Gov. Brian Kemp on Thursday signed House Bill 186, unlocking future growth for Cancer Treatment Centers of America in Georgia and ending a decade-long battle between CTCA and the state’s nonprofit hospitals. CTCA, a private health care business, won.
What it means for Georgia patients is clear: more opportunity to receive treatment at CTCA’s campus in Newnan. The new law wipes away a requirement that at least 65% of the hospital’s patients be from out of state. And it allows the cancer hospital to apply to add more beds on a regulated basis just like other hospitals can.
“Today we will reach a new milestone by enhancing competition in health care,” Kemp said, interrupted by an ebullient “Yeah!” from Richard Stephenson, the founder of the Florida-based business who stood beside Kemp. “In the fight of their lives, cancer patients deserve the freedom to decide for themselves how, where and when they receive treatment,” Kemp added.
Kemp also signed a bill to require financial disclosures from nonprofit hospitals, as well as eight other health care bills on issues including drug prescriptions and interstate licensing for health care professionals.
The CTCA expansion won’t happen immediately. Kemp’s signature kicked off a process that will take several months and may culminate in new openings for Georgia patients this fall.
CTCA currently has 50 beds at its campus in Newnan. That’s a small sliver of CTCA’s business. Of the 3,000 new patients it treated last year, outpatients made up 88%.
HB 186 changed a law called certificate of need, or CON. The law is meant to protect nonprofit hospitals’ bottom lines. Such hospitals spend a lot of money treating uninsured patients, and they are legally obligated to see whoever walks in the door. They try to make up the difference by treating insured patients with profitable services, such as bone surgery and cancer care.
They fear that CTCA and other private businesses will cherry-pick those profitable services and leave them with the money losers.
CTCA counters that it, too, provides charity care, and the number of charity patients will increase as the overall number of patients increases. Georgia law mandates that 3% of CTCA’s business be patients unable to pay, and over time it says it has averaged 4.6%. That is still less than the national average and far less than safety-net hospitals such as Grady Memorial Hospital treat. Georgia has one of the nation’s highest percentages of uninsured patients, approaching 1 in 5.
The tussle between all kinds of big hospitals over insured cancer patients is visible on TV ads and billboards across the state. CTCA is a leader in that fight. Health business researchers reported in the Journal of the American Medical Association that during a 10-year period after 2005, CTCA spent more than $100 million on advertising its five hospitals nationally. That was more than the combined spending of all the other private cancer center businesses they measured.
CTCA says it’s not disparaging other hospitals but letting patients know that CTCA is an option.
“This may be the right place for that patient, it may not be,” said Ray Williams, a lobbyist for CTCA. “One of the differences is, this is all we do. … We’re not taking anything away from any of the other wonderful providers that treat cancer in the state. What we’re advocating for and patients are advocating for is, allow us to choose.”
And the emotions and desires of the patient do matter, he added.
“If you’re in a place where you feel comfort and you feel hope,” Williams said, “then you’re in a better mental position and your family’s in a better mental position to embrace that hope.”
Whether it means better health for Georgia patients is less clear.
CTCA has made an effort to publicize statistics that show its outcomes as better than other hospitals’. A Reuters investigation from six years ago suggested that CTCA cherry-picked healthier patients to begin with that skewed the numbers. CTCA said its data were in no way misleading.
As a business, CTCA also concentrates on insured patients, who are more likely to be healthy.
And other Georgia hospitals have cancer experts, too.
Dr. Walter Curran, the executive director of the Winship Cancer Institute of Emory University, points to the depth of expertise there and notes it is Georgia’s only comprehensive center designated by the National Cancer Institute.
“There is evidence that the chances of surviving cancer are up to 25% higher at an NCI-designated cancer center because of access to state-of-the art treatments,” Curran said.
For Pam Alford of Eatonton, CTCA was the only place she wanted to be because it had a doctor who specialized in her rare condition, inflammatory breast cancer. She testified for CTCA in a Senate committee hearing, saying that she was initially told she couldn’t get into CTCA because of the in-state cap.
“It was like someone punched me in the gut,” Alford said. “It was almost as bad as that day I had heard, ‘Ms. Alford, you have cancer.’”
Eventually, she got in. Whereas before she had had to go to four different hospitals for tests, CTCA had everything there for her, she said. She didn’t have to wait for tests but got them immediately. Asked afterward whether CTCA made any changes to her medical treatment, she demurred but added that CTCA had additional services such as acupuncture.
“The whole concept is what is different,” Alford said. She spoke at the signing ceremony as well and told a reporter afterward that she felt treated like a participant in her care, which she called important because having cancer is also a mental battle.
Andy Freeman, the director of government relations for the American Cancer Society Cancer Action Network in Georgia, called HB 186 “a compromise on all sides.”
“In order to continue saving lives, we need to ensure that all cancer patients, regardless of type of insurance they have, receive the care they need,” Freeman said in a statement. “We look forward to cancer patients in Georgia having access to the quality health care necessary to help them treat and overcome this disease.”
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