The overarching plan used by the state Department of Health to allocate health care resources under the state’s certificate of need program has a goal to reduce surplus, unused bed capacity at hospitals statewide. Yet as the coronavirus pandemic spreads, the number of available hospital beds is expected to become an issue.
The part of the state’s most recent health plan released in 2018 that dealt with hospital bed capacity said there was an importance to reducing excess bed capacity and that it is not likely to result in problematic consequences. It’s been the policy of the department since 2009.
The same document also said there was a glut of licensed hospital beds statewide despite a decreasing trend nationally since 1999. The state Department of Health urges each hospital to voluntarily reduce the licensed bed capacity.
According to the Henry Kaiser Family Foundation, the state (as of 2018) has four beds per 1,000 population, considerably higher than the U.S. average of 2.4 beds per 1,000 population. In 1999, Mississippi had 4.8 hospital beds per each 1,000 of population (the national average was three).
The plan also says that the “carrying cost” of maintaining unused beds could raise operating costs for hospitals and that such surpluses could retard the introduction of more cost-effective practices and services. The document also said continuing surpluses could create an environment that could invite policy intervention by the legislature and others.
The MSDH determines hospital need under the certificate of need program by multiplying the state’s average annual occupied beds per 1,000 population by the estimated county population to determine the number of beds required.
The state health plan provides guidance for the decisions made by the board when considering certificate of need applications. Mississippi law requires CON approval for all projects that increase the bed complement or a capital expenditure of at least $2 million. CON approval is also required for major medical equipment purchases of more than $1.5 million and is not a replacement for existing equipment. Mississippi is one of 35 states that requires a certificate of need.
Most of those applications for a CON are approved, at least in the last decade. From 2009 to 2018, 91.45 percent of the applications passed the first hurdle of a health department staff review.
During the 2009 to 2018 timeframe, there were 234 analyses performed by department staff for CON applications. The Department of Health recommended authorization on 214 without conditions, two received conditional approval and one received a partial approval.
Only 17 applications were recommended for disapproval (7.26 percent) and most of these were for new providers, largely from out of state, seeking to provide services in the state.
CONs originated from the National Health Planning and Resources Development Act of 1974 that was signed into law by then-President Gerald Ford. This act was intended to reduce annual increases in federal health care spending and one of the cost control measures was to require states to institute CON laws to regulate health care facilities.
Congress later eliminated this requirement, but CONs in some form persist in 35 states.