Rep. Matt Ritter
Rep. Matt Ritter

Legislators are closing in on a final version of a massive, controversial health care proposal that could have significant implications for hospitals, doctors, insurers and patients.

An earlier version of the bill already passed the Senate, where the Democratic and Republican leaders developed the measure to address their concerns about growing consolidation among hospitals and physician practices and its potential to drive up costs.

Rep. Matt Ritter, who chairs the Public Health Committee and has been working to revise the bill, said there are not huge disagreements among those working on the proposal, although he said there were a couple of areas in which policy discussions would be required.

“I think when we do finalize this bill and the governor signs it, I think people will write about Connecticut for having done some wonderful things for health care policy, transparency, all that stuff that we’ve been talking about as buzzwords,” Ritter, D-Hartford, said. “But at the same time, we are trying to accommodate reasonable concerns and make changes in a bipartisan way where we can.”

The Senate’s version of the bill aims to make it easier for patients to learn the cost of care, reins in certain hospital billing practices, creates a statewide system for patient records to be shared electronically, revises rules for hospital sales, and charges an existing state panel with examining health care costs and price variation. Many of the provisions were aimed at reducing the advantages large health systems can gain by acquiring hospitals and physician practices.

Hospitals have blasted it as a set of onerous regulations that would move the state backward and make it harder to implement federal health reforms. But unions and some other advocacy groups have praised it as a way to rein in spending, consolidation and other practices that they find concerning.

Ritter said that, in talks on revising the bill, the issues most mentioned among those with concerns are new requirements for hospital sales and a provision that would require hospital systems to negotiate insurance contracts separately for each of their hospitals if insurers request it.

Ritter said other major policy changes in the bill have not required much time in the revision talks. Those include new restrictions on “facility fees” – additional, sometimes costly, charges that patients can face if they get care at outpatient facilities owned by hospitals — and a plan to create a statewide system for health care providers to share patients’ medical records electronically.

The bill has been heavily lobbied since passing the Senate last week. Legislators have received email blasts on behalf of their local hospitals and from the Connecticut Hospital Association, which has warned that the bill includes “onerous new regulations” that would hurt patient care and make it harder to meet the goals of health reform.

The CEO of the Yale Medical Group sent a mass email Thursday urging faculty to contact their legislators, saying the bill “would have a devastating impact on our practice.”

The Yale New Haven Health System controls the most hospital beds in the state, and some legislators are worried about its growth.
The Yale New Haven Health System controls the most hospital beds in the state, and some legislators are worried about its growth. Paul Bass / New Haven Independent

Dr. Paul Taheri, who is also deputy dean for clinical affairs at the Yale School of Medicine, wrote that he was particularly concerned about a provision of the bill that requires insurers to adopt “site-neutral” payment policies — meaning that they would pay physician practices the same rate whether they are aligned with a hospital or not. Taheri wrote that clinical reimbursement represents half of the medical school’s revenue and the bill could reduce payments. Senate leaders have raised concerns that the price of care can rise when medical practices are acquired by hospitals, and view the provision as a way to rein in costs. Ritter said site-neutral payments is one area that negotiators would be looking at.

Others are trying to rally support for the bill. The Universal Health Care Foundation of Connecticut urged its supporters to contact Ritter to urge him to pass the bill, which the organization said “takes a huge step to reign in runaway health care costs and protect patients.”

If a revised version of the bill passes the House, the Senate would need to vote on it before it could go to Gov. Dannel P. Malloy. Ritter said the governor’s office was “heavily involved” in negotiations on the final version of the bill.

The bill the Senate passed was 91 pages and includes a wide range of changes.

Those include the state regulatory process for proposed hospital sales, which has been under scrutiny since the collapse of a plan by the national for-profit hospital chain Tenet Healthcare to buy five Connecticut hospitals. Tenet withdrew after the state regulator, the Office of Health Care Access, indicated it would impose conditions on the sale of Waterbury Hospital that Tenet deemed too burdensome.

Under the proposal, market competition would be added as a factor for regulators to consider, and potential purchasers would have to submit a plan showing how services and staffing would be expected to change in the next five years. The Office of Health Care Access would also have to weigh the burden of any conditions it places on the sale and provide backup to support them.

Sales that involve hospital systems or that turn a hospital into a for-profit would also face new requirements. The purchaser would have to pay for an independent consultant to monitor compliance with the sale terms for three years.

Other parts of the bill are focused on transparency. Those ideas have drawn praise from consumer advocates, although Sen. Joe Markley, R-Southington, warned during the Senate debate that patients might receive so much information they would ignore it all.

The transparency provisions would:

  • Require Connecticut’s health insurance exchange to create and maintain a website that people could use to find information on the cost and quality of care, based on information submitted by insurers and care providers. (Exchange officials have said they don’t have the funding or staff to do this.)
  • Require health care providers to notify patients scheduled for certain procedures or services whether they are in the patient’s insurer’s network. If the patient is uninsured or the provider is not in the network, the provider would have to notify the patient in writing of the charge for the care and the fact that the patient could face higher costs because the provider is out of network.
  • Require hospitals and outpatient surgical facilities to notify patients scheduled for certain procedures of quality information about the facility.
  • Require that hospitals and outpatient surgical centers, within two business days of scheduling a procedure or service, notify uninsured patients about what would be charged for their care. The facilities would have to notify insured patients about how much the care would cost under their insurer’s contract and provide information about how to find cost information from their insurer. Patients would also receive information on the facility’s quality and notification if the facility is not in their insurer’s network.
  • Prohibit contracts between insurers and health care providers that restrict the disclosure of information on their negotiated payment rates.
  • Require insurers to maintain websites, mobile apps and toll-free phone numbers that customers could use to get information on the cost of care.
  • Require insurance companies to disclose, when customers enroll, any coverage exclusions and restrictions, a description of any deductible or other out-of-pocket expenses that apply to prescription drugs, and the copayment or coinsurance level for all benefits. Insurers must also give customers a way to determine whether a drug is covered by the plan, what the customer would have to pay for it, whether it must be preauthorized or if other restrictions apply, and whether health care providers and hospitals are in the insurer’s network.
  • Require managed care companies to notify each member as soon as possible when any provider leaves the plan’s network.
  • Require providers that charge facility fees to tell patients they might have paid less if they had received care at a facility not owned by a hospital. If a hospital buys a medical office and plans to charge facility fees, patients would have to be given notice of it. And some facility fees would be banned.
  • Require providers who refer patients to an affiliated provider to notify the patient in writing of the affiliation, and let the patient know that he or she isn’t required to see that provider.

Dr. Rocco Orlando, senior vice president and chief medical officer for Hartford HealthCare, which includes five hospitals, expressed support for the idea of notifying patients about costs.

“We’re completely supporting that spirit of the bill,” he said.

But Orlando said the bill’s requirements that hospitals report information on the cost and volume of services would be costly for the hospitals to handle, driving up their costs without a clear benefit to patients. And Orlando questioned the value of notifying patients being referred to another provider if there is an affiliation between the two, noting that federal policy is pushing greater collaboration between providers.

Orlando also raised concerns about the new requirements for hospital sales, which he said could make it harder for distressed independent hospitals to find partners.

Arielle Levin Becker covered health care for The Connecticut Mirror. She previously worked for The Hartford Courant, most recently as its health reporter, and has also covered small towns, courts and education in Connecticut and New Jersey. She was a finalist in 2009 for the prestigious Livingston Award for Young Journalists, a recipient of a Knight Science Journalism Fellowship and the third-place winner in 2013 for an in-depth piece on caregivers from the National Association of Health Journalists. She is a 2004 graduate of Yale University.

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