• Connecticut AG Reports on the Effects of Health Care Provider Consolidation
  • April 28, 2014 | Authors: Leslie J. Levinson; Michaela ("Kayla") Tabela
  • Law Firms: Edwards Wildman Palmer LLP - New York Office ; Edwards Wildman Palmer LLP - Boston Office
  • On April 16, 2014, the Attorney General of Connecticut released a report on the potential impacts of horizontal mergers (hospital to hospital) and vertical provider acquisitions (hospital acquisition of physician practices) on pricing, quality, and access to health care within Connecticut. The report stems from an investigation conducted by the Attorney General’s Health Care Competition Working Group, which includes Assistant Attorneys General from the Government Program Fraud and Antitrust Department and members of the Attorney General’s Health Care Advocacy Unit, and is largely based on the results of a survey of Connecticut’s 29 general hospitals and responses from consumers.

    According to the report, one significant effect of consolidation is the hospitals’ ability to separately bill for the use of the office or facility and the physician’s professional fee. This is typically referred to as “provider-based billing” or “hospital-based billing,” and for consumers, can result in a separate “facility fee” charge on their bill. The Attorney General found that these separate fees can be surprising and financially burdensome to patients, especially if the patient had long standing relationship with his or her physician and previously received care at a roughly consistent cost.

    Several hospitals in the study acknowledged the need to provide more information around facility fees. In addition, the Connecticut Attorney General is proposing two bills: “An Act Concerning Hospital Facility Fees” and “An Act Concerning Notices of Acquisitions, Joint Ventures and Affiliations of Group Medical Practices.” The proposed legislation is described within the report.