Forum: State Sens. Fasano and Looney: Data Needed to Craft Appropriate Health Care Policy

By Sens Martin Looney; Len Fasano | New Haven Register (New Haven, CT), January 28, 2016 | Go to article overview

Forum: State Sens. Fasano and Looney: Data Needed to Craft Appropriate Health Care Policy


Sens Martin Looney; Len Fasano, New Haven Register (New Haven, CT)


For many years, Medicare has had a dual reimbursement system for hospitals, paying both a professional fee and a "facility fee" designed to reimburse the hospital for its unique infrastructure and overhead costs. While this made sense when hospitals were isolated, stand-alone facilities providing emergency, acute and surgical care, it makes less sense in the outpatient community care setting.

Facility fees are one of the negative consequences of the rapid acquisition of previously independent physician practices by hospitals. Once a practice becomes hospital-owned, the hospital may charge a facility fee on top of the traditional professional fee. Such fees often come as a surprise to unsuspecting patients who, despite getting the same care from the same community-based doctor, are suddenly subject to a new "facility fee." Such fees pose a significant financial burden on many consumers.

We established a bipartisan roundtable on hospitals and health care in 2014, which held a series of hearings. Based on those hearings, we introduced a number of bills that were then combined into SB 811 (now PA 15-146) to create comprehensive health care reform. With this legislation, Connecticut became the first state in the nation to ban certain facility fees. As of January 2017, hospital-owned practices will not be allowed to charge facility fees for evaluation and management services. We chose these types of services as a starting point because those services include the most common office visits that historically have been performed in a physician's office, and require no hospital support. The legislation also contains some of the most aggressive facility fee notice and reporting requirements in the nation. This will provide information that will assist us in crafting appropriate policy going forward.

The act also requires a comprehensive cost containment study, for which the vendor was recently chosen. …

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