A bill filed at the Arkansas Legislature is an effort to clarify and regulate services partnerships between state supported medical entities and private health systems.
But it doesn’t appear likely to settle the disagreement between the central Arkansas health care providers that started it all.
The proposed legislation is the result of a simmering dispute that began when Conway Regional Health System objected to the University of Arkansas for Medical Sciences’ contract to provide emergency room and orthopedic services at Baptist Health Medical Center-Conway.
Conway Regional officials described the arrangement as an unfair competition in which UAMS — a taxpayer supported teaching hospital — provided doctors to a business rival.
“The essence is that UAMS has entered into a competitive market and offered services that benefit a competitor and using tax-supported funds to do that,” Conway Regional President and CEO Matt Troup said Tuesday.
The issue gained steam in late 2017 and drew the attention of lawmakers. In December, representatives from Conway Regional, Baptist and UAMS appeared before the Legislature's Joint Performance Review Committee.
Discussions there proved fruitless, according to Rep. Mark Lowery, who, along with Sen. Mark Johnson, are now sponsoring House Bill 1510, which would establish an “Any Willing Partner Law.”
The bill would amend Arkansas Code Title 4, Chapter 75, to define when a state-supported entity can provide billable clinical or coverage services to a private health system. It would also regulate billable clinical or coverage services offered in a health system-health care provider partnership.
The bill states: “The purpose of this subchapter is to prevent discrimination in the offering of clinical or coverage services to any willing partner, especially if the offering of clinical or coverage services disrupts the precepts of a fair and free marketplace by an institution of higher education or the University of Arkansas for Medical Sciences.”
Lowery said the bill would expand — not limit — what UAMS can do. But UAMS Chancellor Cam Patterson said on Wednesday that the bill would effectively deny or remove vital coverage and services for Arkansans.
“The state of Arkansas needs about 500 additional primary care providers over the next 10 years,” said Patterson, who joined UAMS in the midst of the controversy in June. “We are the sole entity that trains those primary care providers and our ability to provide these regional programs would go away through this legislation.
“This legislation would cost the state $160 million a year and would result in a net loss of 1,000 jobs. It’s bad for health care. It’s bad for the economy of the state and it’s bad for the 3 million people who live here in Arkansas.”
Baptist Health-Conway opened as a 111-bed facility in 2016. Conway Regional Health System began in 1921, has a 150-bed main clinic and 12 intensive/cardiac care unit beds in Conway and provides services for five central Arkansas counties.
UAMS was founded in 1879, is the state’s only academic health center and is part of a statewide network under the University of Arkansas System. Its Little Rock hospital is a 514-bed facility that features the state’s only adult Level One Trauma Center.
By requiring UAMS to guarantee contracts for all, Patterson said, the bill would guarantee contracts for none because UAMS’ resources are “not endless.”
Lowery, a Republican from Maumelle, said the bill was necessary to ensure fairness in the marketplace and has been well received by legislators once they’ve learned its details and purpose.
“That seems to resonate with members that that’s not right and we need to do something to level the playing field and make sure that all the health care providers are given the same opportunity,” Lowery said.
Lowery said that since the dispute came up he has heard concerns from different parts of the state.
“I think the issue is that you have to make sure that a state entity like UAMS, though they do excellent work and they have a great mission, that the state subsidy — basically, the state funding — does not create a situation where UAMS is able to subsidize services to one hospital in competition with another hospital,” Lowery said. “Or one health care provider in unfair competition with another health care provider.”
With legislation pending, Troup said Conway Regional was not currently considering legal action. While he wouldn’t forecast the outcome of the legislation, he said conversations with lawmakers and community members had been supportive.
“It’s very fair. It’s very open,” Troup said. “It asks — or requires I should say — UAMS to be very open and transparent about its transactions in these kinds of situations and under what circumstances those will be in the scope of UAMS’ mission and when it will be outside UAMS’ mission. ... I think people will have a hard time finding something overtly wrong with the bill.”
Baptist Health-Conway has seen its admission and emergency room visits climb since opening, but reported a combined loss of $55.6 million in 2016 and 2017. Conway Regional saw a decline in admissions and emergency room visits after Baptist Health-Conway opened.
UAMS officials have described the contract with Baptist Health-Conway as nothing unusual. It has more than 160 contracts with other providers in the state, including Conway Regional and a majority of the hospitals, and has had a relationship with the Baptist Health System for more than 20 years.
The contracts are frequently based on community need, Patterson said, noting that facilities around the state have requested orthopedic services like those provided for in the Baptist Health-Conway contract. That isn’t possible because of the limits on UAMS’ resources, Patterson said, noting that the bill would place further demands on resources and harm relationships with a number of entities.
“No. 1, this would unravel our 40-year partnership with Arkansas Children’s Hospital and would adversely impact care of children across the state,” he said. “No. 2, this would undermine our very close relationship with Veterans’ Hospital and would affect Arkansans who have served our country nobly. No. 3, this would adversely impact our ability to provide services outside of Little Rock.”
Lowery said late last week the bill had been undergoing some language tweaks and clarification while it collected co-sponsorship commitments from legislators. The amendments were expected to be in place early this week.