03/12/2008 05:00 PM Senate HEALTH, EDUCATION & SOCIAL SERVICES
| Audio | Topic |
|---|---|
| Start | |
| SCR14 | |
| SB300 | |
| SB245 | |
| Adjourn |
+ teleconferenced
= bill was previously heard/scheduled
| = | SB 300 | ||
| += | SB 245 | TELECONFERENCED | |
| *+ | SCR 14 | TELECONFERENCED | |
ALASKA STATE LEGISLATURE
SENATE HEALTH, EDUCATION AND SOCIAL SERVICES STANDING COMMITTEE
March 12, 2008
5:15 p.m.
MEMBERS PRESENT
Senator Bettye Davis, Chair
Senator Joe Thomas, Vice Chair
Senator John Cowdery
Senator Kim Elton
Senator Fred Dyson
MEMBERS ABSENT
All members present
COMMITTEE CALENDAR
SENATE CONCURRENT RESOLUTION NO. 14
Proclaiming February 4 - 10, 2008, as PeriAnesthesia Nurses
Week.
MOVED SCR 14 OUT OF COMMITTEE
SENATE BILL NO. 300
"An Act establishing the Alaska Health Care Commission and the
Alaska health care information office; relating to health care
planning and information; and providing for an effective date."
HEARD AND HELD
SENATE BILL NO. 245
"An Act establishing the Alaska Health Care Commission and the
Alaska health care information office; relating to health care
planning and information; repealing the certificate of need
program for certain health care facilities and relating to the
repeal; annulling certain regulations required for
implementation of the certificate of need program for certain
health care facilities; and providing for an effective date."
HEARD AND HELD
PREVIOUS COMMITTEE ACTION
BILL: SCR 14
SHORT TITLE: PERIANESTHESIA NURSES WEEK: FEB 2008
SPONSOR(s): SENATOR(s) GREEN
01/18/08 (S) READ THE FIRST TIME - REFERRALS
01/18/08 (S) HES
03/12/08 (S) HES AT 5:00 PM BUTROVICH 205
BILL: SB 300
SHORT TITLE: HEALTH CARE: PLAN/COMMISSION/FACILITIES
SPONSOR(s): HEALTH, EDUCATION & SOCIAL SERVICES
03/06/08 (S) READ THE FIRST TIME - REFERRALS
03/06/08 (S) HES, FIN
03/12/08 (S) HES AT 5:00 PM BUTROVICH 205
BILL: SB 245
SHORT TITLE: HEALTH CARE: PLAN/COMMISSION/FACILITIES
SPONSOR(s): RULES BY REQUEST OF THE GOVERNOR
01/19/08 (S) READ THE FIRST TIME - REFERRALS
01/19/08 (S) HES, FIN
01/25/08 (S) HES AT 1:30 PM BUTROVICH 205
01/25/08 (S) Heard & Held
01/25/08 (S) MINUTE(HES)
02/08/08 (S) HES AT 1:30 PM BUTROVICH 205
02/08/08 (S) Heard & Held
02/08/08 (S) MINUTE(HES)
02/20/08 (S) HES AT 1:30 PM BUTROVICH 205
02/20/08 (S) Heard & Held
02/20/08 (S) MINUTE(HES)
03/12/08 (S) HES AT 5:00 PM BUTROVICH 205
WITNESS REGISTER
GINGER BLAISEDELL, Staff
to Senator Green
Alaska State Capitol
Juneau, AK
POSITION STATEMENT: Provided an overview of SCR 14.
DON BURRELL, Staff
to Senator Davis
Alaska State Capitol
Juneau, AK
POSITION STATEMENT: Read the sponsor statement for SB 300.
JEAN MISCHEL, Attorney at Law
Legislative Legal and Research Services Division
Legislative Affairs Agency
Juneau, AK
POSITION STATEMENT: Answered questions about SB 300.
ROD BETIT, CEO
Alaska State Hospital and Nursing Home Association (ASHNH)
Juneau, AK
POSITION STATEMENT: Supported the language in SB 300 [CSSB 300
Version \O]; supported SB 245.
MARIE DARLIN, Coordinator
AARP Capital City Task Force
Juneau, AK
POSITION STATEMENT: Supported SB 300.
DON KUBLEY, Lobbyist
Mat-Su Regional Hospital
Anchorage, AK
POSITION STATEMENT: Supported SB 300; opposed SB 245.
DR. TODD CURZIE, Treasurer
Alaska Chiropractic Society
Anchorage, AK
POSITION STATEMENT: Supported SB 300 but requested that a
chiropractic medical practitioner be included on the commission.
KARLEEN JACKSON, Commissioner
Department of Health and Social Services (DHSS)
Juneau, AK
POSITION STATEMENT: Supported SB 300 with reservations.
JIM L. LYNCH, Chief Human Resources Officer
Fairbanks Memorial Hospital (FMH)
Fairbanks AK
POSITION STATEMENT: Supported SB 245.
STANLEY ARCHER, representing himself
Fairbanks AK
POSITION STATEMENT: Opposed SB 245.
JEFF COOK, President
Greater Fairbanks Committee Hospital Foundation Board
Fairbanks, Alaska,
POSITION STATEMENT: Opposed SB 245.
JUDY BOGARD, Fairbanks Memorial Hospital
Fairbanks, AK
POSITION STATEMENT: Supported the CON.
KARL SANFORD, Associate Administrator
Fairbanks Memorial Hospital
Fairbanks, AK
POSITION STATEMENT: Supported the CON.
KAREN PERDUE, Board Member
Fairbanks Memorial Hospital
Fairbanks, AK
POSITION STATEMENT: Opposed SB 245.
RICK CAULFIELD, Director
University of Alaska, Fairbanks (UAF)
Tanana Valley Campus
Fairbanks, AK
POSITION STATEMENT: Opposed SB 245.
CHERYL KILGORE, Executive Director
Interior Community Health Center
Fairbanks, AK
POSITION STATEMENT: Opposed SB 245.
MARK ROWDEN, Inpatient Supervisor
Pharmacy Department
Fairbanks Memorial Hospital
Fairbanks, AK
POSITION STATEMENT: Opposed SB 245
DOUG BISHOP, representing himself
Fairbanks, AK
POSITION STATEMENT: Opposed SB 245
PAUL FUHS, Lobbyist
Alaska Open Imaging Center, LLC.
Anchorage, AK
POSITION STATEMENT: Supported SB 245.
ACTION NARRATIVE
CHAIR BETTYE DAVIS called the Senate Health, Education and
Social Services Standing Committee meeting to order at 5:15:52
PM. Present at the call to order were Senators John Cowdery, Kim
Elton and Chair Bettye Davis. Senators Joe Thomas and Fred Dyson
arrived shortly thereafter.
SCR 14-PERIANESTHESIA NURSES WEEK: FEB 2008
CHAIR DAVIS announced the consideration of SCR 14.
5:16:33 PM
GINGER BLAISEDELL, Staff to Senator Green, said a number of
nurses had approached Senator Green to honor the specialized
nurses who help patients come out of surgery. The national
celebration set aside a week in February, but this resolution
proposed a week to coincide with the Pacific Northwest's
PeriAnesthesia Nurses' Association convention scheduled for March
thth
15 and 16 in Fairbanks.
SENATOR COWDERY asked how many were expected to attend the
Fairbanks convention.
MS. BLAISEDELL replied there was only a small group of
periAnesthesia nurses in Alaska; but they were inviting nurses
from other Northwest states including Oregon, Montana, Wyoming,
Idaho and Washington. They expected more than 100 nurses to
attend the convention, which would be held at Sophie's Station.
SENATOR ELTON asked if it would be just as good to set the date
for February 2009.
MS. BLAISEDELL said they had specifically asked for the February
date, possibly because it was the first time a week had been
dedicated to them; but she did not know if the federal
commemorative week would be in February next year or not.
SENATOR COWDERY referred to [page 1] line 14, where Governor
Palin is asked to proclaim the week of February 4-10, 2008 as
PeriAnesthesia Nurses' Week. He asked if that was their
intention.
5:20:06 PM
MS. BLAISEDELL confirmed that was their original intention, but
thought they would be satisfied with a different time period as
long as they had the proclamation by the date of their
convention.
SENATOR COWDERY moved to report SCR 14 from the committee with
individual recommendations and attached zero fiscal note(s).
There being no objection, the motion carried.
SB 300-HEALTH CARE: PLAN/COMMISSION/FACILITIES
5:21:07 PM
CHAIR DAVIS announced the consideration of SB 300.
5:22:48 PM
SENATOR THOMAS joined the meeting.
DON BURRELL, Staff to Senator Davis, read the sponsor statement
into the record as follows:
The Alaska Health Care Strategies Council, established
by Governor Sarah Palin, met during the 2007
Legislative Interim to set long term goals for the
health care of Alaskans. During the Legislative
Interim these legislators, health care professionals,
and committed citizens of Alaska provided seven
clearly delineated goals for 'Making Alaskans the
healthiest people in the nation.'
Among the Council's top recommendations, Senate Bill
300, sponsored by the Senate Health, Education, &
Social Services committee, would establish the Alaska
Health Care Commission to develop policy
recommendations and oversee the newly formed Health
Care Information Office. The Alaska Health Care
Commission would also oversee the database and website
implementation regarding health care and healthy
living in Alaska.
The commission would be comprised of 15 members
including Alaska health care providers, a small
business owner, state officials and public members.
Chaired by the Medical Director of the Department of
Health & Social Services, the Alaska Health Care
Commission would meet regularly, establishing specific
goals designed to promote the health and well being of
the citizens of the State of Alaska.
SB 300 will also establish the Alaska Health Care
Information Office and related database Internet sites
to provide transparency to the Alaska Health care
industry for health care consumers. The information
provided by the Alaska Health Care Information Office
would be consistently updated as specified in the
bill.
These two functions of the bill will provide the
citizens of Alaska a great avenue for choosing health
care for themselves and their families. It is with
Alaskan citizens in mind that your consideration and
passage of this bill to the next committee of referral
is requested.
5:24:12 PM
CHAIR DAVIS said this bill had taken Sections 1 and 2 from SB
245, addressing only the commission and the database system. She
noted that this would be the first time it had been heard in
committee so she would like to hear any questions or concerns
from the committee; she intended to bring it back on the
following Friday under previous bills heard.
SENATOR ELTON said he'd like to discuss the effective dates.
Discussion on the previous bill indicated there were stress
points from effective dates just over the horizon; in this bill,
the effective date for Section 2 was July 1, 2013.
CHAIR DAVIS interjected that the 2013 date was actually the
sunset date of the commission. The effective date for
establishment of the commission was July of 2008.
SENATOR ELTON understood that, with regard to the information
office component, an aggressive effective date could be
problematic for the department.
SENATOR DAVIS said she could have the department speak to that.
She also recollected that in one version of the bill,
establishment of the database would be in 2009 and the effective
date [of the commission] in 2008.
5:27:30 PM
MR. BURRELL responded that those dates were still in the current
bill. On page 9, line 5, under Mandatory Reporting, the
effective date of mandated reporting was July 1, 2009. page 11,
line 26, Sec. 7 was the sunset date for the Alaska Health Care
Commission; line 28, Sec. 9 was the effective date for the
Alaska Health Care Commission.
5:28:02 PM
SENATOR ELTON queried how Section 2, the reference on page 11,
line 26, sunsetted anything.
MR. BURREL said the drafter, Jean Mischel, was on line and could
answer that.
CHAIR DAVIS said Jean Mischel should be able to walk them
through it; those were the requested dates.
SENATOR ELTON said that on page 11, lines 17-18 did say that
some of the statutory provisions were repealed, but line 26
seemed to indicate that Section 2 did not take effect until July
1, 2013.
CHAIR DAVIS said Jean Mischel would have to address that.
SENATOR COWDERY asked if Chair Davis intended to work on this
bill during the summer.
CHAIR DAVIS said no, she intended to pass it during this
legislative session.
5:30:14 PM
JEAN MISCHEL, Attorney at Law, Legislative Legal and Research
Services Division, Legislative Affairs Agency, replied that
Section 2 simply removed the reference to the commission at
sunset in 2013, causing existing law to revert to the way it was
before the Act. She agreed that it was confusing, but explained
that Section 1 added a cross reference to the Alaska Health
Commission to the duties of the department; Section 2 removed
that cross reference on the sunset date in 2013.
SENATOR ELTON said it would be helpful if someone from the
hospital association would chime in and tell the committee
whether this bill addressed the concerns they had expressed
earlier.
5:32:04 PM
ROD BETIT, CEO, Alaska State Hospital and Nursing Home
Association (ASHNH), said the association could support the
language in this version of the bill [CSSB 300 Version \O]. It
addressed the time lines, making it clear that July 1, 2008 was
the beginning of a long journey in terms of trying to understand
what health care information would be helpful to consumers, and
putting that into a user friendly web format. He admitted that
the July 1, 2009 date as a starting point to actually begin
loading information into the system was still very ambitious;
but information was already being provided to the department
that could be made available and added to as the site evolved.
CHAIR DAVIS opened the meeting to public testimony.
5:33:40 PM
MARIE DARLIN, Coordinator, AARP Capital City Task Force, said
the task force had submitted a letter of support for SB 300. She
said they would have preferred to have the three issues that
were addressed in the original bill separated into three
distinct bills; however since CON had been dropped, they were
able to support this version. With regard to establishment of
the commission, she questioned whether the Governor ought to be
making so many of the appointments. They were confident that the
information office would be very helpful in making the
marketplace more competitive by spotlighting information on the
cost and quality of services to the public.
5:35:57 PM
DON KUBLEY, Lobbyist, Mat-Su Regional Hospital, thanked the
committee for their time and effort in the area of health care
and expressed support for SB 300.
5:37:53 PM
DR. TODD CURZIE, Treasurer, Alaska Chiropractic Society, said
the Society had reviewed SB 245 and SB 300 and were generally
supportive of the idea of a health planning commission. They
were concerned about the composition of the committee; both
bills provided seats for 3 public members from the health care
community, one representing physicians. State statute designated
3 classes of primary physicians: Allopathic, Osteopathic and
Chiropractic. If all of the physicians appointed to the
committee were Allopathic, they were not confident that
chiropractic patients would be well represented. They proposed
the bill be amended to seat a chiropractic physician as a member
of the commission.
5:39:37 PM
KARLEEN JACKSON, Commissioner, Department of Health and Social
Services (DHSS), said they would like the Governor's Health Care
Transparency Act to pass; if that was not possible, they would
support this bill as a vehicle to help them with these two
components [Alaska Health Care Commission and Alaska Health Care
Information Office].
CHAIR DAVIS announced that she would like to propose an
amendment to SB 300 and had distributed copies to the committee.
5:40:50 PM
DON BURRELL, Staff to Senator Davis, said the amendment would
add the phrase "relating to a certificate of need study;" to the
title starting on page 1, line 2 of the bill. The title would
then read:
"An Act establishing the Alaska Health Care Commission
and the Alaska Health Care Information Office;
relating to health care planning and information;
relating to a certificate of need study: and providing
for an effective date."
This would require the commission to conduct a study of the CON
and come up with recommendations for regulatory and statutory
changes.
5:42:29 PM
SENATOR THOMAS pointed out that the new verbiage was actually
inserted as the second information in the title [after the
phrase "relating to health care planning and information;"]. He
also suggested that they discuss a timeframe for bringing the
results of that study to the legislature.
SENATOR ELTON said that as he read the title, it now had three
components: 1) establish the Health Care Commission and the
health care information office, 2) relating to health care
planning and information, and 3) providing for an effective
date. He assumed they wanted the Health Care Commission to do
the contracting, and wondered if the title change was in the
right spot.
5:44:08 PM
MS. MISCHEL, responded that Senator Thomas was correct. It was a
stand-alone phrase that appeared after "information;" and was a
generic reference to put people on notice that the Certificate
of Need study was also in the bill. The title change did not
reference who would conduct the study or modify the first phrase
in the title. page 1, lines 6-11 of the amendment inserted the
study into uncodified law for the end of the bill, just as the
House version had done; but it placed the authority to conduct
the study with the Health Care Commission itself. She agreed
that they could certainly add a time frame for that study.
5:45:37 PM
SENATOR ELTON noted that another part of amendment went to page
11 and wanted to verify that it was just renumbering to
accommodate the addition of an earlier Section.
CHAIR DAVIS said that it was.
5:46:13 PM
SENATOR THOMAS said he would be willing to add a timeframe if
someone could suggest what an appropriate time would be to
complete such a study.
5:46:36 PM
SENATOR DYSON joined the meeting.
CHAIR DAVIS explained that she had not included a time frame for
that very reason, because she was not sure how long it would
take. She chose to leave it open-ended and let the commission
make the determination.
SENATOR THOMAS said he could accept that, but conjectured that
it would be done more timely if a date was specified.
CHAIR DAVIS proposed they set a starting date rather than a date
for completion.
MS. MISCHEL said the effective date of the bill as drafted, July
1, 2008, would apply to this section.
5:48:16 PM
SENATOR THOMAS asked if Ms. Mischel meant the effective date of
the bill determined the starting date of the study.
MS. MISCHEL said yes. It established the Health Care Commission
and included the mandate that they contract for a study as of
July 1, 2008. What was not included was when the report would be
due to the legislature, or any end date other than the sunset
date for the commission itself.
5:49:48 PM
SENATOR ELTON surmised that this might change the fiscal note
dramatically.
COMMISSIONER JACKSON said it would change the fiscal note; it
also assumed that the commission would be up and running before
they could contract for the study.
CHAIR DAVIS wondered how they would determine the amount of the
new fiscal note.
COMMISSIONER JACKSON said she could provide that information to
the committee when they met next to consider the bill.
SENATOR ELTON said he understood that a negotiated regulation
process by a group of stakeholders had already begun studying
the CON. He asked Commissioner Jackson what she thought the best
process would be: continue the negotiated regulation process
involving the stakeholders, begin an independent study, or both.
COMMISSIONER JACKSON replied it would depend on what the study
was trying to accomplish. If the study was intended to determine
what should happen with the Certificate of Need program in
Alaska, the committee had heard volumes of testimony both pro
and con from many experts, and that would be part of the body of
knowledge already out there. The Certificate of Need Task Force
had met and come up with some definitions that would also be
part of that body of knowledge. She expected all of that would
be taken into consideration, but she would not presume that the
providers who came together for the negotiated rule-making task
force would necessarily have the time and energy to do all of
that work on their own; she presumed they would need a
contractor to put the existing knowledge together in a report
and recommendation.
5:53:09 PM
SENATOR THOMAS reflected that this could be discussed forever;
but maintained that if they got someone with no dog in the fight
to evaluate the existing information, (s)he should be able to
provide a recommendation rather quickly. He reiterated that he
did not see why it should take more than a year to bring that
report to the legislature; because legislature would not be in
session July 1, 2009 however, they would probably have to make
it an 18 month study to bring the due date to January 2010.
COMMISSIONER JACKSON responded that the sticking point was going
to be how quickly the commission could get up and running, and
that would depend in part on who was responsible for assigning
people to that commission. If the Governor was making the
appointments that would be one thing; if legislators were also
appointed from each body, the time line would have to
accommodate them. Once the commission was operational and the
contract in place, she agreed that it should not take very long.
SENATOR THOMAS speculated that 18 months would allow 4 to 5
months to get the commission going and a year to complete the
study, which should be plenty of time.
COMMISSIONER JACKSON agreed and said she hoped they could do it
quickly, but reiterated that a lot depended on getting that
commission up and running.
5:55:44 PM
CHAIR DAVIS did not want to add a timeline to the amendment.
SENATOR THOMAS asked if they had adopted the original bill.
CHAIR DAVIS said they had not.
SENATOR THOMAS moved to adopt SB 300, Version \A the as the
working document of the committee. There being no objection, the
motion carried.
SENATOR THOMAS then moved to adopt Amendment 1 to SB 300,
Version \A. There being no objection, the motion carried.
5:56:56 PM
SENATOR ELTON objected. He said that he was trying to find the
most polite way possible to voice his concern and hoped he had
been successful; in charging the Health Care Commission to do
this work, the Governor had made it very clear what she wanted
to happen with the CON. She had made it so clear that she was
not willing to negotiate a position in the middle. He pointed
out that this commission was a commission of 15, 11 of whom
would be appointed by the Governor. He would rather have the
program reviewed by the stakeholders, who were customers of the
state and the program, than by a commission, most of whom were
appointed by the Governor who had made very clear what she
thought the outcome should be. He said he was also uncomfortable
doing this without any idea what the cost would be.
CHAIR DAVIS said it was true that many of the members would be
appointed by the Governor, but the study would not be done by
the commission. She stressed that they had been discussing the
matter for years without coming to any conclusion; it had to be
done by another body. She was not sure how they could come up
with a cost however, and suggested they set an outside limit.
SENATOR ELTON said was not sure either, but reiterated that 11
out of 15 of these people would be appointed by Governor. He
remembered the expert witness hired by the department, the first
person to testify on the Governor's bill on her behalf, who he
felt did not have a good perspective and could not see any
shades of gray in a very important discussion. His concern was
that, because the Governor hadn't shown any flexibility on this,
that person could be the contractor if the Governor wanted and
she had 11 votes on the 15 member commission.
6:00:58 PM
SENATOR DYSON agreed the issue was convoluted and the lines were
firmly drawn in the sand; he hoped this study would get down to
the fundamental issues. Much of the problem was driven by the
actions of government, which had told many of the providers,
particularly the hospitals, that they must take everybody who
came in the door, knowing that a significant portion of the cost
of their care would not be recovered. That forced the providers
to shift costs; other patients and/or their insurers ended up
paying the cost for the indigent in kind of a shell game. He was
clear that he was not saying they should not offer services to
those people, but that this had put the health care providers in
an untenable position.
SENATOR DYSON continued that if the legislators as
representatives of the public, and the public decided to provide
some kind of health care to indigents, then that should be paid
for from the tax base and not forced on the care providers. He
noted that everyone he had heard supporting the existing or even
a modified CON process, agreed that they had to maintain it and
continue offering those services on which they could make a
profit in order to support the areas in which they were doing,
for want of a better term, charity work. He hoped this
commission and this study would point that out and rub their
noses in the fact that this was an unfunded mandate by
government and one that government should accept. He said that
he did not know this Governor's intention but sensed a cannon
shot across their bow. That's why he thought having the
commission deal with it would be a good thing; but he
appreciated Senator Elton's concern about the Governor
"stacking" it. He was worried about the composition being too
heavy with care providers whose fiscal life was on the line as
well. He thought that perhaps they should require the
commission to submit recommendations and let this committee
decide who would conduct the study, or let Legislative Council
choose.
In summary he said he appreciated Senator Elton's dedication to
getting this dealt with in a fair and straight way with all the
cards up on the table. Almost everybody that testified had a
pretty big, rabid dog in the fight, and it was all spun
information, with all due respect.
6:05:36 PM
CHAIR DAVIS added that both Senators Elton and Dyson had made
her think about more than just passing her amendment at this
time. She would like to know the approximate cost to do that.
She also liked the idea of having the commission bring back
recommendations for legislative approval of who whould conduct
the study. So rather than voting on the amendment as offered,
she proposed writing up another to replace it and withdrawing
the motion on the floor.
6:06:35 PM
CHAIR DAVIS withdrew Amendment 1, \A.1
SENATOR DYSON said he would like to see this whole process
finished by the time they reconvened in January. He pointed out
that the packets distributed by Mr. Burrell contained some
communications that raised significant questions, and asked if
those had been discussed.
CHAIR DAVIS replied that they had not.
SENATOR DYSON said some of them seemed to contain important
detail, so he would like to review those and get some answers.
SENATOR THOMAS asked if everyone was looking at the same fiscal
note, the contractual aspect of the fiscal note in the period of
2009-2013. He pointed out that was in the range of $250,000 for
each of those 5 years for contractual work alone. The total was
$750,000 in the first year and $660,000 in each of the other 4
years; so it was over $3 million during the 5 year period. He
thought that should be enough.
CHAIR DAVIS reiterated that she was going to come back with
another amendment on Friday. She asked if there were other
concerns or issues regarding SB 300 to be addressed at this
time. She held SB 300 in committee.
SB 245-HEALTH CARE: PLAN/COMMISSION/FACILITIES
6:09:50 PM
CHAIR DAVIS announced the consideration of SB 245 and asked for
public testimony.
6:10:19 PM
ROD BETIT, CEO, Alaska State Hospital and Nursing Home
Association (ASHNHA), thanked the Chair for the rewrite and
noted that a summary of his comments was included in the
committee members' packets. He mentioned specifically that
Section 4 added a reference to critical access hospitals, which
were located in Cordova, Dillingham, Ketchikan, Kotzebue, Nome,
Petersburg, Kodiak, Seward, Valdez, Barrow, Sitka and Homer;
that became important with regard to the CON language and which
communities would have special protections because of the size
of the community. Section 5 contained the piece that replaced
the repeal of CON and was extremely important to clarify the
ongoing disputes between hospitals, imaging centers and
physicians about what was and was not subject to CON review when
there was imaging equipment in the facility or office. This
language was worked out subsequent to the negotiated rule-making
committee breaking up and would eliminate about 80 percent of
the appeals and law suits that were before the department. It
provided that, to be outside CON and to get the benefit of the
physician office exemption in statute, the physicians in
question had to actually work in the practice, own at least 50
percent of the practice and equipment, and must actually
interpret the images that their imaging equipment produced. If
they met that criteria and were in a community with a population
greater than 60,000, they would not be subject to CON. They felt
it was a fair way to take that particular issue off the table
and move forward to deal with the other parts of this
legislation; most of ASHNHA's membership was tremendously
supportive of that language.
He summarized that there was still much to be done; this bill,
unlike the House version, left the discretion and authority with
the commission to make decisions regarding who would need to
report, what they needed to report and when. That was important
in his mind, because so much needed to be accomplished and they
would have to learn a lot along the way to give them that kind
of discretion and to make this work in a positive way for
consumers.
6:13:42 PM
SENATOR ELTON asked if, with Section 5, no CON study was needed
[under SB 300].
MR. BETIT answered that this just set aside most of the disputes
that were costing the department time and money. He agreed with
the committee that they would never reach a conclusion about
whether Certificate of Need helped or hurt consumers in Alaska
unless they took a hard look at that question. Placed in the
hands of someone credible, with sufficient experience and no axe
to grind, he thought the study would point out the concerns they
had been expressing as far as a level playing field.
6:15:45 PM
JIM L. LYNCH, Chief Human Resources Officer, Fairbanks Memorial
Hospital (FMH), Fairbanks, AK, asked for clarification on
several points. He asked whether, on page 5, line 1 of Version
\O, the reference to a borough with a population of 60,000 or
more meant that CON would apply in the Fairbanks North Star
Borough with the modifications Rob Betit referenced as supported
by ASHNHA.
CHAIR DAVIS confirmed that Fairbanks would fall under the
specification of a borough with a population greater than
60,000.
MR. LYNCH agreed and explained that they were trying to
interpret the implications to CON based on that measure.
CHAIR DAVIS said this didn't change the CON.
MR. LYNCH apologized for the confusion, but said it appeared to
read like a new sub-section.
CHAIR DAVIS said he was correct, there was a new sub-section on
page 4.
MR. LYNCH continued that they did support the statements of Rob
Betit and ASHNHA in general, but sought detailed clarification
of that issue to ensure that the CON stayed in place to meet the
needs of the Fairbanks community.
CHAIR DAVIS advised Mr. Lynch that she would get clarification
for him.
6:20:19 PM
MR. LYNCH thanked Chair Davis and said he would be happy to work
with the committee, but did not want the North Star Borough and
the Anchorage municipality to be written out of CON with this
new language.
6:21:05 PM
STANLEY ARCHER, representing himself, Fairbanks, AK, said that
as a long-time resident of Fairbanks with considerable
experience with medical systems as a patient, he was concerned
that the Fairbanks Memorial Hospital (FMH) would be harmed by
the loss of the CON. He said he had watched FMH grow into a
facility that could handle many types of medical procedures that
previously were available only in Anchorage or Seattle. He said
he understood how a free-market economy worked, but that FMH was
not a retail enterprise and should not be compared to one. FMH
was not a for-profit medical facility and had obligations to the
community that for-profit clinics and facilities would not have
to honor; it was tasked with taking care of all patients,
regardless of their ability to pay. He wondered if for-profit
medical facilities that are not obliged to, would be willing to
do the same, and warranted that they would not. Fairbanks
physicians were unwilling even to take Medicare and Medicaid
patients because the level of reimbursement was not up to their
standards. He said in his experience the majority of physicians
in Fairbanks would not take patients who could not show proof of
legitimate health care insurance or demonstrate in some way
their ability to pay, and some were requiring a non-refundable
fee simply to be on their patient list.
MR. ARCHER feared that if CON were eliminated, the new
facilities would heavily court private pay and insurance
business. They would have to do so in order to fill their
facilities to pay for their heavy investment costs, leaving no
room for charity or pro-bono medical care. With that, FMH would
be left with all the charity cases and insufficient income to
support the facility, leading to the degradation of their
community hospital. In closing he asked that the committee
consider the all of evidence carefully and leave the CON in
place.
6:24:41 PM
JEFF COOK, President, Greater Fairbanks Committee Hospital
Foundation Board, Fairbanks, AK, said the board was established
in 1968 to build health care facilities in Fairbanks. It
succeeded the Sisters of Charity, which had St. Joseph's
hospital and chose not to operate it because of financial and
other issues. In two City & Borough elections, the voters chose
not to operate the hospital; fortunately, the foundation was
formed by foresighted citizens who gathered the money to open
the new Fairbanks Memorial Hospital in 1972.
MR. COOK spoke against elimination of the CON, saying it had
worked very well in Fairbanks and was important to the future of
health care in Fairbanks. The CON had not impeded state-of-the-
art health care in Fairbanks. The Foundation Board's motto was
to always act as if there was competition. He said they had a
state-of-the-art cancer center, a new heart catheterization lab,
a new outpatient imaging center, and a newly expanded emergency
department that treated everyone who walked through the door,
regardless of their ability to pay. He asserted that the CON had
not impeded physician recruiting or retention either. In the
past 3 years, 23 physicians had left Fairbanks or ceased
practicing, but they had gained 27 new physicians during that
time. He added that physician recruiting was a problem across
the country and Fairbanks was not unique in that regard.
Fairbanks was actually quite successful due in part to their
acquisition of Tanana Valley clinic and the many employment
options they could offer new physicians.
6:27:21 PM
SENATOR ELTON asked Mr. Cook if they would solve two problems
with the CON issue by modifying Section 5 to add a 3) that said
"accepts any Medicare and Medicaid patients." So to get out of
the CON you would still have to be in a city with a population
of 60,000 or more; the facility would have to be owned by one or
more licensed physicians; and it would have to accept Medicare
and Medicaid patients. He felt that would level the competitive
field while encouraging physicians to accept Medicare and
Medicaid patients.
MR. COOK contended it was not just a matter of taking Medicare
and Medicaid patients; it was also treating the uninsured. He
agreed that would be a step forward, but said he would feel more
comfortable dropping the CON if those who wanted to provide
service did so 24 hours a day, took emergencies including
psychiatric emergencies, helped with the chronic inebriates and
did all the other things that only FMH did.
CHAIR DAVIS said they had quite a few people from Fairbanks
Memorial Hospital signed up to testify, but they were running
out of time. She asked if they were all in favor and, if so, if
they would be willing to come forward and simply state their
position.
6:29:54 PM
JUDY BOGARD, Fairbanks Memorial Hospital, Fairbanks, AK,
supported maintenance of the CON.
6:30:13 PM
KARL SANFORD, Associate Administrator, Fairbanks Memorial
Hospital, supported keeping the CON.
6:30:28 PM
KAREN PERDUE, Board Member, Fairbanks Memorial Hospital,
Fairbanks, AK, wanted to point out how fragile the system was.
She explained that Fairbanks was a city of only about 100,000
people trying to support a Hospital that might normally serve a
population of 250,000 or more, and emphasized that they did not
have the volume Anchorage did. FMH had done everything they
could to increase volumes; they were the only hospital in the
state serving the Indian Health Service (IHS); they served
Alaska Native Beneficiaries; and they did a lot of military
work. Finally, she said that if they were going to start eroding
the CON, there should be a requirement for providers to serve
the uninsured. That was the field the hospital was playing on.
6:32:32 PM
SENATOR ELTON said he thought the section was not as broad as it
was being interpreted. The way he read it, the 60,000 population
for a borough only applied to one component and that was
diagnostic imaging. This bill would not eliminate the CON in
total; it would only eliminate the CON for diagnostic imaging
centers.
CHAIR DAVIS agreed.
6:34:41 PM
RICK CAULFIELD, Director, University of Alaska, Fairbanks (UAF),
Tanana Valley Campus, echoed the concerns of others from the
Fairbanks area. He said their campus worked very closely with
Fairbanks Memorial Hospital and Denali Center (FMH/DC) to meet
work force needs in the health care field and they did not want
the CON eliminated. He was encouraged to see that the commission
envisioned under this legislation would focus on developing a
sustainable health care work force in the state, but could not
think of a better partner than FMH/DC in identifying and meeting
work force needs in the health care field; he was concerned that
doing away with the CON would negatively impact their ability to
partner with FMH.
6:37:18 PM
CHERYL KILGORE, Executive Director, Interior Community Health
Center, said they were a nonprofit Health Center that provided a
broad base of primary care services to people, many of whom were
low income and uninsured or underinsured. She was also a
Hospital Foundation board member and echoed their support for
CON. She felt erosion of the program would make it difficult to
meet the needs of the people in their community.
6:39:00 PM
MARK ROWDEN, Inpatient Supervisor, Pharmacy Department,
Fairbanks Memorial Hospital, Fairbanks, AK, and a member of the
American Society of Hospital Pharmacists, spoke in opposition to
any elimination of the CON. He said there had been a lot of
publicity pro and con about the economic ramifications of the
CON process; but shopping for the best price in health care
didn't really work. He explained that if patients went to more
than one physician, got multiple prescriptions and went to
multiple pharmacies to fill them, they would not get the benefit
of having their whole profile screened for drug interactions; he
was concerned about patient safety.
CHAIR DAVIS thanked him for his testimony and pointed out that
SB 245 would not eliminate the CON.
6:40:54 PM
DOUG BISHOP, representing himself, said he was not aware that
the bill only eliminated the CON for out-patient imaging, which
was an important point. Any elimination of the CON however,
would cause deterioration of the program. He reiterated that
they had an very good community hospital that put a great deal
of money back into their facilities and improved services. He
was concerned that erosion of the CON would dramatically effect
health care and health care availability in their area and did
not think enough research had been done to determine whether
that was true.
6:43:06 PM
DON KUBLEY, Lobbyist, Mat-Su Regional Health [Medical] Center
(MSRMC), wanted to echo some of the statements that had been
made about this bill. As Senator Dyson said, there was a huge
responsibility placed on hospitals to take care of anybody who
walked through the door, 24 hours a day, no matter what the
problem. He cautioned that he was pulling figures out of the air
and asked the committee to bear with his "60,000 foot
perspective," but said if you had twelve departments in a
hospital, 3 of them might be making money. It was those 3
departments that allowed the other 9 critical departments to
keep functioning.
He said when they talked about leveling the playing field, Mat-
Su had played by the rules and on a level field when they went
against the odds to get a CON from the state. As a result of
that they had invested approximately $120 million in the Center,
as well as $15 million in federal money to build a water and
sewer system from Palmer out to the facility. The Mat-Su Borough
now had one of the most sophisticated, best hospitals in the
world serving the fastest growing region in the state, and they
got that by playing by the rules and jumping through all of the
regulatory and monitoring hoops.
He continued that before it even opened, another building began
construction in front of it. It was Providence Hospital building
an X-Ray facility right in front of them, even though they did
not have the state mandated CON to build that facility.
Accordingly, MSRMC filed a grievance with the State of Alaska
and the state told Providence Hospital that the facility was
illegal; but they went ahead. That facility opened despite the
ruling and was sucking business from the Mat-Su Regional
Hospital against the rules that MSRMC had followed. He
admonished that anyone who told them this simple "tweak" to the
CON would level the playing field, was simply trying to
grandfather in a facility that had been wrong from the day
ground was broken. This bill was trying to change the rules in
th
the 9 inning of the World Series with 2 outs; suddenly they
wanted 4 outs instead of 3.
MR. KUBLEY admitted that he had not intended to testify today
and said, with all due respect to Mr. Betit and his
organization, of which MSRMC was a part, when he said a vast
majority of their members were in support of this he was
correct; but the 2 facilities that did not agree with that
position were the second and third largest facilities in the
state. Speaking for Mat-Su Regional, he felt this was just
another attempt to change the law and retroactively give them
[Providence Hospital] permission do run a facility they were
told was illegal. He said he believed the committee a had letter
from MSRMC's CEO Norm Stevens that outlined the severe damage
that facility was doing to their hospital. He hoped the
committee would take a good hard look at what that small change
would actually do to the level playing field in this state as it
had been for a long time.
6:49:42 PM
CHAIR DAVIS said SB 245 wasn't new. It had been heard twice
before.
MR. KUBLEY said he appreciated that and had testified on it
before, which was why he did not intend to do so today; but
there was a change in the title that put in X-Ray imaging
centers and completely changed the bill for Mat-Su Regional and
for the second largest hospital in the state, which was not
present because they did not know about the change.
CHAIR DAVIS argued the point, saying the change was not new.
MR. KUBLEY said it was the first time he had seen "diagnostic
imaging" in the title.
CHAIR DAVIS said he was right.
6:51:13 PM
PAUL FUHS, Lobbyist, Alaska Open Imaging Center, LLC.,
Anchorage, AK, said what they had just heard was a complete
mischaracterization of what was going on with this bill. He said
this [diagnostic imaging] was in the Governor's bill and in the
original version, it just was not in the title. Now that the
bill was restricted to this, it was proper to add it to the
title. He insisted that Alaska Open Imaging had also played by
the rules. The legislature passed a bill in 2003 but did not
define what the terms meant; this bill would just define the
terms. It had led to several lawsuits, and no one could make any
decisions with regard to imaging equipment in the state. It had
put the department in a no-win situation, so the Attorney
General said they had to at least define the terms and that was
what this bill did.
CHAIR DAVIS held SB 245 in committee.
There being no further business to come before the committee,
Chair Davis adjourned the meeting at 6:53:02 PM.
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