Imagine needing to seek approval from your rivals to start a new enterprise: a local café, a diagnostic center, or a surgical facility. For many years, this was the situation in South Carolina’s healthcare sector. Certificate of Need (CON) regulations empowered established hospital networks to challenge new outpatient services, imaging facilities, and doctor-led initiatives. This hindered competition, heightened costs, and maintained the existing order.

That time is coming to a close. In 2023, the South Carolina legislature abolished most CON regulations. By 2027, all remaining hospital CON stipulations will be eliminated. This marks not merely a change in regulations; it presents a rare opportunity for physicians to seize.

**CON regulations did not safeguard patients; they safeguarded monopolies.**

For an extended period, CON was justified as a mechanism to limit excess capacity and manage costs, yet in reality, it acted as a barrier shielding hospital monopolies. Independent practitioners and entrepreneurs faced lengthy, costly, and adversarial proceedings merely to enhance services or establish a new facility. This shielded incumbents, rather than protecting patients. The landscape began to transform when Governor McMaster enacted Senate Bill 164. The repeal of CON, with limited exceptions for nursing homes and hospitals until January 1, 2027, has opened doors for competition, accessibility, and innovation.

However, the law does not ensure a brighter future; it merely eliminates the obstacle. The next steps are ours to determine.

**The rationale for repeal is evident and encouraging.**

National statistics indicate that abolishing CON regulations enhances access without instigating the hospital closures that opponents often feared could result from financial wrongdoing and outdated business practices unrelated to CON legislation. One study revealed that the growth of Ambulatory Surgical Centers (ASCs) surged by 44-47 percent statewide and reached up to 112 percent in rural regions post-repeal. Other research confirms that there are more facilities, not fewer beds. In South Carolina, we are already witnessing the changes:

– More than 80 ambulatory surgical centers have been licensed statewide.
– New investments are on the rise following the repeal.
– Updated regulations necessitate quality oversight, commitments to indigent care, and hospital transfer agreements, ensuring a balance between accountability and flexibility.

According to Mercatus forecasts, full repeal could elevate South Carolina’s hospital count from 82 to 116, including nine new rural hospitals. The evidence is evident, and the door has swung wide open.

**The current threat: indecision.**

Hospitals are aware of the impending changes. Many are already engaged in planning and constructing new initiatives before the 2027 deadline, establishing their positions before true competition manifests. If independent physicians and aligned investors delay action too long, they risk losing the opportunity. Hospitals might cease expansion after 2027, content with their extended reach. Once these new systems are established, they could dominate the forthcoming decade. This moment demands prompt action, not only from policymakers but also from physicians.

**We’ve experienced this before, and we know the outcome.**

South Carolina has learned through hard experience what transpires when opportunities are squandered. The V.C. Summer nuclear disaster illustrated that infrastructure endeavors, even those conceived with good intentions, can fail dramatically without clear leadership and accountability. In other states, partial CON repeals led to rapid expansion, but it was hospital networks, not independent physicians, who capitalized on the opportunity. Physicians in South Carolina have a limited chance to take charge. This necessitates stepping into roles as owners, founders, collaborators, and community-oriented innovators.

**This stance is not anti-hospital; it is pro-choice.**

Hospital systems are essential for complex care and emergencies. However, we also require diversity in how and where care is delivered. A stronger, more resilient system encompasses:

– Physician-led birthing centers
– Outpatient specialty hubs
– Micro-hospitals
– Integrated models that merge insurance, cash-pay, and direct employer contracts

When physicians spearhead these initiatives, the outcome is typically more affordable, responsive, and aligned with local needs.

**The next steps rest with us.**

Here is what I believe:

– Physicians must take action, especially those who have long identified the gaps in access, efficiency, and affordability. If we remain inactive, others will step in.
– Investors should collaborate with doctors, not systems, to co-create care models grounded in trust, autonomy, and clinical excellence.
– Policy leaders must safeguard choice by ensuring access in rural areas, demanding transparency, and resisting efforts to reintroduce regulatory obstacles stealthily.

**I co-founded the South Carolina Health Forum to support this initiative.**

We established the South Carolina Health Forum with a singular aim: to convene physicians, innovators, investors, and policymakers around a common mission: to cultivate a more pluralistic, accessible, and sustainable healthcare ecosystem in South Carolina.

The repeal of CON is merely the starting point. Now we require bold, physician-led initiatives to fulfill its promise.

**This moment will not endure indefinitely.**

On January 1, 2027, CON regulations for hospitals will vanish. That is the