BILL ANALYSIS                                                                                                                                                                                                    Ó



                                                                            



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                                       CONSENT


          Bill No:  SB 357
          Author:   Correa (D)
          Amended:  4/4/13
          Vote:     27 - Urgency

           
          SENATE HEALTH COMMITTEE  :  8-0, 4/17/13
          AYES:  Hernandez, Anderson, Beall, De León, DeSaulnier, Monning,  
            Nielsen, Wolk
          NO VOTE RECORDED:  Pavley

           SENATE APPROPRIATIONS COMMITTEE  :  Senate Rule 28.8


           SUBJECT  :    Elective Percutaneous Coronary Intervention Pilot  
          Program

           SOURCE  :     Author


           DIGEST  :    This bill extends the January 1, 2014, sunset date  
          for the Elective Percutaneous Coronary Intervention Pilot  
          Program (PCI Pilot Program) to January 1, 2015, and requires the  
          final report by the PCI Pilot Program oversight committee to be  
          completed by July 31, 2013, rather than at the conclusion of the  
          pilot program.

           ANALYSIS  :    

          Existing law:

          1.Licenses and regulates general acute care hospitals by the  
            Department of Public Health (DPH), and in addition to the  
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            basic services offered under that license, permits general  
            acute care hospitals to seek approval from DPH to offer  
            special services, including cardiac surgery and cardiac  
            catheterization laboratory services.

          2.Requires DPH, for cardiac catheterization laboratory services,  
            to adopt standards and regulations, as specified.

          3.Establishes the PCI Pilot Program to allow DPH to authorize up  
            to six general acute care hospitals, as specified, to perform  
            scheduled, elective percutaneous transluminal coronary  
            angioplasty and stent placement for eligible patients without  
            onsite cardiac surgery.

          4.Establishes an advisory oversight committee to oversee,  
            monitor, and make recommendations to DPH concerning the PCI  
            Pilot Program.

          5.Requires the advisory oversight committee to submit at least  
            two reports to DPH during the pilot period, and to conduct a  
            final report at the conclusion of the pilot program.

          6.Requires DPH to prepare and submit a report to the Legislature  
            on the results of the PCI Pilot Program no later than 90 days  
            after termination of the pilot program. Requires this report  
            to recommend whether elective PCI without onsite cardiac  
            surgery should be continued in California, and if so, under  
            what conditions.

          7.Sunsets the provisions of law creating the PCI Pilot Program  
            on January 1, 2014.

          This bill:

          1.Extends the January 1, 2014, sunset date for the PCI Pilot  
            Program to January 1, 2015.

          2.Requires the PCI Pilot Program advisory oversight committee to  
            conduct a final report by July 31, 2013, rather than at the  
            conclusion of the pilot program.

          3.Requires the report that DPH is required to submit to the  
            Legislature to be completed within 90 days of receiving the  
            final report from the advisory oversight committee, rather  

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            than 90 days after termination of the PCI Pilot Program, and  
            specifies that this report is to be on the initial results of  
            the pilot program.

           Background
           
           Percutaneous transluminal coronary angioplasty  .  According to  
          Stanford Medical Center online health library, percutaneous  
          transluminal coronary angioplasty is performed to open blocked  
          coronary arteries cause by coronary artery disease and to  
          restore arterial blood flow to the heart tissue without  
          open-heart surgery.  Once the artery has been opened, a stent is  
          placed in the artery.  A stent is a tiny, expandable metal coil  
          that is inserted into the newly-opened area of the artery to  
          help keep the artery from narrowing or closing again.

           PCI Pilot Program background.   According to the Senate Health  
          Committee analysis of SB 891 (Correa, Chapter 295, Statutes of  
          2008), which created the PCI Pilot Program, legislation was  
          prompted by studies showing that elective PCI for low- to  
          medium-risk patients can be safely and effectively performed at  
          hospitals without cardiac surgery services if they meet certain  
          requirements.  The current limitation on hospitals performing  
          interventional cardiac procedures, if they are not also licensed  
          to perform cardiac surgery, was enacted over 25 years ago. Since  
          that time, there have been great technological and  
          methodological advances in interventional cardiology that have  
          significantly improved patient outcomes and reduced incidents of  
          emergency cardiac surgery. 

          The six hospitals selected by DPH for the pilot program are: Los  
          Alamitos Medical Center; Sutter Roseville Medical Center; Kaiser  
          Permanente Walnut Creek Medical Center; Doctors Medical  
          Center-San Pablo; Clovis Community Medical Center; and St. Rose  
          Hospital in Hayward.

          The most recent update from the PCI Pilot Program Advisory  
          Oversight Committee, dated January 17, 2013, found no  
          significant outcome differences between the six hospitals in the  
          pilot program, and the control group of hospitals performing  
          these procedures with onsite cardiac surgery services.

           FISCAL EFFECT  :    Appropriation:  No   Fiscal Com.:  Yes    
          Local:  No

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           SUPPORT  :   (Verified  4/25/13)

          California Chapter of the American College of Cardiology
          California Hospital Association
          Clovis Community Medical Center
          Doctors Medical Center
          Kaiser Permanente Walnut Creek Medical Center
          Los Alamitos Medical Center
          Placer County Water Agency
          St. Rose Hospital
          Sutter Roseville Medical Center

           ARGUMENTS IN SUPPORT  :    According the author, the intent of SB  
          891 (Correa), Chapter 295, Statutes of 2008, which created the  
          PCI Pilot Program allowing six acute care hospitals to provide  
          cardiac catheterization services without on-site surgery  
          services, was to have a report with the recommendations from the  
          advisory committee to be submitted to DPH prior to the end of  
          the pilot program, but there was a drafting error.  The author  
          states that this bill corrects the drafting error, allowing the  
          pilot hospitals to continue with the PCI Pilot Program while DPH  
          reviews the data from the advisory committee, and allows the  
          Legislature an opportunity to take action after reviewing the  
          report on the pilot project.


          The California Hospital Association (CHA) states in support that  
          the PCI Pilot Program expanded patients' access to care,  
          particularly benefitting underinsured and poor patients who are  
          often the least likely to undergo PCI due to barriers accessing  
          specialized cardiac services such as geography, distance,  
          culture, race, language, poverty and lack of education.   
          However, CHA states that there was a drafting error in the  
          original legislation that requires the program to end prior to  
          the Legislature making a determination whether or not to extend  
          the program.  CHA states that there is very good evidence at  
          this time that the program should be extended, and that  
          interruption in the program would mean the patients relying on  
          the program could not receive the services.

          The California Chapter of the American College of Cardiology  
          (ACC) also supports this bill, stating that the intent of the  
          prior legislation was to have a report with the recommendations  

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          of the advisory committee be submitted to DPH prior to the end  
          of the pilot program, however there was a drafting error.  The  
          ACC states that this bill addresses the drafting error by  
          enabling the pilot hospitals to continue with the pilot program  
          while DPH reviews the data from the advisory committee and makes  
          a recommendation to the Legislature on whether the program  
          should continue and if so under what circumstances.

          All six pilot hospitals also wrote in support, pointing to the  
          safe outcomes, and also pointing out that the increased volume  
          of patients has led to the hiring of additional staff, and that  
          returning to the previous process would be a disservice to  
          staff, patients and their families.


          JL:nl  4/25/13   Senate Floor Analyses 

                           SUPPORT/OPPOSITION:  SEE ABOVE

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