BILL ANALYSIS Ó
Senate Appropriations Committee Fiscal Summary
Senator Christine Kehoe, Chair
SB 336 (Lieu)
Hearing Date: 5/2/2011 Amended: 3/21/2011
Consultant: Katie Johnson Policy Vote: Health 9-0
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BILL SUMMARY: SB 336 would require all hospitals with emergency
departments to develop and calculate a "crowding score" and to
submit a full-capacity protocol to the Office of Statewide
Health Planning and Development (OSHPD) in order to mitigate
emergency department overcrowding. These provisions would sunset
January 1, 2016.
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Fiscal Impact (in thousands)
Major Provisions 2011-12 2012-13 2013-14 Fund
Impact on publicly-funded unknown, potentially
significantGeneral/*
health programs, including costs and savings Federal/
Medi-Cal and Healthy Families Local
*Medi-Cal costs shared 50 percent General Fund, 50 percent
federal funds ongoing; Healthy Families Program costs shared 35
percent General Fund, 65 percent federal funds; the state
General Fund portion may include local funds and subscriber
premiums.
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STAFF COMMENTS: This bill may meet the criteria for referral to
the Suspense File.
Staff notes that this bill may meet the criteria for referral to
the Suspense File for the following reasons: there could be
costs and savings.
a) If this bill were to result in an emergency department's (ED)
ability to see patients more efficiently, and thus cause a net
increase in the number of patients seen in a day, there could be
increased costs to the state in the form of claims for
reimbursement for services rendered to Medi-Cal, Healthy
Families, and other publicly-funded health care program
beneficiaries.
b) In contrast, there could be savings to the same
SB 336 (Lieu)
Page 3
publicly-funded health care programs to the extent that ED
efficiencies reduce wait time and thereby decrease the length of
inpatient hospitalizations and correlate with improved health
outcomes.
Any costs to the California Department of Public Health to add
additional criteria to its licensing inspections or to OSHPD to
collect and store full-capacity protocols would be minor and
absorbable. Costs to hospitals to develop and calculate crowding
scores, to create a full-capacity protocol, and to train staff
would be minor. However, the state would not reimburse them
directly for those costs. Those costs would put minor
pressure on hospitals' administrative costs which would in turn
put pressure on the rates that hospitals charge insurance
providers and patients, including those paid to publicly- funded
health care coverage programs.
This bill would require all licensed general acute care
hospitals with an ED to:
1) Calculate a crowding score with the prescribed formula
every 4 hours and would make allowances for small and
uncrowded hospitals;
2) Develop a crowding scale and assign ranges of crowding
scores in 1 of 6 categories, with category 1 representing
the least crowded and category 6 representing the most
crowded;
3) Develop, implement, and file with OSHPD, by January 1,
2013, a full-capacity protocol for each of the six crowding
scale categories that would address the notification of
hospital staff and changes in hospital and ED operations,
such as bed utilization, transfers, elective admissions,
and discharges.
This bill's provisions would be operative until January 1, 2016.
There are 342 hospitals with EDs in the state as of December 31,
2010, according to OSHPD data.
The California Hospital Association is planning to conduct a
pilot program with at least 15 member hospitals in order to test
the relevancy of the variables used to calculate the crowding
score contained in this bill as well as test new variables not
contained in the calculation.
SB 336 (Lieu)
Page 4
This bill is nearly identical to AB 2153 (Lieu, 2010), which was
held on the Senate Floor, and AB 911 (Lieu, 2009), which was
vetoed by the Governor. In his AB 911 veto message, he said,
"Although I support the intent behind this bill, statute is not
necessary and I do not believe it will provide any significant
improvement to the underlying problem?I would encourage them
Ýhospitals] to use the crowding score outlined in this bill and
work to develop full-capacity protocols that best address their
individual needs."
AB 2153 passed out of the Senate Appropriations Committee 7 - 3
and AB 911 passed out of the committee 10 - 0, both without
being held first on the committee's Suspense File.