It's the clinics that were never built, the doctors who didn't venture out on their own, that were the hidden toll of what advocates perceived as heavy-handed regulation of health care that favored existing hospitals and clinics.
With a new year, and many of those regulations repealed in the previous Legislature, the growth from doctor-driven projects will start, said Dr. Marcelo Hochman, a Charleston plastic surgeon and president of Independent Doctors of South Carolina.
"That’s where I think the exciting stuff is going to come," he said, not just for physicians, but for patients and their families, as well.
Dr. Marcelo Hochman, a facial plastic and reconstructive surgeon, performs a revision rhinoplasty at The Facial Surgery Center on Dec. 19, 2023, in Mount Pleasant. It was a long and grueling battle to amend or repeal the state's Certificate of Need law, which required a state license to build new hospitals or projects over a certain size, as well as to buy expensive medical equipment. Gavin McIntyre/Staff
It was a long and grueling battle to amend or repeal the state's Certificate of Need law, which required a state license to build new hospitals or projects over a certain size, as well as to buy expensive medical equipment. Often, those projects were appealed by competitors that could tie up a proposed facility for years. Much of that was repealed after Gov. Henry McMaster signed a new law last year after calling on the Legislature for its repeal.
“South Carolinians will have greater access to affordable health care services with the repeal of the Certificate of Need laws,” he said last year. “Everyone benefits when the proven power of the free market is unleashed in our state.”
Just months later, there were already signs it is kicking in.
"I am seeing fresh new ideas," Rep. Sylleste Davis, R-Moncks Corner, chair of the House Medical, Military, Public and Municipal Affairs Committee, said after a mobile health conference in October.
"People are investing," said Rep. Jordan Pace, R-Goose Creek.
Part of that investment is coming from outside the state. Novant Health, which has hospitals in North Carolina, is acquiring three hospitals in South Carolina, including East Cooper Medical Center in Mount Pleasant. Novant Health has been "waiting for the right opportunity," a Novant Health spokeswoman said. "With CON changing in South Carolina, we look forward to partnering with physicians and others as we continue our long-term vision to improve the health and wellness of communities across the state."
In rural areas, improved access for patients won't come from just new buildings but extending new services virtually, Davis said. The House passed a bill last year expanding the use of telemedicine services, which could be key to providing more care in those areas that lack providers, she said. The Senate is expected to address it in the upcoming session.
Dawn Elliott, an operating room scrub technician, reaches for a medical instruments during a neck lift procedure at The Facial Surgery Center on Dec. 19, 2023, in Mount Pleasant. It was a long and grueling battle to amend or repeal the state's Certificate of Need law, which required a state license to build new hospitals or projects over a certain size, as well as to buy expensive medical equipment. Gavin McIntyre/Staff
The repeal legislation also created a committee to look back to see the impact of the reform on rural areas and whether incentives are needed to get more providers into those areas, said Candace Carroll of the South Carolina chapter of Americans for Prosperity, which pushed for the reforms.
"I would hope that as health care is looking to open across the state, that people would look at those rural areas and lean into those opportunities to better serve those patients," she said.
The hope is the reform will discourage the nearly endless litigation that accompanied the CON process, a contest that favors those with deeper pockets and more lawyers over smaller competitors. Hochman said he knows of practices that did not create their own surgery centers — not because they didn't have the money to build, but because they didn't have the funds for the legal battle.
There are already signs it is making a difference on litigation, both advocates and South Carolina hospital officials noted. For instance, in Horry County, three providers settled their legal cases against each other in September so each could proceed with a hospital project.
There could be more opportunities for doctors and hospitals to partner together as well because "neither one of them could tie the other up in litigation," Carroll said.
It could open the way to more options for patients, with more lower-cost options than what people would think of as services that are only in a big center or in a hospital, Hochman said.
"Really, so many things can be done in very small facilities" with lower overhead, he said.
But there would still be an element largely missing from the South Carolina marketplace, advocates admit, and that would be the ability for patients to shop based on price. It is difficult for patients to go to current facilities now and truly understand what the cost would be, Hochman said.
"Nobody can do that in South Carolina," he said, except for things like cosmetic surgery, where the patient is footing the entire bill.
One example would be the Surgery Center of Oklahoma, where patients can literally call up a procedure or even click on a body part to see what the cost of that surgery would be.
Dr. Marcelo Hochman (left), a facial plastic and reconstructive surgeon, and Dawn Elliott, an operating room scrub technician, perform a neck lift procedure at The Facial Surgery Center on Dec. 19, 2023, in Mount Pleasant. It was a long and grueling battle to amend or repeal the state's Certificate of Need law, which required a state license to build new hospitals or projects over a certain size, as well as to buy expensive medical equipment. Gavin McIntyre/Staff
There needs to be more of that, and some of it will have to come from federal legislation that addresses those issues, Carroll said. It also should be more than just cost.
"There definitely needs to be more transparency in the marketplace just across the board when it comes to the expense of health care," she said. "The patient should be empowered to compare not just the price, but the quality of care when they make those decisions." For instance, using quality metrics used by The Leapfrog Group, which grades hospitals on quality.
That is the future Hochman and others see for health care in South Carolina.
"The doors are open for doctors, for investors, for interested parties, to start exploring and see what they can provide," he said. "And it is up to patients to start demanding that."
