BILL ANALYSIS �
SENATE COMMITTEE ON HEALTH
Senator Ed Hernandez, O.D., Chair
BILL NO: SB 1297
AUTHOR: Hueso
AMENDED: April 2, 2014
HEARING DATE: April 30, 2014
CONSULTANT: Marchand
SUBJECT : Hospital Safety and Transparency Act of 2014.
SUMMARY : Requires OSHPD to publish on its Internet Web site
historical and current information collected by state and
federal regulators about hospitals, including information
regarding Medi-Cal withholds and provider preventable
conditions, as specified.
Existing state law:
1.Licenses general acute care hospitals under the California
Department of Public Health (CDPH).
2.Establishes the Office of Statewide Health Planning and
Development (OSHPD), and designates OSHPD as the single state
agency to collect specified health facility or clinic data for
use by all state agencies.
3.Establishes the Department of Health Care Services (DHCS),
which administers the Medi-Cal program, and requires DHCS to
place a provider under Medi-Cal payment suspension upon a
credible allegation of fraud, as defined.
Existing federal law: Requires, as part of the Affordable Care
Act (ACA), that state Medicaid programs prohibit payments by
states for services related to provider preventable conditions
(PPCs). Federal law defines a PPC, in part, as a condition
occurring in any health care setting that has been found to be
reasonably preventable through the application of procedures
supported by evidence-based guidelines.
This bill:
1.Requires OSHPD to publish on its Internet Web site, from
records in its possession, historical and current information
collected by state and federal regulators about hospitals,
including, but not limited to, information regarding Medi-Cal
withholds, as specified, and provider preventable conditions,
as specified.
Continued---
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2.Makes various legislative findings and declarations, including
that the findings of reviews are dispersed across multiple
state entities, often in multiple locations and varying
formats, and as a result, consumers do not have access to a
comprehensive profile of a hospital's status and performance
on quality and compliance with state and federal laws.
FISCAL EFFECT : This bill has not been heard by a fiscal
committee.
COMMENTS :
1.Author's statement. According to the author, currently, there
is a lack of transparency and clarity when it comes to finding
out which California hospitals have had severe,
performance-related sanctions imposed on them by regulators.
This lack of transparency makes it difficult for patients,
patient advocates, and purchasers of hospital services to
choose the safest hospitals when they need health care and
prevents the market from rewarding hospitals that are quality
providers. This bill addresses the need for transparency and
accountability in hospital reporting by consolidating
information collected by state and federal regulators along
with other hospital data in the OSHPD website. Examples of the
type of information to be included are: detail on deficiencies
and history of violations found by accreditors and
state/federal inspectors; any actions taken by the federal
Centers for Medical and Medicare Services (CMS) or state
regulators, including temporary or permanent exclusions or
withholdings from Medi-Cal or Medicare; and, reports of PPCs.
2.Provider Preventable Conditions. The ACA requires that
Medi-Cal withhold payment from providers for treatment
associated with PPCs. PPCs are defined to include Other
Provider-Preventable Conditions which are to be reported in
all health care settings, and Health Care-Acquired Conditions
in acute inpatient hospital settings only. Health
Care-Acquired Conditions include air embolisms, blood
incompatibility, catheter-associated urinary tract infections,
foreign object retained after surgery, and certain surgical
site infections, among others. According to DHCS, it will
investigate all reports of PPCs to determine if payment
adjustment is necessary. DHCS states that it uses PPC reports
to determine if payment adjustment is appropriate, that it is
required to report PPCs to CMS and abide by confidentiality
requirements, and that it will also evaluate the data of
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reported PPCs to develop quality improvement programs. It is
unclear if PPCs will be made publicly available.
3.Information on hospitals can be hard to find, and is spread
out. Under existing state law, at least three different
agencies have some form of regulatory authority over
hospitals. CDPH licenses and regulates all health facilities,
including hospitals, and conducts inspections both for state
licensing purposes, and on behalf of CMS to ensure hospitals
can continue to be an approved provider under federal payment
programs. OSHPD has oversight over the construction and
modification of health facility buildings, including ensuring
compliance with seismic safety laws, and also serves as the
data collection entity for many different types of hospital
reports, including discharge data reports and summary
financial reports. DHCS, as the administrator of the Medi-Cal
program, approves, and can suspend, hospitals and other
providers for purposes of participation in the Medi-Cal
program.
On CDPH's website, there is a link for "Consumer Information
System," which includes information about administrative
penalties levied against hospitals, penalties for breaches of
patient confidentiality, and a map of infection rates by
hospital.
OSHPD has a "Healthcare Information Division," which includes
quality reports on hospitals (such as risk-adjusted outcome
reports), hospital financial reports, patient discharge
reports, emergency department encounters, ambulatory surgery
reports, and a number of other types of reports.
DHCS, though not easy to find, has a link to an excel report
that lists all of the providers that have been suspended from
receiving payment from the Medi-Cal program. The vast majority
of the provider payment suspensions are for individual
physicians or clinics, but includes six hospitals that have
been suspended, the most recent being Los Angeles Doctors
Hospital, which was suspended indefinitely in 2012.
4.Support. This bill is sponsored by the California State
Council of the Service Employees International Union (SEIU
California), which states that this bill seeks to improve
transparency for Californians about hospital quality by
consolidating information already collected by state and
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federal regulators on the OSHPD website. SEIU California
states that there is no easily accessible online source that
shows whether a hospital was excluded from receiving
Medicare/Medicaid payments due to deficiencies revealed during
inspection, information about Medi-Cal withholds and
suspensions, and provider preventable conditions, however all
of these are significant to a consumer's understanding of a
provider's standing with its regulating bodies and the quality
of care delivered. SEIU California states that this
information is dispersed among numerous state departments and
entities. This bill would take a modest approach to offering
Californians greater transparency about hospital quality by
requiring OSHPD to post this important information along with
all the information it currently posts related to health
providers and facilities.
5.Suggested amendments.
a. This bill requires OSHPD to publish specified
information "from records in its possession." However,
information pertaining to the Medi-Cal program, including
provider suspensions and the provider preventable
conditions, as specified in the bill, would be in the
possession of DHCS, which administers the Medi-Cal
program. To ensure that this bill accomplishes its
objective of consolidating information about hospitals in
one location, the phrase "from records in its possession"
should be deleted from the bill.
b. This bill requires that information published by
OSHPD include information regarding Medi-Cal "program
withholds," as specified. The bill should be amended to
reflect the actual term used in that statute, which is
"payment suspension."
SUPPORT AND OPPOSITION :
Support: Service Employees International Union - California
State Council (sponsor)
Oppose: None received.
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