2016 Member Value Report A Statement of Your Dues Investment in the Hospital Associations
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 1
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 2
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 3
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 4
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. 5
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. 6
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 postelection 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 7
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. 8
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 realtime 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. 9
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. 10