Member Value Report -...
Transcript of Member Value Report -...
A Statement of Your Dues Investment in the Hospital Associations
Member Value Report
2016
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A Year of Accomplishment
We are proud to share with you our accomplishments of 2016. This
report highlights many of the successful advocacy efforts that, together,
we achieved on behalf of California hospitals and health systems. With
the support of committed members and in collaboration with others,
CHA and the Regional Associations advocated with a common voice in
local, statewide and national policy discussions. For every $1 of your
dues paid in 2016, the Associations generated more than $220 in direct
value. The Hospital Association of San Diego and Imperial Counties’
regional accomplishments begin below.
CHA’s statewide and federal accomplishments begin on page 7.
Regional Successes of the Hospital Association of San Diego and
Imperial Counties
Access to Health Care
• Participated in numerous health care stakeholder groups and planning committees to protect, expand
and improve access to health care through programs including Medi-Cal, Covered California, the
Community Care Transitions Program, the Coordinated Care Initiative and Cal Medi-Connect.
• Coordinated hospital-based enrollment and eligibility efforts through the Hospital Outstation Services
(HOS) Program.
• Engaged the HOS Liaison Workgroup to discuss program challenges and represent those concerns to
County of San Diego officials.
• Advocated with County of San Diego officials for specific improvements, including better training of
county staff on new Affordable Care Act (ACA) eligibility requirements and improved capacity for
hospital staff to expedite review of critical cases.
Behavioral Health Services
• Focused on the San Diego Behavioral Health Continuum of Care Initiative and contributed to actions by
County Behavioral Health Services to address crisis services for both adults and children/adolescents.
• Advocacy efforts contributed to the County of San Diego’s $6 million mid-year budget enhancement to
expand existing behavioral health programs, as well as a 9.1 percent increase to psychiatric inpatient
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provider reimbursement rates.
• Served on the County of San Diego Behavioral Health Advisory Board (BHAB) and worked to assure
the integrity of services throughout the county’s system of care in continued implementation of the
Mental Health Services Act Community Services and Support program.
• Chaired the BHAB Drug Medi-Cal Workgroup to better understand the Medi-Cal 2020 waiver and
addressing substance use disorders, as well as the draft San Diego County Implementation Plan and
potential impacts.
Business / Community Collaboration
• Recognized Imperial County Public Health Department Director Robin Hodgkin at the HASD&IC Annual
Meeting for her leadership on efforts to identify and address health care needs within Imperial County.
• Continued to strengthen relationships and opportunities to bring hospital and health care issues to the
forefront with local community and community-based organizations, chambers of commerce, business
coalitions and other key health care organizations through representation on the following boards,
committees and workgroups:
ACHE Regents Advisory Council
Accountable Communities of Health Workgroup
American Society of Quality – San Diego
Anthem Blue Cross Hospital Relations Committee
Association of California Nurse Leaders
Association of Perioperative Registered Nurses – San Diego Chapter
Association for Professionals in Infection Prevention and Epidemiology – San Diego & State
Chapters
Behavioral Health Continuum of Care Initiative
Behavioral Health Hospital Partners
Big Data Community Design Team
Business Alliance for Water
California Action Coalition Advisory Committee
California Association for Healthcare Quality
Children’s Initiative Board of Directors
Children’s Initiative Report Card Advisory Committee
City of San Diego Pure Water
Community Corrections Partnership
Community Health Improvement Partners Public Policy Committee
Community Paramedicine Pilot Projects
Coordinated Care Initiative/Cal MediConnect Advisory Committee
County of San Diego:
• Behavioral & Physical Health Collaboratives
• Behavioral Health Advisory Board
• Behavioral Health Services Community Engagement Forum
• Behavioral Health Services – Drug Medi-Cal Workgroup
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• Department of Environmental Health Working Group: Safe Sharps Disposal
• Health Services Advisory Board
• Healthcare Integration Consolidated Team
• Healthy San Diego Behavioral Health Work Team
• Healthy San Diego Health & Housing Work Team
• Healthy San Diego Joint Consumer & Professional Advisory Committee
• Healthy San Diego Regional Center Work Group
• Integrative Health, Housing, & Human Services Advisory Council
• Inpatient Solutions Workgroup
• Long Term Care Integration Project
• Psychiatric Nurse Practitioners Workgroup
• Regional Continuum of Care Council & Governance Board
• Skilled Nursing Facility Disaster Preparedness Taskforce
• Social Services Advisory Board
• Unified Disaster Council
Downtown San Diego Partnership
East County Chamber of Commerce
Emergency Medical Care Committee
Emergency Medicine Oversight Commission
HealthImpact Advisory Committee
Health Services Capacity Issues Task Force
Health Workforce Initiative
Healthcare Laboratory Workforce Initiative
Hope San Diego Advisory Committee
Lanterman-Petris-Short Task Force and Work Group
Latino Coalition for a Healthy California
Live Well San Diego North County Community Leadership Team
March of Dimes Advisory Board San Diego-Imperial Division
Medical Lab Technicians Advisory Group
San Diegans for Healthcare Coverage Board
San Diego and Imperial Counties Perinatal Council
San Diego Coalition for Compassionate Care
San Diego County Medical Society GERM Commission
San Diego County Taxpayers Association Board and Subcommittee on Health and Community
Services
San Diego Covered California Collaborative
San Diego Health Connect Board
San Diego Healthcare Disaster Council
San Diego Organization of Healthcare Leaders
San Diego POLST ERegistry Workgroup
San Diego Prescription Drug Task Force
San Diego Psychiatric Law Society
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San Diego Regional Chamber of Commerce (SDRCC) Board of Directors
SDRCC Health Committee
SDRCC Regional Jobs Strategy Partner Advisory Group
San Diego State University School of Public Health Advisory Board
San Diego Workforce Partnership Board
South East Regional Trauma Coordinating Committee
Whole Person Care Work Group
Whole Person Wellness Data Committee
Whole Person Wellness Management Committees
Capacity
• Assessed ED saturation and intensive care unit and medical/surgical bed status from the County of San
Diego QA-Net Quality Collector System to address capacity and offload issues during the winter
months.
• Revised regional hospital preparedness planning for significantly increased demand — such as during
influenza season or a disaster — through the Health Services Capacity Issues Task Force.
• Collaborated in planning and support for the eleventh annual San Diego Emergency Care Summit to
address capacity issues in both emergency departments and hospitals with a focus on the impact of
psychiatric patients.
Community Health Needs Assessment (CHNA)
• Completed the 2016 CHNA, which built on 2013 findings and delved deeper into the top identified
health needs.
• Engaged with more than 435 residents, direct service providers, leaders and experts to assess top
health needs and better understand the social inequities that prevent patients and clients from
improving their health and well-being.
Disaster Preparedness/Emergency Response
• Strengthened disaster preparedness and emergency response planning in local, state and national
committees and events, including the Hospital Preparedness Program Work Group, San Diego
Healthcare Disaster Council, County of San Diego Unified Disaster Council, California Annual
Statewide Disaster Drill, CHA EMS/Trauma Committee, Emergency Medical Care Committee and San
Diego County Medical Society Emergency Medical Oversight Commission.
Emergency/Trauma Services
• Engaged with the County of San Diego and other stakeholders to better understand the impact of
ambulance offload delays on our region’s emergency medical services system.
• Collaborated with the state and four other counties regionally on the South East Regional Trauma
Coordinating Committee to improve trauma systems of care and helped plan region-wide meetings.
• Participated in the implementation oversight of two community paramedicine pilot projects in San
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Diego County with focus on addressing the needs of frequent 9-1-1 users of emergency department
services and alternative destination.
• Convened a panel of experts from outside our region at the 2016 HASD&IC Annual Meeting to share
perspectives on innovations in emergency medical services.
Health Equity
• Took the #123forEquity Pledge to Eliminate Health Disparities and encouraged member engagement.
• Convened a panel of experts from outside our region at the 2016 HASD&IC Annual Meeting to provide
groundbreaking approaches to promoting health equity.
Health Care Information Exchange
• Supported the continued growth and development of San Diego Health Connect as our region’s health
information exchange.
• Served on the San Diego Health Connect Board of Directors to provide a voice for the broader
community of hospitals and health systems.
Homelessness/Housing
• Represented hospitals in numerous public forums seeking solutions for homelessness and frequent
service users; as a member of Healthy San Diego’s Health & Housing Work Team, and through
engagement with the County of San Diego to develop whole person wellness programs.
• Represented hospitals on the San Diego Regional Continuum of Care Council to identify gaps in
homeless services, establish funding priorities and to pursue an overall systemic approach to
addressing homelessness.
• Recognized San Diego City Council Member Todd Gloria at the HASD&IC Annual Meeting for his
leadership in addressing homelessness and affordable housing issues to improve the health of our
communities.
Managed Care
• Participated in regional development and coordination of care delivery system changes through the
Coordinated Care Initiative/Cal MediConnect Advisory Committee with special focus on the needs of
dually eligible individuals.
• Engaged with Healthy San Diego to review health plans interested in joining the San Diego market and
provide feedback regarding those plans under the Department of Health Care Services Geographic
Managed Care (GMC) Request for Application (RFA) process.
Political and Public Advocacy
• Met with key candidates running for the County of San Diego Board of Supervisors and the San Diego
City Council to discuss issues of importance to hospitals.
• Supported CHA Political Action Committee (CHPAC) fundraising through HASD&IC board leadership,
hospital campaign assistance and coordination of a regional CHPAC President’s Club reception.
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• Supported CHA state and federal advocacy programs through member communications, team building,
strategic planning and social media.
• Supported CHA’s advocacy efforts to express the impact of Section 603 on hospitals and patients and to
request flexibility in hospital outpatient department payment implementation; to thank state Assembly and
Senate members who supported the managed care organization tax package and elimination of the
distinct-part skilled-nursing facility clawback; to oppose AB 2743 (Eggman, D-Stockton), which would
have established a psychiatric bed registry; to oppose AB 2467 (Gomez, D-Los Angeles), which would
have mandated reporting of hospital executive compensation; to support Proposition 52, the Medi-Cal
Funding and Accountability Act; to support Proposition 55, the California Children’s Education and
Health Care Protection Act of 2016; and to support Proposition 56, the California Healthcare,
Research and Prevention Tobacco Tax Act of 2016.
• Supported CHA’s digital advocacy efforts to raise member awareness of the Our Health California
online community.
Quality and Patient Safety
• Continued to implement the Hospital Quality Institute’s (HQI) blueprint for advancing quality and patient
safety, and raised member awareness and engagement in HQI core activities.
• Directed regional activities in support of Patient Safety First…a California Partnership for Health, a
statewide partnership of the three hospital Regional Associations, National Health Foundation and
Anthem Blue Cross.
• Secured grant funding and produced a Hand Hygiene QI Project Video for infection preventionists’ use
and in support of International Infection Prevention Week.
• Secured grant funding to review and revise the 2014 Respiratory Monitoring of Patients Outside the
ICU Guidelines of Care Toolkit.
• Provided regional representation on the CHA Medication Safety Committee, CHA Certification and
Licensing Committee, HQI Board of Directors and HQI Hospital Quality Committee.
• Served as a member and Nominating Chair for the March of Dimes Advisory Board San Diego-Imperial
Division and as a member of the California March of Dimes Advisory Board.
• Served as staff advisor to the HQI Hospital Acquired Infection Workgroup.
• Convened regional quality and patient safety leaders and hosted CHPSO quarterly Safe Table Forums.
• Provided educational programs, speaker support, and scholarships to hospital members; obtained CME
and CEU credits for HASD&IC Annual Meeting.
• Supported workshop development and support for the HQI Annual Conference.
• Supported regional POLST eRegistry activities and POLST community education programs.
Workforce Issues
• Served as a regional “champion” through the Association of San Diego Chapter - California Nurse
Leaders (ACNL) to implement recommendations in the Institute of Medicine report, The Future of
Nursing: Leading Change, Advancing Health.
• Collaborated with the San Diego Workforce Partnership on efforts to expand nursing and allied health
programs in San Diego.
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• Offered regional hospitals a voice on the CHA Workforce Committee, Allied Healthcare Workforce
Advisory Council, and Human Resources Committee to address workforce shortages and violence in
the work place. Elevated awareness regionally through the San Diego Chapter – ACNL and the San
Diego Healthcare Disaster Council.
The New Year
The core of our activities in 2017 will revolve around behavioral health, emergency services, Medi-Cal, and the
workforce. HASD&IC will continue to focus on addressing gaps within our region’s behavioral health services
continuum of care and other populations requiring special care services, including dually eligible individuals and
the homeless; completing Phase 2 of the 2016 Community Health Needs Assessment; supporting quality
improvements and a culture of safety within our hospitals and health systems; engaging members in post-
election health care policy changes; and educating newly-elected officials on issues of importance to hospitals
within our region and throughout California. Advocacy efforts will be driven by the vision of an optimally healthy
society with access to affordable, medically necessary, quality health care services for the communities of San
Diego and Imperial Counties.
State and Federal Successes of the California Hospital Association
Making the Hospital Fee Program Permanent
Voters in every county passed CHA-sponsored Proposition 52 — the Medi-Cal Funding and Accountability Act —
by a 70 percent majority in the November general election. The act will extend the existing hospital fee program,
which was slated to expire at the end of 2017. In addition to making the program permanent, passage of the act
also prohibits lawmakers from diverting these Medi-Cal dollars to pay for anything other than their intended
purpose. The fee program is estimated to bring in $4 billion annually for California hospitals and $1 billion for the
state. Net benefit to hospitals: $4 billion annually.
Continuing the 2014-16 Hospital Fee Program
CHA continued to drive implementation of the managed care portion of the 2014-16 hospital fee program. In
2016, the program brought in $3.6 billion for California hospitals; it is estimated to increase Medi-Cal payments to
hospitals by $10 billion over three years. Ensuring that the hospital fee and federal matching funds will be used
only for purposes described in current law, the program also guarantees that Medi-Cal rates to hospitals cannot
be cut from current levels. Net benefit to hospitals: $10 billion (2014-16).
Creating New Funding for Medi-Cal
Co-sponsored by CHA, newly passed Proposition 55 — the California Children’s Education and Health Care
Protection Act — will extend the Proposition 30 (2012) personal income tax on high wage earners from 2019 to
2031, directing significant funding to Medi-Cal for acute care in hospitals and preventive health care services.
Estimated to raise $5 billion to $11 billion annually in tax revenues, the majority of the act’s funding will be
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directed to education; the balance will be allocated to the state’s Rainy Day Fund, the General Fund and Medi-
Cal. Approximately $1 billion annually — with a potential for up to $2 billion — could be available for hospitals and
physicians who provide critical, emergency, acute and preventive health care services to children and their
families. Net benefit to hospitals: $1 billion annually.
Defeating Efforts to Limit Executive Compensation
CHA was successful in blocking a proposed ballot initiative that would have limited hospital executive
compensation, avoiding a $60 million opposition campaign. Savings to hospitals: $60 million.
Eliminating Retroactive Payment Recoupment
On March 1, 2016, Gov. Brown signed legislation that eliminated the “clawback,” or retroactive recoupment of
reimbursement for services provided by hospital-based skilled-nursing facilities — representing a savings of $240
million for CHA member hospitals. The provision, which was part of bipartisan managed care organization
financing legislation passed by both houses of the Legislature, was the culmination of more than five years of
CHA advocacy. Savings to hospital-based skilled-nursing facilities: $240 million.
Improving Quality & Patient Safety
This year, the Hospital Quality Institute was selected to lead the California Hospital Engagement Network 2.0,
resulting in 1,618 harms to patients being avoided and savings of $9.2 million.
Advocating to Postpone Use of S-10 Data in DSH Methodology
In its inpatient prospective payment system final rule, the Centers for Medicare & Medicaid Services (CMS)
postponed its proposal to incorporate Worksheet S-10 data for use in calculating the distribution of the Medicare
disproportionate share hospital (DSH) uncompensated care dollars for federal fiscal year 2018. CHA urged CMS
not to finalize its proposal and instead ensure the accuracy of the uncompensated care data reported on
Worksheet S-10 through a hospital-specific data audit. CMS’ proposal would have resulted in a $3 billion shift in
Medicare disproportionate share hospital (DSH) funding across providers and states and would have harmed
states — like California — that stood to lose more than $485 million in Medicare DSH payments. Savings to hospitals: $485 million.
Reversing Unlawful Medicare Funding Cuts to Hospitals
In the 2017 inpatient prospective payment system final rule, CMS published two adjustments that will reverse the
effects of the 0.2 percent cut it unlawfully instituted when implementing the two-midnight policy in fiscal year (FY)
2014. Specifically, the CMS finalized a permanent adjustment of 0.2 percent to remove the cut prospectively for
FYs 2017 and onward. In addition, it finalized a temporary adjustment of 0.6 percent to address the retroactive
impacts of this cut for FYs 2014, 2015 and 2016. The change represents an important, hard-fought victory for
hospitals and health systems. Nationally, a projected $3.1 billion in Medicare funding will be returned to hospitals
over the next 10 years as a result of this change. Net benefit: $82 million to be returned to California hospitals in 2017.
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Avoiding Unfunded Hospital Requirements
Blocking Enormous Collection Requirements
SB 1189 (Pan, D-Sacramento) would have required hospitals to store blood and urine samples from certain
patients — including those admitted with a life-threatening injury and those under the influence — and send those
specimens to the coroner if the patient died prior to discharge. If hospitals had been required to save each sample
for the duration of the admission, they would have needed space for over 18 million specimens every day.
Though the actual cost of the bill’s requirements is unknown, implementation of this unfunded mandate would
have cost hospitals significant time and resources.
Preventing a Mandated Patient Bed Registry
AB 2743 (Eggman, D-Stockton) would have imposed a new unfunded mandate on hospitals by creating a “real-
time” patient bed registry for inpatient psychiatric hospital bed openings. The mandate would have redirected
critical hospital staff to administrative functions and away from patient care. Real-time bed registries have been
tried in other states, both on a voluntary and mandated basis, have proven to be very difficult to implement and
have not shown significantly improved efficiencies. In addition to unknown costs to train staff and pay for access
to the registry, CHA estimated the labor costs to hospitals for keeping the registry updated in real time would have
been millions of dollars annually.
Averting Extraneous Notification Requirements
SB 1252 (Stone, R-Murietta) would have required hospitals to provide written notification to a patient in advance
of treatment if any of the physicians providing medical services to the patient were not contracted with the
patient’s health plan. In addition, hospitals would have been required to notify a patient of the net costs to the
patient for the medical procedure. Costs associated with this enormous new administrative burden would have been in the tens of millions of dollars.
Helping Physicians Lead Change
Now hosting its second cohort, the California Physician Leadership Program is a customized educational program
designed to challenge and grow physician leaders and medical executives. To date, over 50 physicians have
participated in this program, which leverages the University of Southern California’s top-rated Marshall School of
Business faculty, in partnership with the California hospital associations, to offer a unique balance of academic
and real-world subject matter experts.
Preventing Administrative and Legal Burdens
In addition to prohibiting numerous contract provisions between providers and health plans/insurers, SB 932
(Hernandez, D-Azusa) would have greatly expanded the Department of Managed Health Care’s (DMHC)
oversight by requiring any entity that intended to merge with, consolidate, acquire, purchase or control entity
health plan or risk-bearing organization to secure prior approval from DMHC. If this bill had been enacted, myriad
existing hospital contractual relationships would have been negatively affected, requiring expensive legal
expertise to resolve and likely resulting in reduced revenues. In addition, hospitals would have had to incur
substantial legal and other fees to obtain DMHC approval of new contractual relationships – or forgo those
relationships if DMHC withheld approval. Finally, hospitals would have to collect tens of millions of dollars directly
from their patients, because the hospitals would no longer have contracts with those patients’ health plans.
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Impacting Changes to the Electronic Health Record Incentive Program
In response to advocacy by CHA, CMS made a number of changes to its electronic health record (EHR) incentive
program that will significantly reduce hospitals’ reporting burden. Among the changes, CMS finalized an EHR
reporting period of 90 continuous days for both 2016 and 2017 for all hospitals participating in the Medicare EHR
incentive program, as well as those eligible to participate in both the Medicare and Medicaid EHR incentive
programs. In addition, CMS eliminated objectives long opposed by CHA, clinical decision support and
computerized provider order entry, and reduced most Stage 3 measure thresholds required to achieve meaningful
use in 2017 and 2018 to the Modified Stage 2 levels.
Assisting with Seismic Compliance
CHA continued to help hospitals reach seismic compliance through ongoing interactions with the Office of
Statewide Health Planning and Development (OSHPD) and facilitating meetings between hospitals and OSHPD.
Adjustments resulted in savings in the millions of dollars.
Offering Reimbursement Data and Modeling
CHA DataSuite continued providing sophisticated modeling of revenue data, helping hospitals analyze
federal policy changes for budgeting, forecasting and decision-making.
Members-Only Access to Regulatory, Legal and Financial Expertise
• On-call Consultations
CHA staff serve as on-call experts on a variety of issues for hospitals and health systems. CHA
also serves as a link to regulators and their staff, assisting with problem-solving and direct
communications.
• Education and Reference Manuals
Developed exclusively for executives of California hospitals, CHA’s conferences, education
programs and manuals help explain ever-changing regulations and their impact on operations. In-person
programs provide a forum for members to exchange ideas and learn from colleagues.
• Legal Expertise
CHA’s legal department advocates vigorously on issues relevant to California hospitals.
• Timely Updates on Key Issues
CHA’s daily e-newsletter, CHA News, briefs members on key policy issues, legislation, regulations and
legal developments.