Navigating the shifting certificate of need landscape: What healthcare leaders need to know
Historically, CON laws were implemented to regulate healthcare facility development, control costs, and prevent unnecessary duplication of services. But today, many states — including Florida, South Carolina, Tennessee, Georgia, West Virginia, Vermont, and Connecticut — have either significantly reformed or are actively reconsidering their CON programs.
The result is a nationwide trend toward deregulation that is already reshaping how healthcare systems expand, compete, and invest in physical infrastructure.
National trends driving market transformation
Several consistent themes are emerging as states loosen or repeal CON requirements:
Full or partial CON repeals are clearing the way for new market entrants and increased competition.
Accelerated facility development, particularly in high-growth and suburban regions.
Escalating real estate costs as health systems and providers rush to secure strategic locations.
Evolution of delivery models, with a growing focus on outpatient care, ambulatory surgery centers (ASCs), and specialized facilities closer to patients.
For leading health systems, these shifts present an opportunity to expand access and modernize service delivery. But for others, particularly in rural or highly saturated markets, the threat of being outpaced — or outspent — is very real.
Strategic approaches to navigating CON reform
To maintain a competitive edge, healthcare providers must act decisively. That means reassessing growth strategies, tightening execution, and rethinking how real estate supports long-term organizational goals. Based on trends across multiple markets, four strategies are emerging as critical:
1. Market planning and opportunity analysis
Use predictive analytics, demographic trends, and competitive intelligence to identify growth markets and underserved populations. Health systems that move quickly to assess and prioritize expansion zones will be positioned to lead.
2. Real estate acquisition and adaptive controls
Secure high-priority sites before demand drives up costs. In parallel, evaluate ownership models, ground leases, and control structures — such as purchase options and restrictive covenants — to ensure long-term flexibility and protection.
3. Prototype facility development
Scalable, standardized facility designs allow providers to quickly deploy urgent care, imaging centers, ASCs, and other outpatient assets. With streamlined designs and pre-approved plans, systems can reduce time to market while maintaining operational consistency.
4. Strategic capital planning and partnerships
Rising interest rates and capital constraints are prompting systems to reexamine their funding models. Third-party partnerships, developer relationships, and creative joint ventures can reduce financial risk and enhance speed to execution.
Preparing for the future
The shift in CON policy is no longer theoretical. It is happening now, and healthcare leaders must be ready. Strategic market assessments, sound real estate planning, and agile capital deployment will define the next wave of growth in healthcare.
Is your health system positioned to adapt?
To explore this topic further, download our white paper: ' Certificate of Need (CON): The Evolving Landscape – Is Your Health System Prepared? '
Additionally, access our best practice guide for actionable insights into facility development, market planning, and real estate acquisition: ' The Impact of Evolving CON Legislation on Healthcare Systems' Real Estate Strategies '
Or connect with our team to discuss how these reforms may impact your market and your real estate strategy.
Realty Trust Group, LLC (RTG) is a national leader in providing comprehensive real estate solutions for the healthcare industry. Since 1998, we have worked alongside healthcare leaders to leverage real estate as a strategic asset helping to save money, manage risks, create physician alignment, and increase market share. For more information about RTG, visit realtytrustgroup.com, Facebook, and LinkedIn, or call 865-521-0630.
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Navigating the shifting certificate of need landscape: What healthcare leaders need to know
As certificate of need (CON) laws continue to evolve across the United States, healthcare executives are facing a regulatory landscape that is in rapid flux. These changes are opening the door to new growth opportunities — but also intensifying competition, escalating real estate costs, and increasing pressure on strategic planning. Historically, CON laws were implemented to regulate healthcare facility development, control costs, and prevent unnecessary duplication of services. But today, many states — including Florida, South Carolina, Tennessee, Georgia, West Virginia, Vermont, and Connecticut — have either significantly reformed or are actively reconsidering their CON programs. The result is a nationwide trend toward deregulation that is already reshaping how healthcare systems expand, compete, and invest in physical infrastructure. National trends driving market transformation Several consistent themes are emerging as states loosen or repeal CON requirements: Full or partial CON repeals are clearing the way for new market entrants and increased competition. Accelerated facility development, particularly in high-growth and suburban regions. Escalating real estate costs as health systems and providers rush to secure strategic locations. Evolution of delivery models, with a growing focus on outpatient care, ambulatory surgery centers (ASCs), and specialized facilities closer to patients. For leading health systems, these shifts present an opportunity to expand access and modernize service delivery. But for others, particularly in rural or highly saturated markets, the threat of being outpaced — or outspent — is very real. Strategic approaches to navigating CON reform To maintain a competitive edge, healthcare providers must act decisively. That means reassessing growth strategies, tightening execution, and rethinking how real estate supports long-term organizational goals. Based on trends across multiple markets, four strategies are emerging as critical: 1. Market planning and opportunity analysis Use predictive analytics, demographic trends, and competitive intelligence to identify growth markets and underserved populations. Health systems that move quickly to assess and prioritize expansion zones will be positioned to lead. 2. Real estate acquisition and adaptive controls Secure high-priority sites before demand drives up costs. In parallel, evaluate ownership models, ground leases, and control structures — such as purchase options and restrictive covenants — to ensure long-term flexibility and protection. 3. Prototype facility development Scalable, standardized facility designs allow providers to quickly deploy urgent care, imaging centers, ASCs, and other outpatient assets. With streamlined designs and pre-approved plans, systems can reduce time to market while maintaining operational consistency. 4. Strategic capital planning and partnerships Rising interest rates and capital constraints are prompting systems to reexamine their funding models. Third-party partnerships, developer relationships, and creative joint ventures can reduce financial risk and enhance speed to execution. Preparing for the future The shift in CON policy is no longer theoretical. It is happening now, and healthcare leaders must be ready. Strategic market assessments, sound real estate planning, and agile capital deployment will define the next wave of growth in healthcare. Is your health system positioned to adapt? To explore this topic further, download our white paper: ' Certificate of Need (CON): The Evolving Landscape – Is Your Health System Prepared? ' Additionally, access our best practice guide for actionable insights into facility development, market planning, and real estate acquisition: ' The Impact of Evolving CON Legislation on Healthcare Systems' Real Estate Strategies ' Or connect with our team to discuss how these reforms may impact your market and your real estate strategy. Realty Trust Group, LLC (RTG) is a national leader in providing comprehensive real estate solutions for the healthcare industry. Since 1998, we have worked alongside healthcare leaders to leverage real estate as a strategic asset helping to save money, manage risks, create physician alignment, and increase market share. For more information about RTG, visit Facebook, and LinkedIn, or call 865-521-0630.
