Legislature serves up health-care solutions

DENVER — Health-care costs continue to rise, triggering acute pains not only in consumers’ wallets but in Colorado’s state budgets as well. Again this legislative session, lawmakers are seeking ways to control the bleeding.

As a portion of the state’s budget, expenses related to health care climbed from 19 percent in fiscal year 2000 to 35 percent for this fiscal year.

“Certainly we know health-care costs are exorbitant,” said Kevin Unger, president and chief executive of Poudre Valley Hospital in Fort Collins and Medical Center of the Rockies in Loveland, “A lot of times when we pass on discounts, it doesn’t hit the consumer. There are a lot of people in the food chain. Because we’re providing care 24-7, there are costs there just in case someone needs it.”

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Speaking in Greeley in January at BizWest’s annual Economic Forecast event, Unger said new laws at both the federal and state levels are changing the way medicine is practiced. Health-care exchanges likely will extend over state lines, he said, and legislation will force greater transparency in pricing with the goal of encouraging patients to shop for the best value when seeking treatment.

“When hospitals post prices on their websites, that’s a step in the right direction,” he said, although “the tricky part is that the price paid depends on the patient’s insurance company.”

Attempts to rein in costs resulted in a mixed bag during last year’s session of Colorado’s General Assembly, Unger said, pointing to lawmakers’ unsuccessful attempts to address high insurance costs for state employees.

He also noted passage of Senate Bill 267, the voluminous provisions of which included reversing a proposed budget move that would have reduced the hospital provider fee by $264 million in an effort to balance the budget. The bill reclassified that fee, which is assessed on hospital stays, as an enterprise fund to pull it out from under a constitutional revenue cap set by the Taxpayer’s Bill of Rights. The change lets the state address several needs including shoring up rural hospitals.

In the 2018 session, lawmakers are tackling several other areas where costs could be trimmed.

Free-standing emergency rooms: Lawmakers have been flooded with consumer complaints in recent years about receiving big bills for minor treatments at free-standing ERs, which have tripled in number in the state since 2014 and can charge as much as 13 times more for care than at urgent-care centers, according to a 2016 study by the Center for Improving Value in Health Care.

SB 146, sponsored by Sens. John Kefalas, D-Fort Collins, and Jim Smallwood, R-Parker, would require health-care facilities not attached to hospitals to give patients a written disclosure that they’re an emergency facility, not an urgent-care or primary-care center. Patients also would get a list of fees and the ER’s prices for treating the 25 most common conditions. A clause requiring the ERs to provide a list of which types of health insurance they accept was removed.

Opponents noted that the term “non-emergency” on the fee schedule could lead insurers to deny payment of claims, and that the disclosures could conflict with provisions of the federal Emergency Medical Treatment and Active Labor Act, which bars health-care facilities from doing anything that could push away patients seeking emergency treatment.

The bill was carried in the House of Representatives by Reps. Lang Sias, R-Arvada, and Jonathan Singer, D-Longmont.

Over-prescribing: SB 22, introduced by Sens. Jack Tate, R-Parker, and Irene Aguilar, D-Denver, and Reps. Brittany Petterson and Chris Kennedy, both D-Lakewood, would restrict the number of pills a health-care provider can prescribe to a seven-day supply, in hopes of preventing patients from accumulating unused pills that could be found and abused by others. Exceptions would include medications for patients who have chronic pain that lasts for three months or longer. Opponents argue that the restriction is unfair to rural patients who have to travel long distances to a pharmacy.

Privacy and disclosure: House Bill 1207 would require hospitals to disclose financial information to the state’s Department of Health Care Policy and Financing, to be compiled into an annual report. HB 1128 would update requirements for notification of data breaches and outline a disposal process for paper and electronic documents.

Opioid epidemic: Unger predicted in January that the General Assembly would address treatment and prevention of opioid addiction, acting on recommendation of a study committee that met last summer. The results include HB 1007, which would require health benefit plans to restrict certain opioid prescriptions in ways similar to the provisions of SB 22; HB 1136, which would make substance-abuse disorder services eligible for the state’s Medicaid program; SB 24, which would provide $2.5 million in grants for substance-abuse providers in underserved areas; and SB 40, which would make liability protection available to facilities that provide clean syringes. A permanent committee of lawmakers would monitor the opioid-addiction issue and recommend changes if HB 1003 were passed.

Newborn screening: HB 1006 would modernize state law regarding screening of newborn babies leaving hospitals or birthing centers. The facilities would pay a $4 fee for each baby to the state public health department to enable it to establish a program for early detection of such congenital conditions as impaired hearing.

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See additional health care stories from BizWest’s March 2018 edition:

BCH integrates behavioral, physical health

Good Sam treatment targets liver cancer

Community colleges seek to add BSN degree

Health-care pricing remains opaque