Health Equity

Today, MSDC President Dr. Kirstiaan Nevin sent an email letter to DC Health asking for clarification in the DC certificate of need (CON) process.

At its November Advocacy Committee meeting, Society leadership heard a presentation on the CON process and how some recent communication from the State Health Planning and Development Agency (SHPDA) to medical practices may indicate changes in the CON process. Healthcare facilities trigger the need for a CON when they establish new medical facilities or make changes to existing facilities, but MSDC has heard concerns that the regulatory language governing the CON is being interpreted in a new way. The letter asks for written clarification so the physician community can better understand the process, especially at a time when healthcare services are in such high demand.

The letter in full is below:

December 2, 2021


Terri A. Thompson 
Director, State Health Planning & Development Agency
Center for Policy, Planning, and Evaluation Administration
899 North Capitol Street NE, 6th Floor
Washington, DC 20002

Dear Director Thompson,

The Medical Society of DC is the largest medical organization representing metropolitan Washington physicians in the District. We advocate on behalf of all 12,000 plus licensed physicians in the District and seek to make the District “the best place to practice medicine”. 

MSDC has received feedback from medical practices about recent interpretations of DC regulations from SHPDA regarding certificate of need (CON). To assist us and the physician community in understanding the certificate of need process and any recent changes to interpretations, we request written clarification in the areas outlined below.

The concerns we have heard focus on three areas:

1. Definition of “group practice”. Physicians are concerned that there is ambiguity in the definition of group practice and when a certificate of need is required for the practice. We have been told your office uses 22-B DCMR 4099’s definition of ambulatory care facilities in determining what a group practice is, despite there being no stated definition of what one is, simply what it is not. It is important to know what aspect of this regulation is definitive.

2. Definition of “individual practitioner”. We have also heard that the same DCMR section has caused confusion for physicians looking to hire additional healthcare employees for their office. Because the statute defines what a group practice is not and does not have clear language on when adding employees requires a certificate of need, we have heard from our community they feel they need to apply for a CON if they want to hire an additional healthcare practitioner. As the demand for healthcare services increases, new staff to meet existing services may trigger the CON process. If this is the case, we seek clarity to understand when and why.

3. Scope of office services. The same section under “health care facility” lists the areas where a CON is not needed – conventional office services. This is a vague phrase and the explanatory clause following offers limited guidance. We have heard from practices that they do not know if any changes to their practice need a CON determination.

MSDC believes clarification to these issues is important, especially as our healthcare system changes due to the ongoing pandemic. We request written answers to the following questions, so we can better advise our members when they ask questions about changes to their practices:

1. Under 22-B DCMR 4099, how does SHPDA define a “group practice”?
2. How does SHPDA read 22-B DCMR 4099 to define a sole practitioner, and what is the dividing line between a sole practitioner and a group practice?
3. How can a practice determine if they offer a “conventional office service” or do they need to receive a determination from SHPDA?

If you have any questions, please contact Robert Hay Jr., Executive Vice President, at 202-355-9401 or hay@msdc.org to contact me. Thank you for your assistance with this matter.

Sincerely,
 
Kirstiaan Nevin, MD
President, Medical Society of the District of Columbia


CC: Fern Johnson-Clark, Ph. D, Deputy Director for Policy, Planning, and Evaluation
Edward Rich, Deputy Counsel