Health Care Issues
Folks, I worked in healthcare for a decade or so and the Certificate of Public Need (COPN) is one of the big driver of healthcare costs, so this is HUGE or shall we say YUGE to have this piece of legislation before us! Please SUPPORT SB 266 by calling your Senators! See more information below.
ACTION: Call and e-mail your Senator in Richmond and tell him/her to vote for SB 266.
Find your senator and contact info here
A vote will be called Monday or Tuesday, the last day before "Crossover."
SB 266 allows multiple exceptions to the anti-market regulations known as Certificate of Public Need (COPN). We've been trying for years to get COPN repealed in Virginia...
SB 266 would allow independent doctors to establish certain ambulatory services in their offices instead of forcing patients to use hospital facilities for routine tests like colonoscopy, MRI, or simple surgical procedures. Patients pay less, and significant savings to Medicare are possible.
One doctor reports*:
If you look at Medicare colonoscopies across the entire US, every year Medicare overpays a staggering $257,527,703.72 a year by having colonoscopy done in [hospital outpatient departments] ... rather than in the office.
The issue is about the cost of health services, which COPN keeps artificially high by stifling competition. The same physician states:
According to the Virginia Department of Health COPN website, “The program seeks to contain health care costs while ensuring financial viability and access to health care for all Virginia at a reasonable cost.” Is the COPN program really fulfilling its stated mission and intent, or is it in fact part of the proble
OPN is a complex issue, but you don't need to be an expert to make a call to your Senator. This bill may be our only chance this year to begin chipping away at the monopolistic control the hospital lobby maintains on Virginians' access to affordable health care. Please share this alert widely, and call your senator right away (leave a message and ask to be called back.)
*Below are the remarks delivered by Dr. Keith Berger to the Senate Education and Health Committee on 9 Feb. The bill he addressed was one of several that were combined into SB 266.
In Support SB 235 to Allow an Exception to Virginia CON for Center for Health and Cancer
Prevention in Virginia Beach
Mr. Chairman and Members of the Committee:
● I’m Dr. Keith Berger, and I’m here in support of Senator DeSteph’s SB 235
● I’m a board certified Gastroenterologist. In 1985, I was the first gastroenterologist in the State
of Virginia to offer GI procedures (such as colonoscopy) in the office as opposed to the hospital,
where costs were significantly higher. Since then, office based endoscopy has become the
standard of care in Virginia
● My current medical practice is called the Center for Health & Cancer Prevention (CHCP). We
operate a single bed, single physician office endoscopy unit . We specialize almost entirely in
the early detection and prevention of colon cancer , the second leading cause of cancer
mortality in Virginia and the US.
● Our Center sees about 1400 patients per year, about 350 of which are Medicare patients
Medicare patients are at the highest risk for colon cancer , and colonoscopy is a highly effective
means of preventing it.
● So why this Bill? Running an office endoscopy practice requires a lot of resources, so a single
procedure in our office costs the practice around $500, which is, however dramatically less
than the cost of the same procedure at the hospital outpatient department (HOPD), $1213, or
250% higher (see the attached actual patient bill). Since we pioneered the use of office based
endoscopy in 1985, as a result of Virginia CON Law, we have never received a single dollar of
reimbursement for the facility costs of doing Medicare patients in our office , even though
these costs are reimbursable by Medicare. Virtually every insurance company in VA uses the
office based model. For 33 years, we have absorbed the Medicare facility costs ourselves even
though we could have done these patients instead at the hospital at no cost to the practice. We
estimate that we have saved patients and Medicare over this time between $4 million and
● Every year we do office based colonoscopy, the cost savings to patients and Medicare would be
$ 319,594. This figure represents only 1/10 of 1% of the (hospital’s) SVBGH’s total revenue , and
therefore would have no detrimental impact on the hospital.
● If you look at Medicare colonoscopies across the entire US, every year Medicare overpays a
staggering $257,527,703.72 a year by having colonoscopy done in HOPD’s rather than in the
● Because of shrinking Medicare allowances for physicians, doing Medicare patients in my office
and having to absorb the facility costs now leaves the practices losing money on every Medicare
case because under CON, I cannot be reimbursed for any of my office costs, staff, equipment,
supplies etc. This is unsustainable.
● Moreover, I now find myself focused constantly on how to keep my practice running, spending
my attention and energy on just how to ‘survive.’
● All the while, the practice of medicine is becomingly increasingly complex , particularly with the
demands of EHR, complicated insurance billing, liability, changing referral patterns and hospital
consolidations. This leaves independent physicians struggling just to stay in practice, and forces
many excellent, experienced physicians to leave medicine altogether or take employed
positions. Many of us are ‘burned out.’ We are losing invaluable and irreplaceable resources.
● So far, independent physicians have not received much help from our State or Federal
● One of the common objections to CON reform or repeal is that it would negatively affect
coverage for rural or indigent populations. I believe that using the CON Law is a poor and
actually counter-productive means of accomplishing this. Instead, I believe that the way to
solve the ‘coverage’ issue is to begin to address the incredible waste and inefficiency in our
healthcare system . And colonoscopy is just one example. What if we could take that $257
million yearly windfall by moving colonoscopy from the outpatient department to the office, and
invest those savings into indigent care, rural health initiatives and other needed services?
● According to the Virginia Department of Health COPN website, “The program seeks to contain
health care costs while ensuring financial viability and access to health care for all Virginia at a
reasonable cost .” Is the COPN program really fulfilling its stated mission and intent, or is it in
fact part of the problem?
● Based on what has been presented here, I respectfully request that the committee consider
granting my practice an exception to the CON. It would allow me to continue my services to a
very important population and health issue, i.e., colon cancer prevention in middle aged and
elderly Virginians. It would allow me to expand my contribution in healthcare, which is what I
am here to do.
Thank you for your listening.
Keith E. Berger, MD
The Center for Health and Cancer Prevention, LLC