Legislature May Force Hospitals to Disclose Conflicts of Interest in Patient Referrals

AUGUSTA – The Health and Human Services Committee on Tuesday held a work session on legislation that would force Maine’s hospitals to disclose conflicts of interest and other pertinent information to patients when referring them to affiliated nursing homes or rehabilitation facilities.

LD 447, An Act to Increase Patient Choice in Health Care Facilities and Health Care Settings, was introduced by Sen. John L Patrick( (D-Rumford) and would require hospitals to declare conflicts of interest by using statements such as “affiliated with hospital” or “owned by hospital” when referring patients to secondary care facilities. The bill would also require hospitals to disclose the names of physicians who work with such facilities, which is not required under current statutes.

The Maine Health Care Association (MHCA), a group representing Maine’s nursing and retirement homes, is opposing LD 447 as originally written.

“We agree with the aim of the bill, just not the methods,” said MHCA Vice President and Director of Communications Nadine L. Grosso.

“We’re concerned that the bill as originally written would place an undue administrative burden on various facilities,” said Grosso.

Grosso said hospitals already have to provide complete lists of medical facilities available in a given area. “We can have more information for patients and for their families, but I wonder if families really look at it in moments of crisis,” she said.

Jeffrey Austin, the lead lobbyist for the Maine Hospital Association (MHA), said his group is opposing the bill because it is inefficient and will only cause confusion and busy work.

“We’re already obligated under state law to provide lists of facilities to discharged patients,” said Austin. “What this bill seeks to do is expand the information on that list.” He said MHA does not oppose expanding the information available to patients and their families.

“Our objection is to the mechanics of receiving and updating all of this information,” said Austin.

Austin said the bill is inefficient because it requires care facilities to produce and distribute separate lists of doctors with whom they work to various hospitals in the region. “We would rather see this take place in a central location,” said Austin. He said the Department of Health and Human Services could perform these duties better and more efficiently.

Austin said current laws already prohibit the steering of patient referrals to affiliate facilities and that no direct evidence was presented during the bill’s hearing showing these laws have been violated. He said it is possible that the laws have been violated, but that complaints should be pursued under those laws.

“The solution to a violation of a law is not to pass another law,” said Austin.

Supporters of the legislation believe hospitals steer patients they discharge to rehabilitation and nursing home facilities that are owned by or affiliated with them in order to capture the maximum post-acute care Medicare dollars.

“The general idea of the bill is that patients would have improved and informed choice of services after hospital discharge and independent and unaffiliated providers of health care services would have a level playing field,” said Jabbar Fazeli, a medical doctor with Maine Geriatrics and vice president of the Maine Medical Directors Association.

“We want facilities to compete for referrals. It’s about choice for patients and allowing competition among providers,” said Fazeli. “We need to break the hospitals’ monopoly on referrals to affiliated facilities,” he said.

Fazeli’s health care advocacy group recently conducted a poll of post-acute care facilities and hospitals and found broad concern about conflicts of interest in the referral process between hospitals and affiliates. Several anonymous survey respondents said hospitals regularly refer to affiliate facilities before sending patients to independent or unaffiliated facilities. And while critics of the bill are concerned with added administrative burdens for Maine’s nursing homes and rehabilitation clinics, survey respondents unanimously agreed that compliance with the proposed law would not be difficult.

“One-hundred percent of survey respondents had no problem collecting and sharing data on their doctors,” said Fazeli.

Fazeli said the Maine Hospital Association’s desire to have conflict-of-interest disclosures administered by a central government agency is really a way of killing the bill.

“We would have to wait for some central place, some government database to be created,” said Fazeli. “This would add a fiscal note to the bill, which in today’s climate is equivalent to killing it,” he said.

Although Fazeli said some progress was made at Tuesday’s work session, he is not optimistic about the bill’s chances before the full legislature.

Correction: An earlier version of this story mistakenly reported Sen. Patrick Flood (R-Oxford) as the sponsor of L.d. 447

By S.E. Robinson

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