Connecticut Senate adopts major health care changes [New Haven Register]

May 22, 2015

New Haven Register
The state Senate overwhelmingly adopted major health care changes Thursday in a bipartisan vote that reins in some facility fees, looks to development of a health information exchange to guarantee the sharing of patient data and aims to keep private physician practices in business.

State Senate President Martin M. Looney, D-New Haven, and state Senate Minority Leader Len Fasano, R-North Haven, worked for a year on the bill, holding hearings starting last fall and revising it considerably from its original form as developed at the beginning of the session.

The vote was 30 in favor, 5 against the bill and one absent.

Using Greater New Haven as an example, Fasano said there is only one independent neurologist office, no independent oncologists and a handful of cardiologists whose practices have not been bought or affiliated with the Yale New Haven Health System, Fasano said the consolidation of practices drives up prices, citing the cost of chemotheraphy going from $2,500 to $12,500 in one example. “That’s a concern for all of us,” he said.

The minority leader said the big hospital networks will say that the doctors are asking to come into their networks, but Fasano said that isn’t what doctors are telling them given the emails, letters and testimony they have received.

He said the consolidation of practices, with the Yale New Haven Hospital System and Hartford Healthcare the largest, drives up costs.

“It is not a free marketplace,” Fasano said. He called health care access one of the core functions of government.

“If we don’t act now, a year from now it is all done,” Fasano said of further consolidation within Connecticut.
He accused some networks of using their operating system “for competitive advantage to drive others out.”

Fasano said the bill “is not perfect, but it is really, really good. It is the right course.”

Marna Borgstrom, the president and CEO of the Yale New Haven Health System, in an earlier interview, said having a network of doctors and hospitals under one umbrella is the best way to deliver efficient care and rein in the costs of the chronic users of healthcare.

“When we bring people on to the common system, when they work to create common standards of care, you can also demonstrably produce better care, better outcomes, better coordination of care,” she said.

Fasano said they listened to the industry and changed many elements over the couse of the last few months.

Fasano acknowledged that when the state tried to put a health information exchange in place previously, spending $7 million, “we came up with nothing.”

He blamed this on the state not realizing the significance of such a network and it concentrated on other aspects of the Affordable Care Act.

This time, they will put out a request for proposals to contract with an existing system or, with the advice of the Health Information Advisory Committee, the Department of Social Services will submit an alternative plan.

Fasano and Looney have often praised the system now in use in Rhode Island. They have said access to this information is essential to good health care delivery.

Fasano said one could be up and running within a year with hospitals and labs connected; within two years providers could apply to connect.

Both leaders have criticized the Epic system used by Y-NH and which Hartford plans to implement because outside users can’t input or download data to their own systems.

He said this kind of system steers patients away from the private market. He said lawmakers passed a law forbidding steering to auto repair shops and they should forbid steering through health care records.

Fasano said small- and some medium-sized doctor offices are leaving the state in droves. He said if one system controls the electronic medical records and surgical groups, they will control everything.

The minority leader said what is happening in New Haven County will happen throughout the state if Connecticut doesn’t move now.

“People should have a choice. If you don’t have a choice in your health care and you have one or two providers in this state, we have done a disservice to the state of Connecticut,” Fasano said,
In an earlier interview, Daniel Barchi, chief information officer for Yale New Haven Health System and the Yale School of Medicine, said none of the electronic medical record systems are good at sharing patient data between systems, as opposed to viewing records.

Looney said outside the chamber that there were complaints that not enough people had been involved in development of the bill. He countered that by listing the dozens of stakeholders that had been consulted throughout the process.

Both leaders praised Dina Berlyn, Looney’s counsel, and Jennifer Macierowski, Fasano’s counsel, both of whom worked on the health care legislation.

“To hear from some corners outside this chamber that there hasn’t been sufficient consultation to me reflects either a very poor memory or else absolute disingenuousness or a scurrilous effort to disguise what the true facts are,” Looney said.

He listed many of the changes:
Originally, facility fees would have been banned in a variety of outpatient services and capped for outpatient fees at $100. It now bans fees for evaluations and simple office visits in community-based physician offices where such fees traditionally were never charged.

The bill also now protects against multiple copays for facility fees. There will also be annual facility fee reports, such as where they were charged, the number of visits subject to these fees and the amounts paid by insurers.

The bill originally would have cost the University of Connecticut Health Center tens of millions of dollars. The loss of revenue is now less than $2 million, but it also saves the state the same amount, for a zero sum result.

Originally, it would have required that insurers reimburse independent physicians at the same rate as hospital-employed doctors, but the bill only addresses basic office visits and not until July 2016. Over the next year there will be a study of price disparities to determine the factors driving up costs.

Mandates against surprise billing have been limited.

Also, the bill allows insurers to offer tiered networks that incentivize value-based care to those who want do so, but it doesn’t mandate it.

On the Health Information Exchange, it does not require hospitals to invest in interfaces. It simply requires them to use the functions and software available within their system to help the exchange of patient records. They can’t block an exchange when it is possible.

Knowingly using electronic health record systemsto steer patients to affiliated providers would be an unfair trade practice.

There is an emphasis on transparency with insurers and hospitals reporting prices charged for the most common procedures.

Insurers can also ask hospitals within a network negotiate separately.

Looney said on hospital sales and acquistions, the bill augments the existing certificate of need process to look at “market consolidation and the likely impact of the sale on prices.”