Let’s Modernize How We Manage Our Health Care System

By Rosana Garcia

Hospital

Last week, we discussed why Connecticut should create an Office of Health Strategy, which is part of Senate Bill 795.

But there is a second, and just as important, part of that bill – modernizing how we oversee health care providers, including hospitals and ever-larger hospital systems in our state.  It addresses the Certificate of Need program, and the Office of Health Care Access.  Most importantly, it addresses how hospitals and health care providers can be more accountable to the communities they serve.

What is the Certificate of Need program?

Connecticut’s Certificate of Need (CON) Program is run by the Office of Health Care Access (OHCA).  When a health care provider proposes to purchase new equipment, open or close a facility, transfer ownership, and other changes, the provider must get a CON from OHCA before making that change.

Change is needed

In just the past year, L+M Hospital was taken over by Yale-New Haven Health System, and a for-profit company (Prospect Medical Holdings) bought Manchester, Rockville and Waterbury Hospitals.  Next month, there’s a CON hearing for Hartford HealthCare Corporation to acquire Charlotte Hungerford Hospital in Torrington.

And remember when Windham Community Hospital lost its Critical Care Unit – and the community spoke up, but no CON was required?

Where did these proposed changes come from?

Last year, Governor Malloy signed Executive Order 51 (and then revised it with Executive Order 51a), which created the Certificate of Need Task Force (we wrote about that in a few blogs).  After the Task Force completed its work, the governor then used the report from the group to propose changes to the CON Program, as well as OHCA’s duties.  These proposed changes make up the second part of Senate Bill 795.

So what’s proposed?

To address new challenges, Senate Bill 795 proposes changes to the CON Program.  The CON Program and OHCA are well positioned to address the growing market power of consolidating health care services.

Here are some highlights:

New goals for a new era:

  • Revising the goal of the program to:
    • Improve access and quality of health care services
    • Contain costs by making sure that the health care environment is competitive (in other words, more not less providers)
    • Implement a more comprehensive statewide planning effort aimed at promoting health equity and fulfilling unmet needs

More public and consumer voice in decisions:

  • Increasing public input and transparency of the CON process, including mandatory public hearings when a hospital is being acquired by a new owner

More providers, and more protections for Medicaid members:

  • Streamlining and updating the CON application process by
    • Removing barriers to market entry – making it easier for new health care providers to set up shop and offer services
    • Requiring that health care providers serve Connecticut residents on Medicaid

Less unnecessary rules, more protections for access to services:

  • Limiting regulation, but also preserving protections for access to services by underserved populations, which means
    • Eliminating review of most equipment acquisitions
    • Expanding review for closing and reducing services

More protections for people after a merger:

  • Expanding monitoring and oversight of health care mergers and acquisitions, especially after a change has been approved, including allowing OHCA to use civil penalties

Why do we need a change, anyway?

Since the CON Program was established in the 1970’s, our state’s health care landscape has changed dramatically.  The goal of the program was to limit the amount of health care services in the state.  It was once thought that overbuilding, expanding, or buying a lot of major medical equipment would drive up health care costs because there would be too many people offering the same services.

What we know now is that one of the major challenges in the health care landscape are the mergers and acquisitions of health care providers, which means that providers are consolidating into larger and larger behemoths, decreasing choice, and causing health care prices to rise.  Which means that health care is more expensive for all of us.

Two parts of a critical whole

Despite the fact that we’ve written about this bill in two separate parts, both parts of this bill rely on each other.  The changes to the CON program and to OHCA’s work on statewide health planning efforts are critical components of the Office of Health Strategy.

Connecticut needs both the Office of Health Strategy and a more modern, response CON program and Office of Health Care Access.

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