Editorial Roundup: Pennsylvania

Philadelphia Daily News/Inquirer. May 9, 2024

Thirteen states have taken action to ban the charges and protect consumers. In Harrisburg, a similar proposal has stalled in the General Assembly.

There’s so much unfairness in America today that it shouldn’t be surprising to see people take to the streets in protest because they no longer believe needed changes will ever occur if left to the broken political system that’s supposed to ensure right ultimately beats wrong.

What’s unfair?

How about going to your doctor for years and only being charged your health insurance copay, and then getting a bill in the mail after your last appointment saying you owe an “outpatient facility fee” of $50, $100, $200, or more. These fees cover expenses that aren’t directly related to your care, such as air-conditioning or security for your doctor’s office.

If your doctors are charging fees you were not being asked to pay before, they may have quietly ended their independent practice and become employees of a hospital system that now considers that office an outpatient center — which, by law, can charge nonmedical fees for services at a hospital “ambulatory care” facility.

More and more people are being charged facility fees because more and more doctors are no longer independent. Hospital ownership of physician practices grew 124% nationally between 2012 and 2018, according to a Georgetown University study. By 2021, an astounding 74% of all physicians in this country had become employees of hospitals or corporations.

Not only are most physicians no longer their own boss, they also must follow treatment rules imposed by health insurance carriers, even if they don’t agree with them. That dynamic has greatly impacted the doctor-patient relationship, which researchers in a 2015study say is “one of the most moving and meaningful experiences shared by human beings.”

Along with excessive fees for office visits, patients must pay the ever-increasing premiums and deductibles charged by medical insurance companies. That double whammy is one of the reasons polls show many Americans remain uneasy about the economy despite its improvement. They see little or no relief in either their grocery or medical bills.

President Joe Biden has taken notice of the facility fees issue. “The travel industry has figured out how to charge customers $90 a night in resort fees for hotels that aren’t resorts,” he said recently. “Hospitals are trying to do something similar … charging hidden facility fees for going to a doctor’s office in the building owned by the hospital.” But with Congress still flailing in a partisan swamp, not much can be expected from Biden.

That is why 13 states (Connecticut, Colorado, Florida, Georgia, Indiana, Maine, Maryland, Massachusetts, Minnesota, New York, Ohio, Texas, and Washington) have written their own rules to protect patients from being gouged by hospital corporations that seem more concerned with producing maximum profits than treating patients fairly.

Connecticut has the strictest law, which prohibits any hospital or health system from charging a facility fee for services provided on a hospital campus outside of its emergency department. Other states have less restrictive rules, but a common thread among most of the new laws is a requirement that hospitals notify patients in advance that they may be charged fees their health insurance does not cover.

Pennsylvania, so far, has not even done that. Facility fees bills have yet to make it out of committee, including legislation introduced during the last session by two Democrats serving Chester and other nearby counties, State Sen. Katie J. Muth and State Rep. Dan K. Williams. Their proposed changes wouldn’t prohibit facility fees but would require prior notice to patients before they are charged. The legislation would also require state notification when ownership of a physician’s practice changes.

State Rep. Kathy Rapp of Warren, Republican chair of the House Health Committee, told the Meadville Tribune that the facilities fees proposals have stalled because “there have been issues with insurance companies opposing it.” But the insurance companies neither collect facility fees nor include them in their medical services payments to hospitals.

One must ask: If a physician was able to both pay the light bill and provide competent medical care to patients before selling that practice to a hospital, why must the hospital that bought the practice now charge patients an added fee to cover the same maintenance costs?

Revenue goals obviously mean more to some of the enterprises running hospitals today than the compassion for patients traditionally associated with the practice of medicine.

Government reimbursement regulations, insurance company directives, and, yes, corporate greed have changed today’s medical profession. As a result, more steps are needed to protect health-care consumers. Among them is imposing reasonable restrictions on the unfair charges and fees hospitals seem to be collecting from patients — not because they need to pay their bills, but because they can.

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Scranton Times-Tribune. May 12, 2024

The passage last week of a bill that will ban motorists from handling cellphones on Pennsylvania roadways was a testament to the determination of one grieving mother from Scranton whose son was killed by a distracted tractor-trailer driver in Monroe County in 2010.

Known as “Paul Miller’s Law,” the measure, expected to be signed this week by Gov. Josh Shapiro, will impose a fine of $50 for first offenders and add additional jail time for those convicted of homicide by vehicle in crashes involving cellphone use. It aligns Pennsylvania with 28 other states that forbid drivers from using hand-held cellphones, including all of the states that border the Commonwealth.

The law exempts the use of hands-free systems, but it does apply to drivers stopped at traffic lights or sitting in traffic.

Miller’s mother, Eileen Woelkers Miller, who became a traffic safety advocate after the death of her 21-year-old son, lobbied tirelessly for its passage in the General Assembly for more than a decade.

That such a common-sense measure took so long to become law illustrates the difficulties of navigating the competing and often conflicting interests in Harrisburg. The measure finally won majority approval with the addition of language requiring state police and police in municipalities with more than 5,000 inhabitants to collect and publicly report data on traffic stops, including the reason for the stop, details from a search of the vehicle and the race, ethnicity, age and gender of the driver.

The traffic-stop reporting language was sought by the Pennsylvania Legislative Black Caucus, which feared the new law could be used for racial profiling. State police recently began voluntarily collecting and reporting that information and some municipalities already do so, but this bill brings uniformity to the process, making for easier utilization of the data.

In that sense, the law achieves two worthy goals, promoting transparency and accountability in policing and making Pennsylvania’s roads safer. Who hasn’t encountered distracted phone users on the Commonwealth’s highways straying from their lanes or slowing down or speeding up in unpredictable ways?

Statistics show that in most years, distracted driving is the second- or third-leading cause of accidents in Pennsylvania, ahead of alcohol use, careless passing and tailgating.

For the first year after the bill is signed into law, violators pulled over for cellphone use will be issued just a warning. The data collection provision will go into effect after 18 months.

For Paul’s Miller mother, the achievement is necessarily a bittersweet one, but all Pennsylvanians owe a debt of gratitude to her and the legislators who labored over the years to finally make the bill that bears his name into law.

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Pittsburgh Post-Gazette. May 13, 2024

Pennsylvania House legislators have come out in strong support of maternal doula care with a package of bills affectionately called the “Momnibus.” Unfortunately, the next stop will be the Senate, where, despite bipartisan support, another measure to fairly compensate doulas has languished for over a year.

It’s time for the upper chamber to join the universal push to properly compensate, accredit and recognize doulas. They are the non-medical personnel who help new parents through pregnancy, childbirth and breastfeeding. A 2023 meta-analysis of birth outcomes showed that care from doulas effectively reduced rates of cesarean sections, low birth weights in babies and premature labor — all investments that reduce medical costs for both mother and child, with benefits that may last through their lifetimes. But without the proper compensation and best practices mandated by these bills, the doula community won’t be able to expand in the state.

The biggest boost that the bills provide for doula services is coverage under Medicaid. Right now, new mothers on the low-income health care benefit had to pay for doula care out-of-pocket or with the help of grants. Opening up options to Medicaid recipients will expand doula access for hundreds of thousands of Pennsylvanians: Between 2017 and 2021, a third of all births were covered by Medicaid.

Supporting supportive maternal care is of particular importance for women of color. Pregnant and postpartum Black women in Allegheny County face a death rate two and a half times higher than their white counterparts, so establishing proven practices that focus on cultural sensitivity is vital.

The bills also establish a Doula Advisory Board to gather overall expertise, establish accreditation and education best practices, and highlight the biggest areas of need. It’s a proper supplement to the state accreditation system meant to meet Medicaid guidelines launched two years ago.

The accreditation process juggles the sensitivity of regulating a practice often built from passed-down expertise and experience with the necessity of preventing incompetent providers from causing harm. To that end, the mandatory training remains minimal, while in-depth, detailed letters of recommendation from experts and a review of maternal outcomes play a much larger factor. This careful construction of the regulation has brought in numbers of applications that surpassed expectations multiple times, and the new advisory board should take note.

Maternal care is also a hot topic as rural hospital systems close labor and delivery, postpartum and neonatal units across the state. Six Pennsylvania counties currently offer no maternal medical care at all, leaving expectant mothers with no choice but to travel. While doulas can’t (and shouldn’t be expected to) replace medical providers, their role in creating positive maternal outcomes is vital for addressing larger shortcomings across the traditional medical establishment.

In all, the Pennsylvania Department of Health, nonprofits like the Doula Commission and the state House have all laid the groundwork for the launch of a successful alternative maternal care system. Now, the Senate needs to place the capstone.

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Uniontown Herald-Standard. May 11, 2024

The Washington County municipalities of McDonald and Midway, along with Robinson and Mount Pleasant townships, are considering regionalizing their police departments into one unit rather than four separate entities. Town hall meetings have been held on the subject and, from our vantage point, the advantages would outweigh the disadvantages.

The individual municipalities would lose complete control over their police budgets, and someone would lose out in the competition to lead a regional police force. Still, pulling together a regional police force would be a winner for residents, who would have more officers, more patrols, and a force more able to attract and retain officers through higher salaries and more opportunities to move up in the ranks.

More communities across Pennsylvania need to consider similar efforts at regionalizing services, or even merging with one another

Only Texas and Illinois have more municipalities than Pennsylvania. Because the commonwealth does not have unincorporated land that would fall under the control of county government, Pennsylvania is a patchwork of boroughs, cities and townships. These municipalities have a variety of authorities that handle public services like water treatment and hospitals. Then, there’s the multiplicity of school districts, each with their own administrative structure.

Taken to its extreme, Allegheny County has the most municipalities of any county in Pennsylvania – a jaw-dropping 130. The smallest is Haysville, with fewer than 100 residents.

Most of these municipalities and school districts were established decades ago, and residents and their elected leaders are often reluctant to merge or consolidate services with other communities because of the loss of identity that would come with it. For example, almost 20 years ago, residents of Coal Center in Washington County nixed a proposal to join with its larger neighbor, California Borough, even though Coal Center has only five streets.

David Rusk, a senior fellow at the D.C. Policy Center in Washington, D.C., said at a forum sponsored by Spotlight PA in 2023 that many of Pennsylvania’s communities and school districts can be classified as “little boxes” and that “the almost unspoken mission of every little box government and every little box school district is to keep our town or keep our schools just the way they are, for people like us, whoever ‘us’ happens to be.”

If residents can break out of this mentality, it could pay dividends. There would be less reliance on property taxes, bulk purchases could be made at lower costs, services would improve and faltering communities would be stabilized. It would also be a boon to economic development.

We hope that the merger of the police departments in the four Washington County communities happens. And we hope it serves as a much-needed example for other municipalities.