Sens. Martin Looney and Len Fasano: New law protects and empowers patients [NHRegister]

August 3, 2015

New Haven Register Op-ed

By Sens. Martin M. Looney and Len Fasano

There’s a problem with health care in our state.

In local communities hospitals are merging and buying up independent physician practices, which have led to virtual monopolies. Health care monopolies reduce patient choice and lack the competition needed to keep pricing in check. Despite unsubstantiated claims that hospital and physician consolidation will lead to market efficiency, we are seeing significant price increases as a result.

This year, lawmakers passed a new bipartisan law that seeks to protect patients and providers from high costs and reduced access to care by restoring competition and balance to the Connecticut healthcare market.

The new law recognizes that a competitive market requires two things:
1) A critical mass of competitors each with significant market power, and,
2) Informed consumers who have accurate price and quality information and the ability to switch providers based on this information.

Public Act No. 15-146 implements the following policy changes to create this environment.

  • Transparency regarding price and quality. Transparency is a fundamental pillar of this legislation. The new law requires disclosure of actual contracted rates for the most common outpatient, inpatient, surgical and imaging procedures and will make that information available to the public to compare prices by provider, service and payer. If patients know how much a procedure costs upfront, they can make better decisions about their care.
  • Protects patients from surprise medical bills. Surprise medical bills can pop up in emergency situations or when a person is treated by a doctor who doesn’t accept their insurance (out-of-network provider) at a facility that does (in-network facility). Under this law, insured patients receiving emergency care will be billed only the in-network rate with no balance billing and out of network providers will be reimbursed at a reasonable rate.
  • Bans certain facility fees. Facility fees are extra costs tacked on to medical procedures and services at a hospital owned-facility. These additional charges are often surprising and burdensome when a physician’s practice is purchased by a hospital and pricing shoots up unexpectedly as a result of the added fee. Our new legislation bans facility fees for evaluation and management services at hospital-owned outpatient facilities, and it requires transparency in hospital reporting of which procedures incur facility fees and other details. For uninsured patients, the facility fee charged is capped at the Medicare rate. Under the law, patients will be notified when a practice is bought by a hospital and facility fees may be imposed.
  • Increases oversight of hospital consolidations. The legislation seeks to increase competition in the healthcare market by requiring that large hospital mergers and acquisitions be subject to appropriate market review in terms of costs and market power. The bill requires a market impact study for large consolidations and requires the Office of Health Care Access to justify the post-sale conditions it requires.
  • Creates a statewide health information exchange. This technology stores a patient’s complete medical record and gives full control of the information to the patient. The goal is to create ready access to patients’ complete records, reduce medical errors and unnecessary testing by having medical histories readily accessible, support public health monitoring, and promote medical research all while putting patients in control. The new law makes Connecticut the first state in the nation to define, prohibit and sanction “information blocking” (when larger providers use their medical records systems to block information from smaller providers).
  • Aims to help hospitals reduce costs. The legislation creates a cabinet to study cost containment models in other states and requires a study on price disparity. The legislation develops funding mechanisms to support community hospital capital improvements while also removing certain certificate of needs burdens and creating reporting efficiencies.

Taken together, the various parts of this law will create a framework for protecting and empowering patients, improving oversight of our hospital and health care system, and allowing for fair competition.

Martin M. Looney, D-New Haven, is president of the state Senate. Len Fasano, R-North Haven, is the state Senate minority leader.