BILL NUMBER: SB 830	INTRODUCED
	BILL TEXT


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). 
   (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.  
   (d) 
    (   e)  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. 
   (e) 
    (   f)  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. 
   (f) 
    (  g)  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. 
   (g) 
    (   h)  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.