The state Senate Thursday night passed an expansive bill aimed at influencing the state’s fast-changing health care landscape, a measure driven largely by Senate leaders’ concerns about large hospital systems gaining too much market power and driving up costs.
But with less than two weeks to go in the legislative session, the controversial proposal’s fate in the House is uncertain.
Hospital officials and others in the health care industry have been staunchly opposed to many elements of the proposal.
And Rep. Matt Ritter, D-Hartford, the House chair of the Public Health Committee, said the measure that passed the Senate 30 to 5 was unlikely to be the final version. House members and staffers were still reviewing the Senate’s 91-page bill – a revision of earlier proposals – Thursday afternoon. If the House passes a revised version of the bill, it would need to be approved by the Senate before the session ends June 3.
Still, Ritter, who has expressed reservations about some pieces in the bill in the past, said the divisions were not extreme.
“We’re not talking about 75 pages of disagreement,” he said, adding, “I’m very confident we’ll get to a good end product.”
Senate leaders’ concerns
The bill includes several broad goals: making it easier for patients to learn the cost of care, reining in certain hospital billing practices, creating a statewide system to allow patient records to be shared electronically and reshaping the rules for hospital sales. It also aims to reduce advantages large health systems can gain through consolidation and size.
Underlying it are concerns by Senate President Pro Tem Martin M. Looney, D-New Haven, and Senate Minority Leader Len Fasano, R-North Haven, about the speed of change in the state’s health care landscape.
Fasano, in particular, has been a vocal critic of the Yale New Haven Health System, which owns three hospitals and hundreds of physician practices – and which Fasano described as operating in a monopoly-like fashion in the New Haven area. He warned that without action, patients will soon have fewer choices of health care providers.
“If we don’t act now, if we don’t take a stand, if we don’t say we need to control the health care costs of the state of Connecticut constituents and put our bill out there, it will be too late,” Fasano said during the floor debate.
But the concepts in the bill have faced significant pushback from hospital officials, who have warned that many would run counter to national health care market trends and federal policies that encourage consolidation. Some have described them as threatening to move the state’s health care system backwards.
And Ritter, who said he supports many of the bill’s provisions, suggested that the conversation behind parts of the bill was driven by one hospital system that might not reflect conditions across the state.
“In Hartford, we have a different situation,” he said.
What the bill does
The measure that passed the Senate represented a consolidation of several bills proposed earlier in the session, but some aspects were scaled back or revised.
Under the bill, Connecticut would establish a statewide system to allow health care providers to share patients’ records electronically, as an earlier version called for. But this proposal would also allow the Department of Social Services – which has pushed for a different approach to handling the infrastructure for sharing medical records – to propose an alternative. Fasano has warned that the lack of a neutral, statewide system can give large health systems a business advantage, steering patients to other providers within the same system.
And instead of creating new bodies to analyze health care costs, market competition and price variation, as earlier versions would have done, the new proposal would give those responsibilities to the state’s existing health care cabinet.
Some of the measures have drawn praise from patient safety advocates and community groups concerned about consolidation.
The bill includes several provisions aimed at increasing transparency in health care costs and quality, requiring health care providers and insurers to give patients more information and calling for the state’s health insurance exchange to create a website with information on care cost and quality. The concept of transparency has generally received support, although health care providers have raised concerns about the practical details.
The bill also sets rules for situations in which patients receive emergency care from providers outside their insurer’s network or situations in which patients see providers outside the network without knowing it.
In addition, managed care companies would have to provide notice to members – in writing or through the Internet – if health care providers leave their network.
Facility fees – additional charges patients can face if they receive care at an outpatient facility owned by a hospital – also would be subject to more rules. Providers that charge facility fees would have to clearly identify them in billing statements and tell patients they might have paid less if they received services at a facility not owned by a hospital.
And any time a hospital purchases a medical office and plans to charge facility fees, the hospital would have to notify all patients served there in the past three years. In certain cases, facility fees would be barred under the bill.
The proposal would allow insurance companies to request that hospitals owned by the same company negotiate contracts separately, which could reduce the hospitals’ leverage.
Changes to approval process for hospital sales
Other parts of the bill involve hospital mergers or acquisitions, a topic that gained considerable attention last year when Tenet Healthcare, a national for-profit hospital chain, sought to buy five Connecticut hospitals. The Tenet deals ultimately fell through after the state regulator, the Office of Health Care Access, indicated it would require conditions that Tenet deemed unworkable.
The bill would add a focus on market competition to the approval process for sales. The regulator would be charged with considering, among other factors, whether consolidation in the market could reduce competition and raise prices. In addition, any purchaser of a hospital would have to submit a plan showing how services and staffing would be expected to change in the next five years.
But the Office of Health Care Access would also be required to weigh the burden of any conditions it imposes, and must provide more backup for them.
If a hospital is purchased by a hospital system or becomes for-profit, the purchaser would have to pay for an independent consultant to monitor compliance with the terms of the sale approval for three years.
Another piece of the bill more broadly addresses the approval – known as a certificate of need – that health care providers must obtain to open or close a facility or acquire certain medical equipment. The bill charges the Department of Public Health with identifying certificate of need requirements that are no longer necessary and streamlining the process in other situations.
The debate
Sen. Joe Markley, R-Southington, raised concerns about the process, noting that he and others had just hours to look at this version of the bill before it came to the floor.
“We all want to have good health care available for the people we represent, for all the people of Connecticut, at an affordable price,” he said. “In some ways, we want to hold onto the desirable aspects of the system as it exists, despite the fact that both the nature of the industry and the laws which have passed at the federal level are driving a kind of change that I feel we can’t resist.”
“Are we confident enough about what we have before us to give it our endorsement?” Markley asked.
Markley also detailed concerns raised by hospitals, insurers and businesses. Businesses worry that the exchange’s website with cost and quality information would be funded through an assessment on insurance plans – fees that get passed on to customers.
And while Markley said he favors transparency, he noted that the bill would require hospitals and insurers to provide a lot of notices to patients, which he said could have the effect of making people throw away all the paperwork rather than use it to make meaningful choices.
But Looney said the content of the bill had been extensively vetted in recent months.
And he called the bill “critically important,” dealing with a topic that can at times be a matter of life and death.
“It is something so vital to all of us because it’s not something we can opt in or opt out of,” he said.
Republicans Tony Hwang of Fairfield, Tony Guglielmo of Stafford, Toni Boucher of Wilton and Markley voted against the bill, as did Democrat Joan Hartley of Waterbury.