Senate Bill No. 830

Introduced by Senator Galgiani

January 6, 2014

An act to amend Section 128745 of the Health and Safety Code, relating to health care.

LEGISLATIVE COUNSEL’S DIGEST

SB 830, as introduced, Galgiani. Health care: health facility data.

Existing law establishes the Office of Statewide Health Planning and Development, which is vested with all the duties, powers, responsibilities, and jurisdiction of the State Department of Public Health relating to health planning and research development. Existing law requires the office to publish certain risk-adjusted outcome reports.

This bill, commencing July 1, 2015, would require the office to publish risk-adjusted outcome reports for percutaneous coronary interventions, including the use of angioplasty or stents, and transcatheter valve procedures.

Vote: majority. Appropriation: no. Fiscal committee: yes. State-mandated local program: no.

The people of the State of California do enact as follows:

SECTION 1.  

Section 128745 of the Health and Safety Code
is amended to read:

128745.  

(a) Commencing July 1993, and annually thereafter,
the office shall publish risk-adjusted outcome reports in accordance
with the following schedule:

 

		Procedures and
Publication	Period	Conditions
Date	Covered	Covered
July 1993	1988-90	3
July 1994	1989-91	6
July 1995	1990-92	9

 

Reports for subsequent years shall include conditions and
procedures and cover periods as appropriate.

(b) The procedures and conditions required to be reported under
this chapter shall be divided among medical, surgical, and obstetric
conditions or procedures and shall be selected by the office. The
office shall publish the risk-adjusted outcome reports for surgical
procedures by individual hospital and individual surgeon unless
the office in consultation with medical specialists in the relevant
area of practice determines that it is not appropriate to report by
individual surgeon. The office, in consultation with the clinical
panel established by Section 128748 and medical specialists in the
relevant area of practice, may decide to report nonsurgical
procedures and conditions by individual physician when it is
appropriate. The selections shall be in accordance with all of the
following criteria:

(1) The patient discharge abstract contains sufficient data to
undertake a valid risk adjustment. The risk adjustment report shall
ensure that public hospitals and other hospitals serving primarily
low-income patients are not unfairly discriminated against.

(2) The relative importance of the procedure and condition in
terms of the cost of cases and the number of cases and the
seriousness of the health consequences of the procedure or
condition.

(3) Ability to measure outcome and the likelihood that care
influences outcome.

(4) Reliability of the diagnostic and procedure data.

(c) (1) In addition to any other established and pending reports,
on or before July 1, 2002, the office shall publish a risk-adjusted
outcome report for coronary artery bypass graft surgery by hospital
for all hospitals opting to participate in the report. This report shall
be updated on or before July 1, 2003.

(2) In addition to any other established and pending reports,
commencing July 1, 2004, and every year thereafter, the office
shall publish risk-adjusted outcome reports for coronary artery
bypass graft surgery for all coronary artery bypass graft surgeries
performed in the state. In each year, the reports shall compare
risk-adjusted outcomes by hospital, and in every other year, by
hospital and cardiac surgeon. Upon the recommendation of the
clinical panel established by Section 128748 based on statistical
and technical considerations, information on individual hospitals
and surgeons may be excluded from the reports.

(3) Unless otherwise recommended by the clinical panel
established by Section 128748, the office shall collect the same
data used for the most recent risk-adjusted model developed for
the California Coronary Artery Bypass Graft Mortality Reporting
Program. Upon recommendation of the clinical panel, the office
may add any clinical data elements included in the Society of
Thoracic Surgeons’ database. Prior to any additions from the
Society of Thoracic Surgeons’ database, the following factors shall
be considered:

(A) Utilization of sampling to the maximum extent possible.

(B) Exchange of data elements as opposed to addition of data
elements.

(4) Upon recommendation of the clinical panel, the office may
add, delete, or revise clinical data elements, but shall add no more
than a net of six elements not included in the Society of Thoracic
Surgeons’ database, to the data set over any five-year period. Prior
to any additions or deletions, all of the following factors shall be
considered:

(A) Utilization of sampling to the maximum extent possible.

(B) Feasibility of collecting data elements.

(C) Costs and benefits of collection and submission of data.

(D) Exchange of data elements as opposed to addition of data
elements.

(5) The office shall collect the minimum data necessary for
purposes of testing or validating a risk-adjusted model for the
coronary artery bypass graft report.

(6) Patient medical record numbers and any other data elements
that the office believes could be used to determine the identity of
an individual patient shall be exempt from the disclosure
requirements of the California Public Records Act (Chapter 3.5
(commencing with Section 6250) of Division 7 of Title 1 of the
Government Code).

begin insert

(d) In addition to any other established and pending reports,
commencing July 1, 2015, and every year thereafter, the office
shall publish risk-adjusted outcome reports for percutaneous
coronary interventions, including, but not limited to, the use of
angioplasty or stents, and transcatheter valve procedures.

end insert begin delete

(d)

end delete

begin insert ( end insert begin insert e) end insert  The annual reports shall compare the risk-adjusted outcomes
experienced by all patients treated for the selected conditions and
procedures in each California hospital during the period covered
by each report, to the outcomes expected. Outcomes shall be
reported in the five following groupings for each hospital:

(1) “Much higher than average outcomes,” for hospitals with
risk-adjusted outcomes much higher than the norm.

(2) “Higher than average outcomes,” for hospitals with
risk-adjusted outcomes higher than the norm.

(3) “Average outcomes,” for hospitals with average risk-adjusted
outcomes.

(4) “Lower than average outcomes,” for hospitals with
risk-adjusted outcomes lower than the norm.

(5) “Much lower than average outcomes,” for hospitals with
risk-adjusted outcomes much lower than the norm.

begin delete

(e)

end delete

begin insert ( end insert begin insert f) end insert  For coronary artery bypass graft surgery reports and any
other outcome reports for which auditing is appropriate, the office
shall conduct periodic auditing of data at hospitals.

begin delete

(f)

end delete

begin insert ( end insert begin insert g) end insert  The office shall publish in the annual reports required under
this section the risk-adjusted mortality rate for each hospital and
for those reports that include physician reporting, for each
physician.

begin delete

(g)

end delete

begin insert ( end insert begin insert h) end insert  The office shall either include in the annual reports required
under this section, or make separately available at cost to any
person requesting it, risk-adjusted outcomes data assessing the
statistical significance of hospital or physician data at each of the
following three levels: 99-percent confidence level (0.01 p-value),
95-percent confidence level (0.05 p-value), and 90-percent
confidence level (0.10 p-value). The office shall include any other
analysis or comparisons of the data in the annual reports required
under this section that the office deems appropriate to further the
purposes of this chapter.