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Last week’s cover story examined Oregon’s dramatic shortage of inpatient rehabilitation beds for people suffering traumatic brain injuries (“Free Fall,” WW, Jan. 19). Out-of-state companies seeking to open new rehab hospitals have been stymied by what’s known as a “certificate of need” process in which existing providers can challenge whether more beds are necessary. Legacy Health and the Oregon Association of Hospitals & Health Systems have both opposed more rehab beds for TBIs—and have gone to court to block them. Here’s what our readers had to say:
Wim de Vriend, via wweek.com: “Several years ago, my stepson was hit in the face by a chipper, fell down backwards on concrete, and was out cold for months, in an induced coma. But he only started making progress after he was moved to Craig [Hospital in Englewood, Colo.], which specializes in TBI cases, and has the staff and the expertise and the programs for it. Without going into all the details, he made amazing progress in so many ways at Craig.
“The certificate of need program was instituted as a local program but in reality funded by the federal government, around 1970, supposedly as a cost control measure. Too many hospitals were expanding, which had become a real concern because Medicare paid for those unnecessary beds, often added for the vanity of the hospital board, and as job protection for the hospital manager. The program was pompously named CHP, or ‘Comprehensive Health Planning,’ and I worked in it for a few years until it got way too political. That’s because the health care business figured out that it was better to join ‘em than to fight ‘em, so what’s known as regulatory capture occurred.
“With regard to the situation in Oregon, it is clear that no care at the level of Craig is available, and human nature being what it is, there will always be people who consider warehousing helpless people a good business model.”
AdvancedInstruction, via Reddit: “Certificate of need laws don’t just limit rehab beds, they limit the construction of any medical facility. All new facility construction, even expansion of existing facilities, requires a ‘certificate of need’ to be issued by the state before they can be built.
“It’s bullshit created to protect existing hospital networks, and it’s why Oregon has among the lowest number of hospital beds per person.”
Scott Kerman, via Twitter: “This is a must-read—and even more tragic given the link between TBI and homelessness. An important solution to homelessness is providing services that help prevent people from becoming homeless in the first place.”
hmmpf, via Reddit: “Both of the rehab entities wanting to come to the area are for-profit. They will poach the commercial and Medicare patients. Personally, I find companies whose goal is to cut patient care in order to generate profit for shareholders to be pretty reprehensible, too.
“I have worked in the acute rehab arena in the Portland area (though not for Legacy, Peace Health or Providence) prior to my retirement, and agree that there are too few beds. But I am also aware of significant differences in the level of care provided between even the local facilities. I can’t imagine a for-profit has the expertise for TBI and spinal cord injuries. TBI is very, very complex, and often includes issues around addiction and having a safe discharge location.
“I wish Providence or Legacy would expand their rehab services, or have Kaiser open one.”
snusjunction, via wweek.com: “Good—better than good—investigative journalism. Hope the Legislature changes the ‘certificate of need’ process. The market should decide, accompanied with high operating standards.”
generalist herbalist, via Reddit: “I should not have read this before bed. I know that there aren’t any beds. I know I can’t get anyone into the amount of help they need, and I know it’s a systemic issue, but for fuck’s sake. If a cartoon villain pulled this shit, the editor would say the greed went too far.”
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