States’ Oversight Approaches to Hospitals’ Market Behaviors: A Set of 50-State Maps

By Karen Davenport, Julia Burleson, Abigail Knapp, and Kennah Watts

Hospitals present essential, complicated companies to their communities, reminiscent of trauma care, intensive care, and life-saving surgical procedures, and are additionally an vital supply of major and preventive care by means of their outpatient departments. However this vital care doesn’t come low-cost. The US spent $1.5 trillion on hospital care in 2023, which represents 31 % of complete well being care spending, with non-public payers shouldering greater than one-third of this spending. Personal payers additionally pay greater than twice as a loton common, as public applications for hospital care, and expertise considerably increased charges of development in spending for these companies. These dynamics elevate vital affordability considerations for well being care shoppers, with implications for medical health insurance premiums, cost-sharing tasks, and entry to care.

As state and federal policymakers study essential points within the American well being care system, notably the inter-related problems with protection, value, and entry to care, they want a deep understanding of how the general public sector at the moment regulates and, in some circumstances, workouts oversight authority over this vital part of the nation’s well being care supply system. Many of those regulatory and oversight actions happen on the state stage. To foster this understanding, and to tell future policymaking, CHIR examined states’ oversight of hospitals’ function in well being care markets and have arrayed the findings over a sequence of eleven distinctive maps depicting approaches in all 50 states and the District of Columbia. This evaluation ranges from states’ broad curiosity in understanding well being care spending and affordability, to extra focused interventions, particularly:

• Value development benchmarks
• State affordability workplaces
• Hospital transaction oversight
• Certificates of public benefit
• Certificates of want
• Anti-competitive contracting restrictions
• Hospital billing oversight
• Hospital monetary reporting necessities
• Hospital possession transparency
• Hospital value regulation
• Hospital shopper monetary protections

For the definitions of the phrases above, go to our glossary right here.

CHIR’s Early Findings and Observations

The CHIR staff shall be diving deeper into most of the matters these maps illustrate over the approaching months, reminiscent of value regulation, cost-growth benchmarks, possession transparency, and monetary reporting necessities. A few of our preliminary observations embrace:

• States take distinctive and generally idiosyncratic approaches to managing hospitals’ function within the well being care system. Some states take a constantly hands-off place to hospital regulation. Utah, for instance, workouts state authority in solely one of many eleven domains we examined¹. Different states are far more concerned in regulating hospitals’ market conduct. Oregon, for instance, exerts statutory or regulatory authority in ten of our eleven map domains and is arguably a coverage chief in transaction oversight and value regulation². Lastly, states reminiscent of Texas, which is one among 4 states within the nation that prohibit anti-tiering and anti-steering provisions in payer/supplier contracts, takes an in any other case comparatively laissez-faire strategy to hospital regulation as demonstrated by the dearth of transaction oversight authority.
• Coverage areas ripe for larger adoption embrace: value regulation, notably using reference pricing, with states increasing their use of this technique from state worker well being applications (SEHPs) to the business market; billing oversight, together with use of enhanced price evaluate and prohibitions on facility payment prices; and the extension of merger evaluate authority to post-transaction oversight.
• Some states are investing important capability in knowledge assortment and evaluation to grasp hospitals’ function inside their state’s complicated well being care financing and supply system. Organizations reminiscent of Massachusetts’s Heart for Well being Data Evaluation, the Maine Well being Knowledge Group, California’s Division of Well being Care Entry and Data, and comparable businesses in different states have developed subtle knowledge assortment, evaluation, and dissemination capabilities that enhance policymakers’ understanding of the well being care panorama.
• Greater than half of the states haven’t established sure monetary protections for hospital sufferers, reminiscent of requiring hospitals to supply fee plans or limiting rates of interest on medical debt. New federal insurance policies, mixed with Congress’s failure to increase enhanced premium tax credit (PTCs) for Market protection are anticipated to cut back medical health insurance protection by greater than 14 million folksconsiderably rising the chance that many shoppers will fall into medical debt. The absence of state-level monetary protections may due to this fact be of pressing curiosity to state residents.

For extra info, please go to CHIR’s interactive maps right here.