Legislators advocated for community hospitals, especially Pennsylvania's healthcare deserts, during a hearing at Lackawanna College.
Pennsylvania's Senate and House Democratic Policy Committees debated how to make hospitals more efficient and accessible at the hearing held Tuesday in Scranton.
They focused on the state’s Health Professional Shortage Areas (HPSAs), which are geographic areas, populations, or facilities without enough providers, according to the Health Resources & Services Administration.
Rep. Dan Williams from Chester County criticized the consolidation of hospitals through mergers and acquisitions. He argued it strips resources from smaller community hospitals.
33 hospitals closed in Pennsylvania over the last 20 years, including 15 over the last five. That data comes from the Pennsylvania Health Access Network (PHAN), a healthcare consumer-rights organization.
“When you consider 33 closures, we’re talking about business models that are running the healthcare system and we haven’t yet mentioned the word ‘greed.’ So, the idea to continue to do what we’ve always done seems to me somewhat pointless,” said Williams. “Because unless we do an overhaul of the system, change the paradigm, we’ll be back at these tables for decades.”
PHAN’s Patrick Keenan advised legislators at the hearing. He said lawmakers cannot change healthcare’s corporate structure, but they can finance community hospitals to foster economic competition. He is PHAN’s director of Consumer Protections and Policy.
“I’m really terrified because you can’t unscramble the egg, to be really clear. Like, this is what it is,” said Keenan. “So, I think the number one cause we got to have is this comprehensive approach that starts looking at those local dynamics, right? That starts looking at not only the capacity within the hospital, but also the cost. And what I’m really worried about, what we see in so many of these places where you don’t have any kind of competition, that suddenly means that you can charge whatever you want for care.”
Keenan argued opening more neighborhood centers fosters competition between hospitals and consumer choice, which would reduce healthcare costs. He criticized insurance companies that manage hospitals.
“We’re here to…talk about health deserts, but some of the people who are kind of involved in this picture are not only controlling the hospitals, but they’re controlling the insurance product that ultimately sets the rates that you as a patient pay,” said Keenan. “...The best way of saying this is that it gets back to the metaphor of a company store: you set the wages, you set the product, you set the price and then [the employee] is consistently in debt.”
Sen. Katie Muth of Berks, Chester and Montgomery counties added legislators cannot see which insurance or private equity companies own which hospitals and healthcare systems. She said hospital finances and leadership should be public information.
“Are these hospitals who claim to be saviors…are they really who they say they are,” said Muth.
Hidden fees? What’s the price of care?
Legislators also pushed to make healthcare prices more transparent to limit unexpected fees and varying prices between hospitals and healthcare networks. Keenan said Pennsylvania does not meet transparency requirements.
“Pennsylvania is in the bottom third, we’re actually in the bottom twelve of states that comply with the federal regulations. And so, we really need a legislative effort here in Pennsylvania to mandate simple compliance with what’s already the rule at the federal level,” said Keenan.
Pennsylvania Senate Bill 83 would require hospitals to be transparent with patients on healthcare costs and increased scrutiny from the state’s Department of Health when a hospital or hospital system is purchased. Sen. Muth introduced that bill.
Keenan said SB 83 and similar legislation would make hospitals more sustainable. It would require them to be organized and file all medical records, revenues and costs of care in the same place. Pennsylvania’s hospital systems are not required to use a central hub for their data, said Keenan.
“There’s no one place where you can get a clear picture. And so, I would say transparency is the best kind of accountability that we could bring to this. To have real clear objective data that not only talks about the hospital experience, but also the patient experience,” said Keenan.
Legislators said transparency would give patients more control over their healthcare and finances. According toPHAN, only 5 percent of Pennsylvania’s hospitals are fully compliant with pricing transparency and financial assistance laws.
