Many in health care say joining larger systems is key to small hospitals’ survival. But some policymakers are wary of the trend, saying it can raise prices without necessarily improving quality. And leaders of the state’s few remaining independent community hospitals say their organizations are facing stresses that could jeopardize their viability.
From an ailing state budget to potential changes in the way the state oversees what services hospitals deliver, state lawmakers will be dealing with a variety of health-related issues during the upcoming legislative session. Here are five to keep an eye on.
The recommendations are aimed at curbing health care costs, but some members of the state’s Health Care Cabinet wondered if they will be too expensive. Another key recommendation faces opposition from one of the agencies that would be charged with implementing it.
The proposal grew out of work by the Senate’s top Democrat and Republican to address the changing health care landscape, including the trend toward doctors giving up owning their own practices to work for hospital systems or large group practices.
The amount paid for a cesarean childbirth and newborn care in the hospital, for example, averaged $20,107 in Connecticut – 26 percent above the national average of $15,917, according to data based on claims paid by three private insurance companies. But costs also ranged within the state, averaging $20,773 in the Bridgeport area, $19,715 in the Hartford region, and $18,915 in and around New Haven.
The Senate passed a proposal Wednesday to limit non-compete clauses in physician contracts and broaden the types of organizations that can employ doctors, a measure intended to address concerns among Senate leaders about doctors’ ability to remain in independent practice or return to it after joining a hospital system.
Middlesex Hospital has reached a settlement with state regulators that will allow it to put a new piece of cancer treatment equipment in its shoreline clinic in Westbrook – a proposal that drew opposition from Yale-New Haven Hospital and sparked questions about the intersection of state regulation and health care competition.
The task force, created by a February executive order, will review the state’s certificate of need process, which governs whether hospitals, nursing homes, residential care facilities and certain physician organizations can open certain facilities, acquire certain equipment, change ownership or eliminate services.
As hospital officials describe it, state policy is pushing them in two opposing directions. Higher state taxes and funding cuts have added to the factors pushing independent community hospitals to join larger health systems, they say. But at the same time, legislators concerned about the growth of large health systems have been pushing for new restrictions on changes in hospital ownership, which hospital officials say makes it harder for them to adapt.
Charlotte Hungerford Hospital in Torrington has become the latest independent hospital to begin the process of joining a larger health system – in this case, Hartford HealthCare, the parent company of five Connecticut hospitals.
As hospitals join larger systems and critics worry about access to care, a key legislator said the time is ripe for lawmakers to revisit the way the state regulates major changes in health care. But it’s not yet clear what shape such changes will take – or whether they would leave the state with more regulation or less, a sign of sharply differing views on its role.
Zack Cooper recently co-authored a high-profile paper linking higher hospital prices to market power. He advocates for strong antitrust enforcement when it comes to health care consolidation. But when his father was very sick, Cooper told state policymakers, he wanted him to go to a large medical center that treated a high volume of patients with the same condition. “There’s this tension,” he said.
What began with a plan to replace an aging piece of medical equipment has turned into a dispute over the delivery of cancer care along Connecticut’s affluent shoreline. And at a time when policymakers have expressed worries about preserving competition in the state’s fast-consolidating health care market, one side has suggested the case highlights questions about competition – and the way state regulation can limit it.
As part of a major new health care law, a state board has until December to recommend ways to address rising health care costs and market changes.
Lisa Freeman recently tried an experiment: Before having a medical diagnostic test, she tried to figure out what it would cost. “It took no less than five phone calls, and I still never got to the end of the thing,” she said. A major transparency law intended to change that is taking effect this year. How will it work in practice? Health care providers say it might be bumpy at first.