When hospitals consolidation take place, it might be a good cause of concern for consumer healthcare advocates as the possibility of shrink healthcare could possible take place in the future if conditions are not in place to prevent that.
On Nov. 21, State Attorney General Xavier Becerra approved the Ministry Alignment Agreement between Dignity Health and Colorado-based Catholic Healthcare Initiatives to join the two systems to become CommonSpirit Health, which will be controlling more than 30 hospitals in California.
However, the Attorney General’s approval includes significant conditions that keep key services open for 10 years, ensuring charity care levels at historical levels, and $ 180 million in capital improvements, two concerns for consumer healthcare advocates.
“We support the Attorney General’s work to impose strong conditions on this hospital merger, part of a worrying trend toward an increasingly consolidated health care system,” said Anthony Wright, executive director, Health Access California, the statewide health care consumer advocacy coalition. “These conditions will help ensure that patients and communities served by these hospitals will continue to have access to critical services, for at least a decade if not more,”
Becerra’s conditions included commitments to keep key emergency and women’s reproductive health services open for at least 10 years, as consumer advocates sought, beyond what was committed by Dignity and Catholic Health Initiatives.
“Consumer and health advocates had sought to keep these emergency, women’s health and other services open longer than the initial commitment because of the important role these hospitals play in the community,” Wright said.
As part of the conditions for the Dignity-CHI hospital deal to take place, CommonSpirit Health, also agreed, for the first six years, to maintain or increase charity care and community benefits investments, provide free care to those uninsured patients under 250% of the poverty level, actively publicize their financial assistance and charity policies, and make a $ 20 million investment for coordinated care for homeless patients.
“The commitment for CommonSpirit Health to provide, and publicize the availability, of free or discounted care for income-eligible uninsured patients is welcome and needed at a time when California continues to have 3 million remaining uninsured even after major and successful coverage expansions,” Wright said. “These commitments both incorporate existing charity care and fair pricing laws and expectations, and go beyond them to meet the real needs of California’s communities,” said Wright.
“We also welcome the new investments in coordinated care for homeless Californians, which is a small fraction of the worth of this mega-deal but will have a beneficial impact for those served,” he said.
Health Access California and other consumer, community, and health care groups had submitted written and oral testimony in the multiple hearings around the state seeking conditions on this transaction.
One major concern from LGBTQ groups was CHI’s adherence to Ethical and Religious Directives which restricts access to reproductive health services and services for transgender patients.
The conditions of the deal also prohibit discrimination against LGBTQ patients. Consumer and community advocates had sought more explicit protections for specific services but will be vigilant, according to Wright.
“We are pleased that the Attorney General’s conditions require CommonSpirit Health facilities to have written policies banning discrimination against lesbian, gay, bisexual, transgender, and queer (LGBTQ) Californians, and for those policies to be strictly enforced”, said Amanda McAllister-Wallner, Director of the California LGBT Health & Human Services Network. “Access to affirming health care continues to be a major challenge for many LGBTQ Californians, and so we hope the AG is vigilant in monitoring this anti-discrimination condition which is crucial to achieving our health equity goals.”
“California hospitals and health care providers should be held to the highest standards of providing affirming health care,” she said.
“We are glad that the Attorney General imposed standards for maintaining key services, as well as charity care and community benefits, as the Department of Justice has done for other transactions,” Wright said.
Also consumer and labor groups sought protections against anti-competitive contract provisions, but the deal doesn’t incorporate them.
“We are disappointed that the approval does not include conditions against anti-competitive conduct and contract provisions, as consumer and labor advocates had sought,” Wright said. “We think such conditions to protect competition will become even more important for pending and future mergers between two in-state hospital chains, which will exacerbate the concern about consolidation inflating health costs.”
Consumers and healthcare advocates push for monitoring of the deal as it gets implemented.
“We urge the Attorney General to monitor this deal closely into the future to ensure the goals of these conditions, from improving care for the uninsured and underinsured, to the continuity of care for patients served by these hospitals,” Wright said.