BILL ANALYSIS
Senate Appropriations Committee Fiscal Summary
Senator Christine Kehoe, Chair
2153 (Lieu)
Hearing Date: 6/28/2010 Amended: As Introduced
Consultant: Katie Johnson Policy Vote: Health 7-1
_________________________________________________________________
____
BILL SUMMARY: AB 2153 would require all hospitals with
emergency departments to develop and calculate a "crowding
score" and to submit a full-capacity protocol to the Office of
Statewide Health Planning and Development (OSHPD) that would
address emergency department overcrowding mitigation policies
and procedures.
_________________________________________________________________
____
Fiscal Impact (in thousands)
Major Provisions 2010-11 2011-12 2012-13 Fund
Impact on publicly-funded unknown, potentially
significantGeneral/*
health programs, including costs and savings Federal/
Medi-Cal and Healthy Families Local
*Medi-Cal costs shared 50 percent General Fund, 50 percent
federal funds ongoing; Healthy Families Program shared 35
percent General Fund, 65 percent federal funds; the state
General Fund portion may include local funds
_________________________________________________________________
____
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: there could be
costs and savings.
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 (ED)
efficiencies reduce wait time, decrease the length of inpatient
hospitalizations, and correlate with improved health outcomes.
Any costs to the California Department of Public Health (CDPH)
to add additional criteria to its licensing inspections or to
OSHPD to collect and store full-capacity protocols would be
minor and absorbable. Costs to hospitals to develop and
calculate crowding scores, to create a full-capacity protocol,
and to train staff could be minor and absorbable to up to
approximately $150,000 one-time. The state would not reimburse
them for those costs.
Page 2
AB 2153 (Lieu)
This bill would require all licensed general acute care
hospitals with an emergency department (ED) to:
1) Calculate a crowding score with the prescribed formula
every 4 hours and would make allowances for small and
uncrowded hospitals;
2) Develop a crowding scale and to assign ranges of
crowding scores to 1 of 6 categories, with category 1
representing the least crowded and category 6 representing
the most crowded;
3) Develop, implement, and file with OSHPD, by January 1,
2012, a full-capacity protocol for each of the six crowding
scale categories that would address the notification of
hospital staff and changes in hospital and ED operations,
such as bed utilization, transfers, elective admissions,
and discharges.
This bill's provisions would be operative until January 1, 2015.
This bill is nearly identical to AB 911 (Lieu, 2009), which was
vetoed by the Governor.
The Governor said in his AB 911 veto message, "Although I
support the intent behind this bill, statute is not necessary
and I do not believe it will provide any significant improvement
to the underlying problem?I would encourage them [hospitals] to
use the crowding score outlined in this bill and work to develop
full-capacity protocols that best address their individual
needs." AB 911 passed out of Senate Appropriations Committee 10
- 0.