Connecticut House passes bill on hospital expansions, patient cost disclosures [Middletown Press]

June 1, 2015

Article as it appeared in the Middletown Press

HARTFORD >> The state House passed a wide-ranging hospital bill just before midnight Saturday that looks to inform patients about costs, provides a way for the smoother sharing of medical information and considers the market impact of hospital purchases.

The vote was 98 in favor, 43 against and 10 not voting.

The bill, which came together after hearings led by Senate President Pro Tem Martin Looney, D-New Haven, and Senate Minority Leader Len Fasano, R-North Haven, starting last fall, was amended again by the House in a bipartisan effort that continued on Saturday.

The amended bill will now go back to the Senate, where it is expected to be quickly adopted.

The Senate bill was changed considerably from its original iteration and the House made further changes.

It kept the ban on facility fees for simple office visits in outpatient community settings, but it delayed the effective date until Jan. 1, 2017.

It prevents surprise billing but only applies it to emergency services or when an insured patient is undergoing a procedure at an in-network facility and an out- of-network physician performs services without their knowledge.

The bill directs Access Health CT, the state’s health insurance exchange, to encourage tiered networks that are designed to lower costs as options for consumers.

Based on feedback from hospitals, the bill does not require them or surgical centers to provide pricing of common procedures to all patients they see. Instead, hospitals will only have to provide it for patients who ask for it.

The bill also simplified other notifications that were in the Senate bill.

Providers now only have to tell uninsured patients of the estimated charge for a procedure and warn them about likely higher charges when a provider is out of network.

It deleted a requirement that insurers pay community physicians the same for basic office visits regardless of employment by a hospital or an affiliation with a hospital. Looney said the hospitals explained that they have extra costs when teaching medical students.

The new version has the proposed health care cabinet study cost containment models in other states and make recommendations for policies and procedures in Connecticut.

Fasano thanked all those in the House who worked to amend the bill.

“I think this is going to be the beginning of a new era in controlling the cost of medical care,” he said. The minority leader said transparency will work to the benefit of patients and practitioners alike.

Looney was also happy that the massive bill was a bipartisan effort. He said the sharing of data between the hospitals and physicians will be an important progressive change as will controls on surprise billing and clear rules on hospital purchases.

The purchase of Waterbury Hospital by Prospect Medical Holdings, a California-based company, will proceed under the current certificate of need requirements, rather than the revised version.

The Waterbury area delegation felt this was important to make sure that deal goes through.

Waterbury has been looking for a suitor since 2012; purchase by Texas-based Tenet Healthcare fell through in December after it balked over the state’s regulatory requirements.

The bill includes similar requirements and the Office of Health Care Access would have to determine if the purchase would reduce competition and increase costs to consumers, while OCHA would have to justify any conditions it imposed. Large hospital systems and for-profit hospitals would also have to go through a market-impact review.

Expansions by other large hospitals in the country have been reined in through court action.

Both Looney and Fasano have been highly critical of the reach of the Yale New Haven Hospital System, which they said was squeezing out independent physician practices. While the Affordable Care Act encourages cooperation, it does not mandate consolidation into large systems, they argued.

Marna Borgstrom, the president and CEO of the Yale New Haven Health System, has said that 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 in an earlier interview.

State Rep. Matt Ritter, D-Hartford, said the bill makes clear what the rules are on the purchase of hospitals, rather than allowing the Office of Health Care Access too much flexibility.

He did not think it would prevent strained hospitals from finding buyers, but if it did, lawmakers could reconsider the regulations.

State Rep. Patricia Dillon, D-New Haven, said patients and staff at Yale-New Haven were distressed by the “rhetoric” directed at Y-NH and she asked if the hospital would be treated fairly by regulators.

Ritter said he assumed the state’s regulatory review process treats everyone fairly.

The bill also provides a path to a Health Information System that is aimed at the easy affordable sharing of medical data between hospitals and physician practices.

There was much praise for the work done by Ritter, co-chairman of the Public Health Committee, and state Rep. Prasad Srinivasan, R-Glastonbury, the only physician in the General Assembly, in making the complex, large bill understandable to House members and agreeing to changes as requested by Republicans.

Several lawmakers felt hospitals were being unfairly criticized.

State Rep. Terri Wood, R-Darien, said it was “one more slam” against hospitals that have seen their profits cut and taxes on them increased.

State Rep. Laura Devlin, R-Fairfield, said hospitals have been forced into new models of delivering care and maybe the state should back off on regulation given how important they are as economic drivers.

State Rep. Jason Perillo, R-Shelton, said he “abhorred” the bill before it was amended by the House. “This is a different bill today. It is a better bill,” he said.

State Rep. Craig Miner, R-Fairfield, was happy with the emphasis on consumer interests as the health care system goes through this transition.

Perillo and Miner were among the Republicans voting for it.