built to have my fully intact body put on permanent display.

    How very Communist of you.

  • The Late P Brooks||

    Why aren't you in Montreal, Archduke?

  • Archduke Pantsfan||

    Didn't make it this year.

  • The Late P Brooks||

    You could always be fired into space like Miss Thanatopoulos.

  • Archduke Pantsfan||

  • Ted S.||

    It's amazing that anybody can know about the Certificate of Need system and still think the US has a free-market health care system.

  • WomSom||

    Sounds liek a pretty solid plan to me dude.

    www.AnonStuff.tk

  • Lisa Hanawalts||

    I think government of health planners take a better decision about ability that will not execute appendage transplants. They are experts in hemorrhoid surgical treatments, but needless to say this doesn't happen take considerable ability to operate about assholes as big as individuals within the actual DC area.

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