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Senate | May 8, 2013 | Committee Room | Finance

Full MP3 Audio File

Good afternoon. The Finance Committee will come to order. Welcome. Today our pages in the Senate are Kristen Mora, Senator Jenkins, Jordan Thomas, representing sponsor by Senator Blue. Our Sergeant at Arms staff is Earnie Shell, Donna Blake, Anderson Meadows and Canton Lewis. You're welcomed. We're not going to be hearing House Bill 484, the Permitting of Wind Energy Facility, we will be hearing it in another finance committee next week. We will be hearing today, Senate Bill 473, Health Cost Care and Reduction and Transparency, going to be given by Senator Rucho. We have a PCS, a motion to hear the PCS by Senator Hise, all in favor say aye. [SPEAKER CHANGES]Aye. [SPEAKER CHANGES]Opposed no. Senator Rucho. [SPEAKER CHANGES]Mr. Chairman, thank you, members of the Finance Committee, it's good to be back. I know we had some good questions and good debate last time. Senator Tarte was helpful in putting some simplicity and understanding. We've also got some great feedback from many of the stake holders. I'm going to very, go over the high points, Ms. Reilly will help us with some additional detail as this bill goes forward, and so, let me start. What this is, is the first time that we can start to get some cost information on various hospital procedures as part of our cost transparency, and I don't know if you've heard this morning, but apparently the federal authorities have been collecting this information for a number of years. We'll have a opportunity to compare it to North Carolina. Actually there was one example they mentioned on the news this morning that said that there was a surgical procedure done at one hospital and it cost $8,000 and the same surgical procedure was done at another hospital and it cost $38,000. Maybe we can find out why those things are so different. And again, this is all about providing the opportunity for consumers, and also for the individuals, the business people that are paying the bills on health care, to start to get a better picture as to what is the real cost of health care, and where they should put their health care dollars, and the like. So, this is an effort to set the platform in place, and understand, this is a first step in a process so we can find some of the information on how we can best get control over the cost of health care that's so important to our future. The cost that would be included would be charged to someone who is uninsured, the average negotiated payment for the uninsured person, the Medicaid rate, the Medicare rate, the range of commercial payments, and the state health plan rate. That is the gambit of what the State of North Carolina and the consumers would be interested in. We also have some feedback and decided that the best way to collect this data and use a repository is VHHS will collect this data, not NC Health Informations Exchange. And there were questions on who owned the information, and the like, and what we've done is eliminated that concern completely, and it will be part of the Medical Care Data Act. We also changed the fact that we moved away from episodes of care to a building block of that, and that is DRGs, every health care provider, every hospital facility understands exactly what are DRGs. There are many thousands of them, and if you lump a bunch of DRGs together, that is one episode of care, basically. But what we'll be allowed to do is get a clear picture of not bundling, but what each of those costs will be, so it is actually a more knowledgeable way of collecting the cost data. We've decided to do the top 100 DRGs and report that information for hospital out-patient settings, for hospital settings, ambulatory surgical facilities, and we'll change a little bit on those because they have a different terminology called Hicks Picks, you don't want me to explain that to you. But what is does do, is we'll look at the top 20 surgical procedures in ambulatory care, and the top imaging procedures in ambulatory care. It would give us a good cross section of what health care costs would be under the most used procedures.

Also have a portion on certain charge of payments and what that is is help kids services charges or accepted payment for any health care procedure or component of health care or procedures. Was not performed or supply unlawfully what that really means this was part of the radiology section. With some input from every body we decided that the best way to manage this is not to look at radiology but determine what cost would be or remove any possibility of duplication of a procedure. Trough any medical or surgical procedures, or DRGs it didn't target one specific area. What it is is a universal system that we will not, universal statement that we will not. State government will not be involved or part of any contract that will allow for a double costing of a procedure. And remember by doing this and whether its the entire transparency bill or this section, its all about controlling health care cost. Which we are all trying to get done. Part four will also talk about the fact that we prohibit still a UNC and ECU form utilizing dead off collection procedures to collect outstanding debts to tactual garnishment of tax refund, lottery winnings and alike. We believe that UNC and ECU, great institutions, should be treated like any other hospital and therefore would be able to use the normal procedure trough the legal system. As any other hospital facility or any other business for that mater. And then we are talking about fair billing practices. What that is, this is the part talking about the fact that when you get a bill, when you requested as a patience. You will have one that you can actually understand in its design language comprehensible to an ordinary lay person. That means the bill will come in there, won't be bundling it, will be clear as to what you are charged for the procedure all the components of the procedure. So once you sit down and try to understand what you been bill for, you will have a clear understanding. That goes along way for helping the process. Also part of the fair billing practice section, the bill also prohibits leans from attaching to primary residence's of a husband or wife when there spouse has died. It is trying to be sure that the consumer has some protection. The governments entity to manage care and control, we are not specifically the telling CCNC that they need to have or not have people on their board as it was question earlier. But more importantly wanting to encourage them to put on that board, not just the provider of health care those are the ones that would receive the money. But some folks on that board that are the payers on it. The ones that buy the insurance for their employers or that pay it individually so that they have a full understanding on what it cost. But more importantly how does that business entity pay for it. Those would be, the bill will describe by the section by the president Pro Temp and the speaker. Hopefully they'll put those folks forward. Mr. chairman that is a quick over view. [SPEAKER CHANGES]. Mr. Rayley has anything else. [SPEAKER CHANGES]. Thank you senator Rucho do you have any thing else you would like add ?? [SPEAKER CHANGES]. I really don't have a whole lot to add senator Rucho when trough that in great detail. I would be happy to do a line by line if you want though. [SPEAKER CHANGES]. what is the pleasure Mrs. dale [SPEAKER CHANGES]. no takes on that but if you have any question you can address them. [SPEAKER CHANGES]. thank you. We will open the floor to question from the members of the comity. Question, numbers for senator Rucho. Senator Woodard. [SPEAKER CHANGES]. Thank you Mr. chair on page two senator Rucho, line 37. I'm trying to think trough this. But the hospitals will give the amount of payments that they have received, form the five largest health insurers. I'm wondering why you limited to the five largest. And two, I'm wondering whether that might have some effect on the competitive nature, on what this health insurance do. Are you basically, not reviling the full contract of each health insurance? [SPEAKER CHANGES]. we are trying to act.

we had my cities. there was some concerns about negotiated prices in an proprietary information and what we try to do to get it average and a range so that there can be some cap harasses without losing proprietary information and follow-up Mister and so you don't end up putting any carrier at a disadvantage of those who want to undercut correct whenever the issue follows just one of page three. now, beginning on the eighteen Steve that the disclosure of charity care policy and cost and use the EEC are effective. the information must be given a format and on a schedule pretty much determined by the State Department. are you saying that they have to adopt a reporting period different than the reporting period. nineties [SPEAKER CHANGES] my understanding is in and if I'm wrong, will get correct information is there making this report. anyhow, in which is directing you to the repository in a list with the schedule H ninety five pictures of their doing it on the same [SPEAKER CHANGES] when they found the nine nineties. that's when the file in it, rather than having a valid on and on a more current bassist goes than ninety legs about a year and a half or two years of that provides that information be provided annually to the departments would be what was available that your questions are the attempts that runs our [SPEAKER CHANGES] thank you terms may be a question for staff, a notice of that does have fiscal note on us, as does have a fiscal impact someone is trying to decipher what the fiscal impact of their cost, say in your who give evidence of force [SPEAKER CHANGES] thanks research division, nothing will impact of the state is not in the general fund. that's why you don't get on the table on the front of the front of the book on that. however, there is a cost to me. see you that the late VCU faculty practice plan author community healthcare system, and that by not being allowed to collect revenue using the setup debt collection act, they will be losing the revenue that they are currently collecting that grew his procedures to process and distribute to third minds DVDs they would be losing that revenue they would find another mechanism to to talk collected through similar collecting agency other than using the Department of revenue is neglecting each correct. there are other mechanisms that UN continues to attend to collector unallocated. they already are, are able to use other mechanisms to collect revenue as well. having to use the FECA to collect us. however, if you are other mechanisms that I did so good I want to thank you for bringing this bill forward. I can tell you what pleases me the think that this was serious of a movement towards reducing our healthcare costs also be similar to understand my medical bills through change without allowed us to the medical and/or local degree in the case when the times of paper that looked for a favorable report register. we have a couple of moral questions and is thank you sincerely good in a novel safe use it to Senator Brown joins me in trying to get this accomplished in this is any bad news. it goes to Senator Brown and only good news to me, we would expect nothing else to do this at the same original also thank you for writing this forward. I think that a lot of hard work into it. now they give CNN the good thing for the citizens of North Carolina understanding wheels from the hospital and he was moving. thank you, Sharon Johnson reaches around again. I grew that certain cooking so you had to have a loan agreement that you will agree. does you no good and really medical bills you all had New Year's price and for my clients and it's still very hard to interpret in the indecipherable ethic, yet I have a special degree in medical billing or something like that should have universities won't be created, PhD, for that is that his program is sorely overdue. I used to have a medical savings entail and how is God walked past with Cisco calls me when I can pay him a medical savings account that I could ever tell me that you know I will restate maybe this year you'll you'll find out in three months

I'm looking forward to voting for this one on the floor. [SPEAKER CHANGES] Thank you. Its designed so that the individual can make a decision based on the fact. You go out to Walmart or some place you know what the cost is. Well we may not get right into that degree but we'll get a lot closer with this. Thank you. [SPEAKER CHANGES] Thank you senator Daniel. Thank you mr chairman. Senator Rucho in regards to the amount collected in the chart over the past five years. The garnishments from these university high schools. Does the staff know how many garnishments it took to get to that level so that they may have an idea of how many cases they would have to file to collect that? [SPEAKER CHANGES] Thank you. I'll allow the staff to answer if you can please. [SPEAKER CHANGES] Denise Harp physical research division. I don't have that information available but could get it from the University system. [SPEAKER CHANGES] Thank you. OK anyone else in the committee? Any more questions? If not we will hear from the audience at this time. If that's ok? We do have a sign up sheet to not have them. And we have a few people that want to speak. Chuck Stone. Please sir if you would turn on the mic. Introduce yourself. [SPEAKER CHANGES] Thank you Mr Chairman. Chuck stone obvious for state employs association for North Carolina. We support this bill. I pray the concerns about the ECU med school UNC med school that it may well be state employs and the state health plan may be overpaying well in excess of 300 million dollars per year for hospital cost. We urge you to support this bill. Lets put the state health plan on sound financial footing. [SPEAKER CHANGES] Thank you mr stone. Cody Hand, welcome back. [SPEAKER CHANGES] Thank you. Good afternoon everybody. Cody Hand, North Carolina hospital association. First of all Senator Reach I thank you so much for working on this with us on this bill. The first version that came out I think it was a good bill but it was something that we were having problems complying with given the terminology so. Senator Reach you and your staff have been very good at working with us to get this to something that we can be very proud of. A few points, first of all we're very proud of our charity care policies. We are fine posting those, we want everybody to know first of all that we have charity care and we want it to be available to everybody who qualifies. Second of all that we spend a lot money on charity care every year so thank you for bringing that ?? ??. One thing that I do wanna talk about and senator Reach and I have talked about this. Is the data that you're going to be getting from the hospital is hospital data only. We have no control of what anesthesiologist charge and we have no control over when they charge that. And we cant know that because of the HIPPA laws. The same applies to the surgeons and the physicians that are not employed by our hospitals. So while we do think this is a great step forward until we can get that full picture of what happens in a hospital facility based on all those indpendent charges. It's only gonna be half of the picture. I would encourage you to tell all of your patients and all of your constituents. To go to their hospital when they need a procedure and give them their insurance information or if their uninsured, their financial information, so that we can give them a picture of what it would look like for them. Really our hospital charges mean nothing until we take into account each individual patient and everyone of our hospitals is going to do that. Again senator Rucho I thank you so much. [SPEAKER CHANGES] Senator Rucho. [SPEAKER CHANGES] Thank you. We appreciate your help in trying to make this a better bill. And understand the members of the committee this is the platform that we start with. We will refine this and include what will the anesthesia cost primary physician's cost, but it all has to have a starting point. We have a platform and then we can build on it accordingly. [SPEAKER CHANGES] Thank you sir. Since there's no more comments or questions, we have a motion by senator Cooke unfavorable to the original. Favorable to the PCS. All those in favor of the motion please say aye. Opposed no. Ayes have it. Motion carried. [SPEAKER CHANGES] Thank you members of the finance committee and appreciate you helpin. [SPEAKER CHANGES] If there's nothing else to come before the committee today the committee is adjourned.

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