Democrat Ted Kennedy, Jr. and Republican Bruce H. Wilson, Jr., who are now vying for the state Senate 12th District seat, may be at odds over how campaign contributions work, but they are on the same page when it comes to key issues patients face as hospitals acquire doctors’ practices.
What their views on other topics may be will be learned when Kennedy and Wilson meet for their first debate Tuesday, Oct. 14 in the Guilford High School Auditorium. The debate, which begins at 6:30 p.m., is free and open to the public.
The 12th District includes the towns of Branford, North Branford, Guilford, Madison, Killingworth and Durham.
Both candidates are extremely knowledgeable about the medical industry. Kennedy is a health care attorney and long-time disability advocate.
Wilson led a medical products business and knows well the economics and philosophy of health care. Each said he was prepared to assess, monitor and develop new laws as rapid changes in the state’s health care industry unfold.
Wilson observed that this issue presents “one of those rare opportunities to say that the Republicans and the Democrats are able to recognize the same problem and work together towards a solution for the benefit of everyone.”
On October 1, two new laws that both candidates favor took effect. Both center on hospital absorption of medical practices.The Connecticut legislature passed the two laws with near unanimity in a bi-partisan vote.
One law requires that Connecticut hospitals or health systems notify individual patients and the public of fees for outpatient services provided at hospital-based facilities. Typically they are way higher than the same tests given at a private medical practice. As a result of the new law, hospitals or a hospital-based facility must notify patients by publicly and prominently displaying a sign indicating “it charges a facility fee and that it is marketing itself as a hospital-based facility.”
A second new law requires parties to any transaction resulting in a material change to a group medical practice to notify the Attorney General at least 30 days prior to the effective date of the transaction. That gives the Attorney General’s office time to weigh in on the consequences. The laws are the first, but likely not the last, in fast-changing medical profession.
When doctors’ practices are absorbed by local hospitals, patients have had to pay more for a service at a hospital than they would at a doctor’s office, a fact the patient may not understand.
That’s one issue. Another issue is that without knowing it patients are forced to choose between their doctor and a hospital of their choice. If they want the hospital, they may lose the doctor because they doctor may no longer have privileges at that hospital.
Wilson Discusses Competition For Patients
File Photo
In a previous interview, Wilson said that while the free market is at work when hospitals acquire private practices, a reality that has accelerated under the Affordable Care Act, the competition for patients has become more intense.
“One of the ways a hospital can compete for patients is to control the physicians the patients go to. So if you own a big practice in Wallingford, you may have patients that could go to Hartford Hospital or they might come to Yale. If Yale buys your practice, then you are going to go to Yale and Hartford Hospital can’t get you as a patient. So it is a way of locking in patients to a particular provider.
“Now the patient can say I like Hartford Hospital better but the physician would not have privileges there. So the doctor would say you have to go to another doctor. Most of us are going to stick with our primary care physicians. We identify as patients with our primary care physicians and not with the hospital he or she is affiliated with. So I think most people are more concerned with their doctor and less concerned with their hospital. They don’t recognize the choice or lack of choice they have.”
In a separate interview Kennedy agreed that patients are unaware of many of these changes.
Kennedy On What Patients Know And Don’t Know
“Why do you think all these shoreline medical centers are sprouting up?” he asked.
File Photo
“Because everyone on the shoreline has insurance. And the hospitals want to be able to capture that. They want to send you to their hospital, and not have the risk of where patients go. So the doctors are now the huge referring source. If the doctor is employed at Yale, and they practice at the Shoreline Medical Center in Guilford, guess who is going to get that referral?” Same thing if the doctor is employed at Middlesex Hospital,” Kennedy said.
“Hospitals want to control the doctors because the doctors are interfacing with patients and referring the patient to the specialist and to the hospital. That’s the economic driver.”
Cost of Services Depends On Location
Then there’s the location, location, location issue.
It’s the acronym called “Site of Service Differential “or SSD. Both Wilson and Kennedy referred to SSD as the ability of a hospital to charge more for the exact same procedure done in a doctor’s office.
“Now imagine if the hospital bought the physicians’ office and the physician is an employee of the hospital and the physician says you need to have your x‑ray done at the hospital. What was $150 for an x‑ray at the doctor’s office is now $1,500 at the hospital, “Wilson said. “Somebody has to pay for that. It isn’t free. Whether it is an extra amount of money from your pocket as the patient or the collective we all pay through our insurance premiums, somebody is paying for it,” Wilson said.
“Or you are told it comes from your co-pay and now that is directly out of your pocket.
“So is that fair? I respect that the hospitals are simply working in a free market environment but as they begin to establish a monopoly in a geographical region it can’t be an entirely free market,” Wilson added.
Kennedy said patients will also be notified of these changes. He said “because the government pays for over 50 percent of all health bills, both Medicare and Medicaid, in the U.S. I think the government has an interest in making sure they are getting the best value for their money. And in the last 5 to 10 years there has been a huge shift in the employment of physicians. We are now at the point where 65 to 70 percent are employed by hospitals. That was not the case even five or ten years ago,” he said.
“If you need an MRI and you wander into Yale-New Haven hospital, the procedure might cost $2,000. If you go to a free standing center, say Temple Medical, around the corner, it might cost you $650. It is the same machine and often the same radiologists. It doesn’t make any sense,” Kennedy said. “Why are hospitals buying these free standing imaging centers all over the state and all over the country? Because they know they can charge more. Because if you get an MRI at the Shoreline Medical Center you are paying as if you were getting it at Yale New Haven Hospital,” he added.
###
