BILL ANALYSIS
Senate Appropriations Committee Fiscal Summary
Senator Christine Kehoe, Chair
911 (Lieu)
Hearing Date: 8/17/2009 Amended: 7/23/2009
Consultant: Katie Johnson Policy Vote: Health 9-1
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BILL SUMMARY: AB 911 would require all hospitals that operate
emergency departments to assess the condition of its emergency
department by determining a crowding score of 1 - 6, with 1
being the least crowded and 6 being the most crowded. The bill
would require hospitals to develop and file full capacity
protocols that would correspond to the crowding score with the
Office of Statewide Health Planning and Development.
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Fiscal Impact (in thousands)
Major Provisions 2009-10 2010-11 2011-12 Fund
CDPH inspection minor and absorbable Special*
OSHPD file collection minor and absorbable Special**
and storage
Publicly-funded health unknown, potentially
significantGeneral/
program impact costs or savings Federal
*State Department of Public Health Licensing and Certification
Program Fund
**California Health Data and Planning Fund
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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:
a) If this bill were to result in an emergency department's
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 publicly-funded health
care programs to the extent that emergency department
efficiencies reduce wait time and correlate with improved health
outcomes.
Existing law provides for the licensure of health facilities,
including hospitals, by the California Department of Public
Health (CDPH).
Page 2
AB 911 (Lieu)
This bill would require every licensed acute care hospital with
an emergency department (ED) to calculate and record a crowding
score, as specified, a minimum of every four hours. The crowding
score would be a measure of the crowdedness of an ED. This bill
would make exceptions to recording the score every four hours
for hospitals with low crowding scores and those with fewer than
12,000 visits annually. Staff recommends a technical amendment
to insert a Section 1250 of the Health and Safety Code reference
to the definition of general acute care hospitals where
appropriate.
This bill would require every licensed general acute care
hospital with an ED to determine the range of crowding scores
that constitute each of the six categories of the crowding scale
for its ED. Level one would be the lowest level of crowding and
level six would be the highest. This bill would establish a
formula for calculating the crowding scores and would provide
that no score may exceed 200.
This bill would require hospitals with EDs, by January 1, 2011,
to develop and implement a full-capacity protocol for each of
the six categories of its crowding scale and to submit it to the
Office of Statewide Health Planning and Development (OSHPD). The
full-capacity protocol would address such factors as the
notification of hospital administrators and medical and nursing
staff of crowding scale category changes; hospital operations,
including bed utilization, discharges, and supplies; ED
operations, including diversion, triage, and alternative care
sites; planned response.
This bill would provide that these provisions would sunset
January 1, 2014.
Costs to CDPH to check for enforcement of these provisions
during site surveys would be minor and absorbable. Similarly,
costs to OSHPD to accept and file the hospitals' full-capacity
protocols would be minor and absorbable.
There would be unknown, likely absorbable, one-time costs to
hospitals to develop the full-capacity protocols and to train
current staff on the crowding calculator and the full-capacity
protocol. Ongoing training costs and the calculation of the
crowding score would be minor.