BILL NUMBER: SB 830 AMENDED
BILL TEXT
AMENDED IN SENATE APRIL 7, 2014
INTRODUCED BY Senator Galgiani
JANUARY 6, 2014
An act to amend Section Sections
128745 and 128748 of the Health and Safety Code, relating
to health care.
LEGISLATIVE COUNSEL'S DIGEST
SB 830, as amended, 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. reports for specified medical,
surgical, or obstetric conditions or procedures, including a coronary
artery bypass graft surgery. Existing law requires the office to
collect the same data used for the most recent risk-adjusted model,
as specified, and authorizes the office to add any clinical data
elements included in the Society of Thoracic Surgeons' database.
Prior to any additions from the Society of Thoracic
Surgeons' database, existing law sets forth factors the office is
required to assess. Existing law authorizes the office to
add, delete, or revise any clinical data elements not included in the
Society of Thoracic Surgeons' database, as specified.
This bill, commencing July 1, 2015, would additionally require the
office to publish risk-adjusted outcome reports for all coronary
artery bypass graft and heart valve repair and replacement surgeries,
and all percutaneous cardiac interventions and transcatheter valve
procedures performed in the state, as specified. The bill would
remove the office's authorization to add, delete, or revise clinical
data elements not included in the Society of Thoracic Surgeons'
database, would authorize the office to add any clinical data
elements included in the National Cardiovascular Data Registry
CATH/PCI and TAVR databases with regard to the reports for
percutaneous cardiac interventions and transcatheter valve
procedures, and would revise the factors to be considered before the
office adds clinical data elements.
Existing law requires the Director of the Office of Statewide
Planning and Development to appoint, as specified, a 9-member
clinical panel for each risk-adjusted outcome report on a medical,
surgical, or obstetric condition or procedure that includes reporting
data of an individual physician, including coronary artery bypass
graft surgery. For the clinical panel authorized for coronary artery
bypass graft surgery, existing law requires 3 members to be appointed
from a list of names submitted by the California Medical
Association.
This bill would instead require the office director to appoint 3
members from a list of 3 or more names submitted by the California
Society of Thoracic Surgeons and would additionally require that one
appointee be an interventionalist and a member of the Society of
Angiography for a clinical panel authorized for coronary artery
bypass surgery and heart valve repair and replacement surgery. The
bill would additionally require the office director to appoint
specified individuals, including, among others, 3 members from a list
of names submitted by the California Chapter of the American College
of Cardiology, to a clinical panel authorized for percutaneous
cardiac interventions and transcatheter valve procedures.
The bill would require all heart valve repair and replacement
transcatheter interventions or surgery procedures to be reviewed by a
joint subpanel of the coronary artery bypass graft surgery and heart
valve repair and replacement surgery, and percutaneous cardiac
intervention clinical panels, as provided.
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 panels established by Section
128748 based on statistical and technical considerations, information
on individual hospitals and surgeons may be excluded from the
reports.
(3) 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 coronary artery bypass
graft surgery and heart valve repair and replacement surgery for all
coronary artery bypass graft surgeries and heart valve repair and
replacement 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 panels established pursuant to Section
128748 based on statistical and technical considerations,
information on individual hospitals and surgeons may be excluded from
the reports.
(3)
( 4) Unless otherwise recommended by the
clinical panel panels established by
subdivision (d) of 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: office shall consider the utilization
of sampling to the maximum extent possible.
(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 and heart valve repair and
replacement 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) 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 cardiac
intervention and transcatheter valve procedure for all percutaneous
cardiac intervention and transcatheter valve procedures performed in
the state. In each year, the reports shall compare risk-adjusted
outcomes by hospital, and in every other year, by hospital and
physician. Upon the recommendation of the clinical panel established
by Section 128748 based on statistical and technical considerations,
information on individual hospitals and physicians may be excluded
from the reports.
(1) The office shall collect the same data used for the National
Cardiovascular Data Registry Cath/PCI and TAVR databases. Upon
recommendation of the clinical panel, the office may add any clinical
data elements included in the National Cardiovascular Data Registry
Cath/PCI and TAVR databases. Prior to any additions from the National
Cardiovascular Data Registry Cath/PCI and TAVR databases, the office
shall consider the utilization of sampling to the maximum extent
possible.
(2) The office shall collect the minimum data necessary for
purposes of testing or validating a risk-adjusted model for the
percutaneous cardiac intervention and transcatheter valve procedure
report.
(3) 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).
(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, 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.
(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.
(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.
(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.
SEC. 2. Section 128748 of the Health
and Safety Code is amended to read:
128748. (a) This section shall apply to any risk-adjusted
outcome report that includes reporting of data by an individual
physician.
(b) (1) The office shall obtain data necessary to complete a
risk-adjusted outcome report from hospitals. If necessary data for an
outcome report is available only from the office of a physician and
not the hospital where the patient received treatment, then the
hospital shall make a reasonable effort to obtain the data from the
physician's office and provide the data to the office. In the event
that the office finds any errors, omissions, discrepancies, or other
problems with submitted data, the office shall contact either the
hospital or physician's office that maintains the data to resolve the
problems.
(2) The office shall collect the minimum data necessary for
purposes of testing or validating a risk-adjusted model. Except for
data collected for purposes of testing or validating a risk-adjusted
model, the office shall not collect data for an outcome report nor
issue an outcome report until the clinical panel established pursuant
to this section has approved the risk-adjusted model.
(c) For each risk-adjusted outcome report on a medical, surgical,
or obstetric condition or procedure that includes reporting of data
by an individual physician, the office director shall appoint a
clinical panel, which shall have nine members. Three members shall be
appointed from a list of three or more names submitted by the
physician specialty society that most represents physicians
performing the medical, surgical, and obstetric procedure for which
data is collected. Three members shall be appointed from a list of
three or more names submitted by the California Medical Association.
Three members shall be appointed from lists of names submitted by
consumer organizations. At least one-half of the appointees from the
lists submitted by the physician specialty society and the California
Medical Association, and at least one appointee from the lists
submitted by consumer organizations, shall be experts in collecting
and reporting outcome measurements for physicians or hospitals. The
panel may include physicians from another state. The panel shall
review and approve the development of the risk-adjustment model to be
used in preparation of the outcome report.
(d) For the clinical panel authorized by subdivision (c) for
coronary artery bypass graft surgery and heart valve repair and
replacement surgery , three members shall be appointed from a
list of three or more names submitted by the California Chapter of
the American College of Cardiology. Three members shall be appointed
from a list of three or more names submitted by the
California Medical Association Society of
Thoracic Surgeons . Three members shall be appointed from lists
of names submitted by consumer organizations. At least one-half of
the appointees from the lists submitted by the California Chapter of
the American College of Cardiology,
Cardiology and the California Medical Association
Society of Thoracic Surgeons , and at least one
appointee from the lists submitted by consumer organizations, shall
be experts in collecting and reporting outcome measurements for
physicians and surgeons or hospitals , and one appointee shall
be an interventionalist and member of the Society of Angiography and
Intervention . The panel may include physicians from another
state. The panel shall review and approve the development of the
risk-adjustment model to be used in preparation of the outcome
report.
(e) For the clinical panel authorized by subdivision (c) for
percutaneous cardiac interventions and transcatheter valve
procedures, three members shall be appointed from a list of three or
more names submitted by the California Chapter of the American
College of Cardiology. Three members shall be appointed from a list
of three or more names submitted by the California Medical
Association. Three members shall be appointed from lists of names
submitted by consumer organizations. At least one-half of the
appointees from the lists submitted by the California Chapter of the
American College of Cardiology and the California Medical
Association, and at least one appointee from the lists submitted by
consumer organizations, shall be experts in collecting and reporting
outcome measurements for physicians and surgeons or hospitals, and
one appointee shall be a cardiovascular surgeon and a member of the
California Society of Thoracic Surgery. The panel may include
physicians from another state. The panel shall review and approve the
development of the risk-adjustment model to be used in preparation
of the outcome report.
(f) All heart valve repair and replacement transcatheter
interventions or surgery procedures shall also be reviewed by a joint
subpanel of the coronary artery bypass graft surgery and heart valve
repair and replacement surgery and percutaneous cardiac intervention
panels. The subpanel shall be comprised of three members appointed
from the clinical panel established in subdivision (d), three members
appointed from the panel established in subdivisions (e), and shall
be chaired by one member of the office. The subpanel may make
recommendations to the panels established in subdivisions (d) and (e)
relating to valve repair and replacement transcatheter interventions
or surgery procedures.
(e)
( g) Any report that includes reporting by
an individual physician shall include, at a minimum, the
risk-adjusted outcome data for each physician. The office may also
include in the report, after consultation with the clinical panel,
any explanatory material, comparisons, groupings, and other
information to facilitate consumer comprehension of the data.
(f)
( h) Members of a clinical panel
shall serve without compensation, but shall be reimbursed for any
actual and necessary expenses incurred in connection with their
duties as members of the clinical panel.