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Since its establishment, TriStar Horizon Medical Center in Dickson, Tennessee has acquired a less-than-favorable reputation in the minds of Dickson County residents. According to a 2018 study reported by the Tennessean, 60 percent of potential patients in Dickson County are leaving the area for medical care provided in Davidson County. For any serious health incident or concern, the hospital is often bypassed in favor of more respected healthcare facilities in Nashville (looking at you, Vanderbilt). The lack of available services and equipment at hospitals such as the TriStar Horizon Medical Center has become a real problem for those seeking the necessary medical attention. 

Luckily, TriStar Horizon Medical Center has begun to implement over 30 million dollars worth of expansion and renovation projects over the last few years. Most importantly, they began construction of a brand-new 17 million dollar intensive care unit, which should be finished by the end of this year. With the addition of an ICU and a newly renovated cardiac catheterization unit, along with the expansion of their oncology office and imaging services, access to top-of-the-line healthcare services will no longer cost residents of Dickson a trip out of the county. These improvements come only after thousands of dollars in filing fees and countless hours spent submitting Certificate of Need applications to the Tennessee Health Services and Development Agency.

Unfortunately, this ‘happy ending’ is often not the case for many Tennessee citizens. This is where certificates of need come into play. Certificate of Need (CON) laws require healthcare providers to seek permission and prove there is a shortage of some medical services in the area in order to change, add, or reduce the services they provide. Intended to regulate healthcare costs and competition, the unintended consequences of CONs often make it difficult for Tennesseans to access adequate healthcare services. Currently, 22 counties in the state of Tennessee do not have hospitals, and 17 counties do not have emergency departments. Research shows that states that have CON requirements have fewer rural hospitals and rural ambulatory surgical centers. Eliminating these onerous regulations would make it easier for more providers like TriStar to further invest in underserved communities.

Tennessee has made progress in repealing and reforming its CON requirements. For example, legislation enacted in 2021 now exempts healthcare services and facilities from CON requirements in economically distressed counties without an existing hospital and allows previously licensed hospitals to open up opioid addiction treatment centers without obtaining an additional CON. However, there is still much work to be done. CON laws in Tennessee are still much more stringent compared to other states. Tennessee still requires a CON for nearly 20 different services by the state, while 15 states don’t require a CON at all and many other states’ CON regulations can at least be counted on one hand. 

Tennessee must continue to take action to ensure that every citizen can access and receive the medical care that they deserve by continuing to reform and repeal CON laws. While those in Dickson County are fortunate enough to benefit from an approved Certificate of Need application, there are still many Tennesseeans that deserve increased access to healthcare and further investments in their health. This is unlikely without additional CON reform that permits more straightforward implementation of necessary healthcare services.