By Pauline
Bartolone June 18, 2018
In
Maryland, Carmela Coyle is known as a reformer.
During
her tenure as president of the Maryland Hospital Association, she helped
establish a first-of-its kind state program that capped hospitals’ yearly
revenue — a counterintuitive move for a leader in an industry anxious
to defend its bottom line.
But
here in California, just eight months into her new job as president and CEO of
the California Hospital Association,
Coyle, 57, has already helped defeat a legislative effort to cap the amount
hospitals are paid for medical procedures. And she did so with “scorched earth”
vigor, said Anthony Wright, executive director Health Access California, a
consumer advocacy group.
Coyle
told the Assembly Health Committee in April that if the proposal were adopted,
“60 percent of hospitals in the state of California would be operating … at a
loss,” and hospitals would close.
The
400-member California Hospital Association is a heavyweight in the state
Capitol. Since the beginning of 2017, the trade group has spent $3.3 million dollars to influence
policymakers, more than any other health business or association.
When
Coyle took the helm in October, she brought almost 30 years of experience
representing hospitals in Maryland, and in Washington, D.C., for the American
Hospital Association before that.
“California really needed
a strong leader,” Coyle told California Healthline. “At the end of the day,
surprise! It was me.”
In
Maryland, Coyle earned a reputation for being collegial —but tough.
“She’s
the kind of person you can disagree with on one issue, and work with on another
at the same time,” said Joshua Sharfstein, a professor at the Johns Hopkins
Bloomberg School of Public Health. Sharfstein, the former secretary of
Maryland’s Department of Health and Mental Hygiene, worked with Coyle to
implement the state program that capped hospital revenues.
The
program, launched in the late 1970s, regulated the cost of hospital medical
procedures by setting rates. Under the system, the state determines how much is
paid to hospitals by private insurers, uninsured patients and public programs
such as Medicare and Medicaid.
In 2014
— with the support of Coyle and Maryland hospitals — the state went a step
further and capped the total revenue hospitals take in each year. Since then,
the program has saved taxpayers and insurers hundreds
of millions of dollars as hospitals try to keep patients away by making them
healthier, according to a recent analysis of
the program.
Coyle
said a rate-setting system could be possible in California, but not the one
that she helped kill last month. That legislation, AB 3087, would have
created a state agency to set the rates that private insurers pay doctors,
hospitals and clinics for procedures. It would not have regulated the rates
paid by the public insurers Medi-Cal, California’s Medicaid program, and
Medicare.
But
unions in the Golden State don’t expect Coyle to rally hospitals behind any
rate-setting proposals.
“The
hospital industry has to decide that it wants to change, and that it wants to
be part of making care less expensive, not increasing the expenses,” said Dave
Regan, president of SEIU-UHW, which represents almost 100,000 service and
health care workers at hospitals statewide. “There is no sign that they want to
do that.”
California
Healthline sat down recently with Coyle to discuss her views on controlling
hospital prices and other issues. The interview was edited for length and
clarity.
Q: Why
did you find the rate-setting bill so threatening?
It was
just a big, bad bill for the health of Californians.
This
bill would have set prices only for the commercially insured population. What
that does is completely ignore that the Medicare program pays about 22 percent
less than cost. And the Medi-Cal program for low-income individuals pays even
further less than cost, about 34 percent. You can’t pull down commercially
insured rates unless you increase the Medicare and the Medi-Cal rates.
Q: The
legislature is likely to consider that bill again next year. Could it be
tweaked so that the hospital association would support it?
No, and
I don’t know that it will be picked up next year. As the bill author and as
many of the supporters have said, their real desire is to have a conversation
about the affordability of health care in California. That’s a conversation
that we not only want to be a part of, but we are happy to lead.
Q: You
said in a previous interview that
you support the concept of insuring all Californians. What measures would the
association support to get there?
We’ve
got about 3 million Californians yet to cover … and we ought to support
providing them with the coverage they need. We have to work on lifting the
amount of income you can have while still receiving subsidies that reduce the
cost of your premiums.
Q: Two
bills in the legislature would expand Medicaid to unauthorized immigrant adults
between the ages of 19-25 and those 65 and older. What is your position on
doing that?
We
treat everyone, documented or undocumented. They are in our states and our
hospitals’ emergency departments. It is always better if somebody has a full
package of coverage so that we can deal with their health needs earlier rather
than later. … It’s always a debate about where the state should spend its
dollars.
Q:
Research shows a correlation between hospital mergers and higher
health care costs. California Attorney General Xavier Becerra
recently filed a lawsuit against
Sutter Health related to this. Do you think hospital consolidation is a
problem?
I worry
that many are taking a too simplistic view of consolidation. There are also
studies that say it has the effect of lowering the cost of care and creating
efficiencies and creating the scale that is needed for hospitals to be both
efficient and continue to maintain quality and safety.
So
there are probably arguments on both sides. I know the attorney general’s
action makes a series of allegations, but I think they are [just] allegations
until we get an opportunity to really take a closer look.
Q: Do
you support government scrutinizing the mergers more closely?
Government
already scrutinizes them. For any of these mergers to go through, the attorney
general has to approve them and the Federal Trade Commission has to approve
them.
Q: The
hospital association didn’t take a position on the single-payer bill that faltered
in the legislature last year. What’s your view?
The
single-payer approach is one that doesn’t make sense for a couple of reasons.
It had a $400 billion dollar price tag,
and moving to single-payer would require employed individuals to give up their
coverage. I think many people are happy with their coverage. We need to create
stability in this health care market. And trying to pull all of this into a
state-based system would have created tremendous fiscal challenges for
California.
Pauline
Bartolone: pbartolone@kff.org,
@pbartolone
No comments:
Post a Comment