The way the COPN process is currently constructed and interpreted, it’s really designed to protect current monopolies over growing health care systems, if the COPN process continues to exist in Virginia, then the regulators should evaluate current practices to ensure a consistent and fair approach for every applicant. 

In a recent COPN application, Medarva Healthcare highlighted consistently high utilization of its surgical services and also discussed the need for the population of patients that live in the northern and western portions of the planning district, that application was determined to be unauthorizable as an institutional need-based project by the (state health) commissioner.  The primary objection came from an acute care hospital that has unutilized OR's and has closed ASC's.  Despite evidence being given to the value and costs of a free-standing ASC, the Commissioner ignored these points and chose, instead, to protect the more expensive acute care hospital.

In a second COPN application to relocate 2 OR's from Stony Point Surgery Center (even though Stony Point is the busiest ASC in the State) the staff recommended denying our application.  At the same time, however, two new operating rooms proposed by Bon Secours St. Francis Medical Center were recommended for approval.  The staff person who reviewed the application was upset that the Commissioner had denied the first application and was concerned that Stony Point would request permission to replace the 2 OR's that were being relocated.  This demonstrates that the process is now subject to the personal bias of the COPN staff and is no longer based upon rational thought, data or as implied in the name, "Public Need."

Medarva Healthcare challenged the decision by the Virginia Department of Health’s staff to recommend denying an application to relocate two licensed operating rooms from its Stony Point Surgery Center to West Creek Medical Park and after two years fighting with the state, Medarva Healthcare received approval from the Virginia Department of Health to build its West Creek Surgery Center in Goochland County. In that time, Medarva spent more than 1,000 hours of staff time and in excess of $300,000 in legal and other fees to complete the Certificate of Public Need — or COPN — process.

The current antiquated bureaucratic system favors incumbents by inviting opposition from competitors and considering any impact on a competitor’s patient volume as a basis to deny an application.   A mechanism is needed to ensure even handed application of the process for ever applicant.