On behalf of the Virginia Orthopaedic Society (VOS), I am submitting public comments on the periodic review of the Virginia Medical Care Facilities Certificate of Public Need (COPN) Rules and Regulations, 12VAC5-220. VOS believes these regulations should be repealed because they are harmful to patients in Virginia and place an undue burden on small business physician practices.

The review specifically seeks public comment on whether the regulations are necessary for the protection of public health, safety and welfare. VOS believes they are not necessary and furthermore, do harm by serving as a barrier to low-cost, high-quality health care services. COPN regulations require physicians to receive permission from a state agency in order to provide new services for our patients or expand our current services. It directly impacts the kind of care we can provide and the setting in which we are able to provide it.

Virginia’s COPN process prevents competition and limits the services physicians can offer. For example, an orthopaedic surgeon must obtain a COPN in order to have a MRI (Magnetic Resonance Imaging) machine at his or her office. Many physicians are denied by the COPN process and not allowed to have this service at their practice. Instead, they must refer a patient to a hospital for this service, which can be more expensive and time-consuming for the patient.

In addition, these regulations place an undue burden on our practices, which we operate as small businesses. In order to remain as an independent practice and maintain patients, a physician must offer the services patients need. By requiring procedures and services be performed at hospitals (at a much higher cost), the state is directly hurting physician practices.

Virginia’s COPN regulations are outdated and ineffective. They increase out-of-pocket health care costs for our patients, limit access to the services they need and stifle competition within the health care field.

Thank you for the opportunity to provide comments on this critical issue.

Quanjun Cui, MD

President, Virginia Orthopaedic Society