Senators File Bills to Control Hospital Costs
Thursday, April 14, 2011
Members of a special Senate commission on hospital costs yesterday introduced a package of bills intended on making the state’s health care system cheaper and more effective.
The bills are intended on implementing the recommendations of what is formally known as Special Senate Commission to Study Cost Containment, Efficiency and Transparency in the Delivery of Quality Patient Care and Access by Hospitals. It was chaired by state Sen. Josh Miller, D-Warwick, Cranston.
“We’ve identified a number of inefficiencies in the health care system, and these bills are aimed at fixing them. One of the reasons health care costs keep climbing is that we have institutionalized inefficient practices. These bills are about changing the status quo so insurers, health care providers, state agencies and patients are able to make the health care choices that provide the right care without unnecessary costs,” Miller said.
GET THE LATEST BREAKING NEWS HERE -- SIGN UP FOR GOLOCAL FREE DAILY EBLASTLt. Gov. Elizabeth Roberts yesterday also issued a statement expressing her support for the legislation.
THE BILLS
Below is a list of the bills and an official description. Bill numbers were not available for all of them.
■ Payment Obligations and Transparency – This bill calls upon the Health Insurance Commissioner to annually establish a maximum payment that an insurer can pay for a particular service, set as a percentage of, or above, what Medicaid pays for that same service. Setting a maximum payment obligation for private payers to hospitals would change the negotiating dynamic instantaneously and equalize the balance of power. Any contract that includes a rate of payment for service that exceeds that level would have a public hearing wherein the parties would detail in a transparent and public forum why the higher payment is necessary.
■ Transition from Fee for Service – This bill would expand the powers and duties of the Health Insurance Commissioner to help steer the health care payment system away from the current fee-for-service payment method and toward payment methods that encourage doctors and patients to focus on overall health, and improve the efficiency, effectiveness and quality of healthcare delivery and decrease per capita health care expenditures. The fee-for-service system serves as an economic disincentive for facilities to improve care, since the fewer instances of services they provide, the less money they receive.
■ Community referrals for intoxicated individuals – This bill would eliminate a requirement that police bring intoxicated persons to emergency rooms for evaluation, instead allowing them to receive care in non-hospital settings with non-physician medical staff (still following clearly defined medical protocols) who can then determine the necessity of transferring a person to an emergency room. Community-based settings may offer more appropriate and less costly care for substance abuse patients.
■ Children Behavioral Health Referrals – This legislation would promote the use of community-based evaluations for a child’s mental health by requiring the “Kids Link” hotline operated by the Department of Children, Youth and Families to direct families with children in need of behavioral health evaluations to community-based settings unless a hospital emergency admission is voluntarily sought or deemed medically necessary. The goal of the bill is to preserve flexibility in the provision of emergency care while promoting community-based settings as the first option for behavioral care interventions to lower costs, improve outcomes and preserve limited emergency room resources.
■ Comprehensive Discharge Planning – This bill would require hospitals to participate in a high-quality comprehensive patient discharge planning and transitions improvement projects. Discharge planning has been shown to significantly decrease readmissions among patients. According to Department of Health data, over 1 in 5 patients is readmitted to a hospital within 30 days.
■ Primary Care Designation – This bill, which has been proposed by Lt. Gov. Elizabeth Roberts and endorsed by the commission, would require that individuals identify a primary care provider as a condition to receiving health insurance. Designating a primary care provider has been shown to greatly improve health outcomes. Studies indicate that improving and expanding primary care is perhaps the most impactful step toward containing health care costs.
■ 2011-S 0475 – Utilization Review, sponsored by Sen. Rhoda E. Perry (D-Dist. 3, Providence) – This bill allows physicians to delegate the flow of insurance paperwork to a qualified provider who can fill it out appropriately, allowing the primary doctor more time to meet and treat patients.
■ 2011-S 0348 – Provider Apologies, sponsored by Sen. James C. Sheehan (D-Dist. 36, North Kingstown, Narragansett) – This legislation would make expressions of sympathy, statements by a health care provider to a patient or to a patient’s family and any offers by a health care provider to undertake corrective action to assist the patient inadmissible as evidence of an admission of liability in any claim, action or proceeding against the provider. Studies indicate that sometimes, when a doctor makes a mistake that harms a patient, a genuine apology and admission of guilt can deter a lawsuit. Yet doctors’ fears of having such condolences and regrets admitted as evidence in a legal proceeding prevent them from making this simple, yet heartfelt, gesture.
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