Top 10 healthcare organizations issuing certificates of need

A certificate of need (CON) is a legal document required in many states or federal jurisdictions to ensure that healthcare facilities and providers meet certain criteria before establishing or expanding their services. Under a CON program, healthcare organizations typically need to obtain approval from a state regulatory agency, often a health planning agency or a similar entity, before initiating certain projects, such as:

• Renovating an existing healthcare facility (hospitals, nursing homes, ambulatory surgery centers, etc.).
• Closing an existing healthcare facility
• Changing the ownership of a healthcare facility
• Adding a new healthcare service, or removing an existing service
• Acquiring major medical equipment (MRI machines, CT scanners, etc.).

The rationale behind CON programs is to prevent unnecessary duplication of healthcare services and facilities, which can lead to higher healthcare costs and uneven distribution of resources. By requiring providers to demonstrate a need for their proposed construction projects or services, CON programs aim to ensure that healthcare resources are allocated efficiently and that communities have access to essential healthcare services.

However, CON programs have been subject to debate and criticism. Critics argue that CON regulations can stifle competition, limit innovation, and potentially restrict patient access to care. Proponents, on the other hand, argue that CON programs are necessary to maintain quality, control costs, and ensure that healthcare resources are distributed in a manner that best serves the needs of the population. The effectiveness and necessity of CON programs continue to be topics of discussion and vary from state to state.

How many states require CONs?

Currently, 35 states in the U.S. have certificate of need (CON) programs in place. The specifics of CON requirements, regulations, and the types of healthcare facilities or services subject to CON vary from state to state. Some states may have more stringent CON requirements, while others may have less extensive programs. Additionally, the status of CON programs can change over time as states may amend or repeal their CON laws. For the most up-to-date information on the states that require CONs and the specifics of their programs, it's important to consult the relevant state's health department or regulatory agency.

How are certificates of need tracked?

Definitive Healthcare tracks certificates of need throughout their entire lifetime, from the initial application to the final decision. Our database houses information on more than 27,000 CONs, with the earliest record dating back to 1989 and the most recent application submitted in March 2024. CONs are organized by applicant name, project category, current status, project amount, application date, decision date, project description, and details.

What healthcare organizations issue the most certificates of need?

Determining which healthcare organizations issue the most certificates of need can vary depending on the state and the specific projects being undertaken. In many cases, larger healthcare systems or hospital networks may be more active in pursuing CONs for expansions, acquisitions, or new services.

Hospitals, academic medical centers, and a dialysis center all appear on our top 10 list of healthcare organizations issuing the most CONs. Strong Memorial Hospital, part of the University of Rochester Medical Center in Rochester, New York, has issued the most CONs, mainly for renovations or expansions of their existing facilities. Check out the most common types of hospital certificates of need in this post.