Inslee orders state to update hospital-merger rules

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Pressed to address the many recent hospital mergers and affiliations with Catholic health care systems that proscribe some types of reproductive and end-of-life care, Gov. Jay Inslee has directed the state to modernize its process for approving changes in hospital ownership or delivery of care.

Hospital realignments, although presented as "affiliations," may be similar to traditional sales, Inslee said in a recent directive to the state's Department of Health. Changes in control of the hospital may affect access to health services, cost containment or quality of care, he said.

"I am very concerned for the potential of these relationships to lead to restrictions in constitutionally protected care for Washingtonians," he said in a letter to Kathleen Taylor, executive director of the ACLU of Washington, whose organization has taken issue with potential curbs in services because of affiliations governed by religion-based health care systems.

Considerations about how such arrangements might affect access, costs and quality -- not what a hospital calls the deal or what it says in preliminary documents -- should govern how the state's approval process is applied, Inslee said in the directive.

The process has not kept current with how the health care delivery system is changing in response to the new federal health law, he said.

Inslee also directed the Department of Health to consider ways to improve hospital transparency for consumers and ensure that hospitals make public their policies on nondiscrimination, end-of-life care and reproductive services. The department should also take into account the principles and policies contained in the federal law, he said, including the guarantee of choice for patients.

Inslee's directive could lead to revised rules for the state's Certificate of Need program, which assesses substantial changes in health facilities' services, size and ownership. The Department of Health on Wednesday began the process to revise the rules.

In the letter to Taylor, Inslee said his office had not yet identified any situations where Washington residents had been denied access as a result of mergers and affiliations. However, he said, it was continuing to examine "a number of scenarios" that might Klimit patients' access to certain types of care.

Inslee noted that the state is a major purchaser of health care services.

As such, the state "must be vigilant in ensuring that these proposed mergers, restructuring and affiliations occur in an open, public manner and receive the scrutiny necessary to determine that important hospital facilities and services continue in the best interests of the public."

He said there were many unanswered questions about how hospitals will operate after a merger, restructuring or affiliation, and what services will continue to be available or how they might be modified. "I believe the state should use its legally available tools to ensure a more transparent, thorough and systematic review of these proposals."

In response, the American Civil Liberties Union (ACLU), in a letter signed by eight other groups, said the governor's action was an important step but far from the only one needed. It said restrictions on patient access based on religious doctrine already have occurred.

Inslee said the Office of Financial Management would review specific access-to-care concerns the ACLU identified.

The state must report the status of the rule-making process to the governor by Oct. 31.