California Hospital Association

Hospital Topics

Jul 26, 2009 admin

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Hospital Topics

Aug 29, 2009 admin

Overview

Clinical Care

Clinical care touches every aspect of hospital operations. Policies and procedures surrounding clinical care are of the utmost importance in meeting regulatory, legal and licensing requirements. CHA has numerous area-specific groups — including specialty centers and committees — that address the many aspects of clinical care. Some areas of clinical care are subject to rapid changes in public policy and regulations, creating additional challenges for hospitals. In addition to providing representation and advocacy to address these challenges, CHA focuses on the unique needs of certain facilities, and the services and programs they offer their communities.

Behavioral Health Patients with mental health and substance-use disorders are commonly seen in general hospitals. The behavioral health disorder may be a patient’s primary diagnosis, or it may be a co-morbid condition accompanying a physical health disorder, such as diabetes, cancer or coronary artery disease. Read more »	Clinics Hospital-based outpatient clinics (HBOCs), including rural clinics, are one example of outpatient programs that have become an important part of the health care infrastructure and safety-net system Read more »	Emergency Department/Trauma Emergency services and trauma care in California are being threatened. Financial pressures, infra-structure requirements and shortages of licensed health care professionals have caused numerous emergency department (ED) and trauma center closures or downgrades. Read more »
Laboratory CHA represents hospitals in the regulatory and legislative arenas related to the environment in which hospital laboratories must operate. This includes testing and quality-assurance standards, equipment and procedure requirements and staffing. Read more »	Nursing As an integral part of hospital staffing, nursing is front and center for California hospitals. CHA works closely on many nurse-related issues with the Association of California Nurse Leaders, California Institute for Nursing and Health Care, California Board of Registered Nursing and other related organizations to address clinical, quality, safety and practice issues. Read more »	Palliative Care Palliative care is used to relieve the pain, symptoms and stress of serious illness, with a goal to improve quality of life for patients and their families. Palliative care, which may be used in any patient-care setting, is appropriate at any point in an illness and may be provided at the same time as curative treatments. Read more »
Pharmacy As an integral part of the health care delivery system, pharmacies present many high-priority issues for hospitals. CHA works with the California Society for Health Systems Pharmacists to assure legislation and regulations pertaining to the administration of pharmaceutical products are safe for patients, cost-effective and realistic. Read more »	Post-Acute Care Following a hospitalization for injury or illness, many patients require continued medical care, either at home or in a specialized facility. Post-acute care refers to a range of medical care services that support the individual’s continued recovery from illness or management of a chronic illness or disability. Read more »	Respiratory Therapy Respiratory therapy’s function and availability are vital throughout hospitals and outpatient departments, and respiratory therapists have become an integral part of the health care team. Read more »
Telemedicine & eHealth Telemedicine and telehealth use videoconferencing and specially adapted diagnostic tools to allow providers to care for patients located in distant locations. Read more »

Construction / Renovation

In the area of construction and renovation, CHA assists hospitals by reviewing and commenting on proposed regulations, attending all Hospital Building Safety Board (HBSB) meetings, nominating hospital representatives to the HBSB Board and serving as liaison between hospitals and the Office of Statewide Health Planning and Development's (OSHPD) Facility Development Division when issues need to be resolved.

Seismic Mandate

Following the 1994 Northridge Earthquake, which resulted in $3 billion damage to hospitals, the Alfred E. Alquist Hospital Facilities Seismic Safety Act was amended under SB 1953 (Chapter 740, Statutes of 1994. Seismic Mandate)

Emergency Preparedness

California hospitals are a critical component of the disaster medical response system and work collaboratively with local government, other health care providers and other agencies to plan, prepare for and respond to the needs of victims of natural or man-made disasters, bioterrorism, and other public health emergencies. Hospital emergency preparedness is a priority for government at all levels, as well as a key focus of regulatory and accrediting agencies. Hospitals must respond to increasing preparedness standards and activities, while simultaneously providing effective service to their communities. Through the Office of the Assistant Secretary for Preparedness and Response, Office of Preparedness and Emergency Operations, Hospital Preparedness Program (HPP) grant, CHA has created a web site specifically devoted to Emergency Preparedness at calhospitalprepare.org. Visit the Emergency Preparedness website

Finance

Hospital finance is complicated, and California hospitals operate in a challenging environment. Hospital executives are faced with the task of developing financial strategies that contain costs yet allow for the provision of health care to the state’s large uninsured population.

Billing & Collection The shared mission of California’s hospitals is to be on the front-lines of serving the health care needs of their local communities – 24 hours a day, seven days a week. Hospitals and their medical staff are relied upon to care and cure patients; this task requires a relationship with their communities built on trust, reliability, and compassion. Read more »	Budget The ability of California hospitals to provide high-quality health care to millions of patients across the state, day in and day out, depends heavily on local, state and federal funding. Read more »	Capital Financing & Access to Capital CHA works closely with state agencies that provide access to capital for financing hospital construction, renovation, equipment and other capital projects. Read more »
Charity Care Effective Jan. 1, 2008, hospitals are now required to submit charity care and discount payment policies bi-annually to the Office of Statewide Health Planning and Development (OSHPD) using OSHPD’s online system. Hospitals have had to comply with new fair pricing policies since Jan. 1, 2007, as required by AB 774. CHA’s handbook, Hospital Charity Care & Discount Payment Policies, can assist hospitals with creating a process for redeveloping business practices consistent with current, common interpretations of the hospital fair pricing policies, including the new OSHPD reporting regulations. Read more »	Commercial Insurance / Managed Care California has an exceedingly complex commercial health insurance regulatory and business environment. The state has one of the highest concentrations of managed care in the nation. Read more »	Financial Data Reports CHA provides a comprehensive source of tools and information to assist member hospitals with navigating through financial reporting requirements, including charity care discount policies, Medicare cost reporting and hospital annual financial disclosure reports. CHA also provides comprehensive analysis of reported financial data through CHA DataSuite, as a free member benefit. Read more »
Hospital Fee Program The hospital fee program was signed into law by the governor and becomes effective on January 1, 2010. This primary legislation (AB 1383, Jones – D /Alquist – D), was stripped of the necessary appropriations for the state to cover it's implementation costs and to make the new payments to hospitals; however, a secondary legislative solution – AB 188 (Jones – D/Alquist – D/Steinberg – D), passed the Senate and is expected to be heard in the Assembly soon before making its way to the governor for his signature. AB 188, an urgency bill, contains the two necessary appropriations that were removed from AB 1383. The urgency clause will make the bill immediately effective once it is signed by the governor. The Hospital fee program legislation expires on December 31, 2010. Read more »	Recovery Act On February 17, 2009, President Obama signed H.R. 1, the American Recovery and Reinvestment Act (ARRA), into law. The $787 billion economic stimulus bill contained a number of funding opportunities for hospitals and health systems. Read more »	Tax-Exempt / Nonprofit The tax-exempt status of nonprofit hospitals is being reviewed by policymakers, regulators and public interest groups. Read more »

Health Care Reform

CHA's longstanding vision is for "an optimally healthy society." CHA remains committed to health care reform with a goal of giving every person in California equitable access to affordable, medically necessary, high-quality care. Meaningful health care reform requires shared responsibility and should be paid for by all.

HCR & Geographic Variation The version of the health care reform bill, H.R. 3200, passed by the House Ways and Means Committee contains language that would require two studies regarding Medicare payment and cost variations in different locations around the country. Read more »	HCR & Readmissions Hospital readmissions policies have become an integral part of quality improvement measures in the health care reform debate. CHA supports the goal of comprehensive health care reform and improving quality of care. However, CHA urges caution regarding the appropriateness of relating Medicare payments to hospital readmissions Read more »	HCR & the Public Plan Universal coverage is the foundation on which reform, fairness and cost control will be built. The need for universal coverage is especially obvious in California, and therefore, all options deserve serious consideration, including another government health insurance plan. Read more »
HCR Bills As the health care reform debate progresses, various proposals and amendments continue to be released. Read more »

Health Informatics and Technology

Hospitals are moving away from paper-based records to electronic medical records and electronic health records to retain patient-care data. Electronic formatting facilitates data capture in a “real-time” environment, and allows many users to access the data at the same time. CHA supports the capture and availability of secure patient-care data through the use of health information technology (HIT) across the continuum of care. CHA believes HIT will serve as a tool to enhance patient safety, promote information for preventative health and reduce health care costs.

Human Resources

California hospitals and health systems employ more than half a million people — from entry-level positions to senior executives. Many health care human resources (HR) departments are responsible for a wide range of issues, such as recruitment, staffing, compensation, benefits, labor/employee relations and employee health. Navigating the complex regulatory environment, while monitoring how it applies to HR in the health care setting, can be a challenging and dynamic task.

Compensation & Benefits Compensation and benefits are an important aspect of the human resources. Creating compensation and benefit programs that are competitive and legally compliant is a challenge for hospitals and health systems. Through Allied for Health, CHA provides hospitals with the opportunity to participate in compensation and benefit surveys, and receive survey results. CHA's annual Labor and Employment Law seminar also provides practical guidance on these issues. Read more »	Discrimination / Harassment Both federal and state laws prohibit discrimination and harassment in employment decisions. However, an employer's legal obligation with regard to these issues is constantly changing. Statutes, regulations and case decisions provide guidance to help an employer maintain a workplace free of discrimination and harassment. CHA keeps health care human resources professionals current on these issues, provides resources to assist with compliance and advocates on behalf of hospitals and health systems at the federal and state level. Read more »	Immigration Immigration continues to be a controversial issue at both federal and state levels. Numerous legislative proposals are constantly being considered that may impact employers’ obligations regarding record keeping and pre-employment checks, as well as the availability of foreign-trained health care workers. CHA advocates both in Sacramento and Washington, D.C., on these issues. CHA supports the expansion of available visas as one of several creative solutions to help ease the workforce shortage while domestic supply is created. With regard to employer recordkeeping and background checks, CHA advocates for methods that do not create unreasonable burdens or hinder the hiring process. Read more »
Labor CHA believes that patients, employees, hospitals/health systems and the public are best served when management and employees work directly with each other. If employees of an organization vote to be represented by a third party in a lawful election, it is the responsibility of management to work with the elected representative in accordance with applicable laws. While federal law generally governs labor relations of private employers, state law may touch on some issues, such as property rights. For public employers, California state law takes precedence. Thus, it is important to keep abreast of developments on both state and federal levels to ensure compliance. Read more »	Leaves of Absence Federal and state laws impose various obligations on employers to provide qualified employees with paid or unpaid time off. The myriad of applicable laws makes compliance a challenge. However, keeping current on these obligations will help avoid misunderstandings and potential legal liability in the future. CHA keeps hospital human resources executives apprised of developments in this area throughout the year, and provides a comprehensive summary at the Annual Labor and Employment Law seminar. Read more »	Occupational Health & Safety Employee health issues are a primary concern for hospital employers. From infection control to ergonomics, hospitals strive to provide a safe work environment in the context of providing excellent patient care. Read more »
Wage & Hour California and federal wage and hour laws are complex, particularly in a hospital environment. Keeping current on meal and rest period rules, overtime obligations, and pay stub and payday obligations is a challenge for hospitals and health systems of any size. CHA offers members an annual Labor and Employment Law seminar, which brings hospital human resources executives up-to-date information on wage and hour issues. In addition, CHA issues member memoranda on significant developments. CHA devotes resources at both state and federal levels to advocate on behalf of hospitals with regard to legislation, regulations and enforcement activity. Read more »	Workforce The mission of CHA's Healthcare Workforce Coalition is to lead a coordinated, statewide effort to develop and implement long-term, strategic solutions that address the need for specific allied health professionals in California. The CHA Workforce Committee, comprised of CHA member hospitals and health systems, leads and directs the goals and activities of the coalition. Read more »

Legal

Overview of legal ...

CHA’s legal department advocates vigorously before the courts on behalf of California hospitals, both as a party in litigation and as amicus curiae in important appellate cases. In addition, the CHA legal department prepares legal memoranda and manuals to help hospitals understand and comply with state and federal laws. The CHA legal department also supports CHA staff in their advocacy efforts before the state legislature and regulatory agencies.

Compliance CHA actively assists hospital compliance officers, privacy officers and other hospital personel regarding compliance with the myriad federal and state laws that govern hosptial administration and the delivery of health care. CHA also sponsors legislation on behalf of California hospitals on issues related to compliance. Read more »	Consent Consent issues arise in a wide variety of circumstances including informed consent to medical procedures, release of patient information, advance health directives, research, and reporting requirements. CHA provides assistance to members in meeting consent requirements and advocates legislation that makes consent requirements more useful and understandable. Read more »	Language Access & Translation California hospitals are actively addressing the challenge of providing quality health care services to the diverse limited-English proficient (LEP) population, as well as deaf and hearing-impaired Read more »
Litigation The California Hospital Association represents the interests of California hospitals before state and federal courts in lawsuits involving MICRA, reimbursement, labor and employment, medical staff, and other issues. In addition, CHA summarizes cases of interest to hospitals. Read more »	Medical Staff Bylaws The medical staff is an integral and prominent part of the delivery of patient care. CHA produces Model Medical Staff Bylaws & Rules, a guide for hospitals and medical staffs in creating or amending bylaws, rules and regulations. CHA also advocates for legislation that will enhance the peer review process. Read more »	Mental Health Law Providing health care to individuals with mental health issues is complicated — requiring an understanding of the multiple bodies of law that govern the treatment, rights and protections of these patients. Read more »
MICRA CHA strongly supports the Medical Injury Compensation Reform Act (MICRA) of 1975. MICRA was enacted in response to a medical malpractice insurance crisis that threatened California’s health care system. As then-Gov. Jerry Brown explained in his proclamation calling a special session of the Legislature to address the crisis, “The cost of medical malpractice insurance has risen to levels which many physicians and surgeons find intolerable. The inability of doctors to obtain insurance at reasonable rates is endangering the health of the people of this State, and threatens the closing of many hospitals.” Read more »	Patient Rights California and federal laws give hospital patients many rights. Hospitals must notify patients of these rights by giving patients a handout and/or by putting posters up in the hospital. Read more »	Privacy/HIPAA Maintaining the confidential nature of patient records is integral to the practice of health information management. Read more »
Records Retention The retention of records and other important documents is an important aspect of all hospital operations. The retention of patient treatment records is particularly crucial for providing medical treatment continuity to patients. Read more »

Quality & Patient Safety

CHA is committed to helping hospitals improve quality, reduce medical errors and adverse events, and maximize patient safety. CHA’s vision is an “optimally healthy society.” CHA’s goal is for “every Californian to have equitable access to affordable, high-quality, medically necessary health care.”

Adverse Events The Institute of Medicine landmark report, To Err is Human (1999), identified that between 44,000 and 98,000 deaths per year are caused by medical errors. To create incentives for hospitals to prevent certain types of medical errors, the Centers for Medicare & Medicaid Services (CMS) instituted a policy that reduces Medicare reimbursement for conditions the agency believes are hospital-acquired, and are not noted as “present on admission” in patient charts. Read more »	California Hospital Patient Safety Organization CHA established the California Hospital Patient Safety Organization (CHPSO) to improve hospital patient safety and quality by providing leadership and serving as a means of intercommunication and cooperation between hospitals. Read more »	Infection Control Health care-associated infections (HAIs) constitute a risk to patients and health care facilities. Estimates indicate that 240,000 patients admitted to California hospitals annually develop HAIs, contributing to the suffering associated with illness and increasing costs to the health care system by approximately $3.1 billion. Read more »
Patient-Safety Collaboratives Read more »	Pay for Quality Reporting/Performance Pay for performance is an emerging movement — in which providers are rewarded for the quality of their health care services — among health plans and insurers (the Centers for Medicare & Medicaid Services and others). Some programs are initially providing financial incentives to participate in quality reporting. Read more »	Public Reporting of Quality Data CHA supports a single, meaningful reporting system of quality data that allows transparency and enhances accuracy. Consumer groups, health plans and payers continue to push for more public disclosure of hospital quality. CHA remains supportive of transparency if the measures are scientifically based, valid and accurate. Read more »

Reimbursement

California hospitals’ revenue stream is critical to their overall mission of providing care and cures in the communities they serve. While over half of hospitals' revenue, nearly $30 billion a year, is derived from government-funded programs, including Medicare, Medi-Cal, Healthy Families and county indigent programs - Private Insurance revenues are also significant.

County Medical Services Program The County Medical Services Program (CMSP) provides health coverage for low-income, indigent adults in 34 primarily rural California counties. Read more »	Disproportionate-Share Hospital Program The disproportionate-share hospital (DSH) supplemental payment program is designed to provide additional funding to hospitals that serve a disproportionate number of Medi-Cal and low-income/charity Read more »	Healthy Families / SCHIP Healthy Families is California’s low-cost insurance program that provides health, dental and vision coverage to children who do not have insurance and do not qualify for no-cost Medi-Cal. Read more »
Medi-Cal / Medicaid Medi-Cal is California's Medicaid program — a public health insurance program that provides needed health care services for low-income families with children, seniors, people with disabilitie Read more »	Medicare According to the Office of the Actuary for the Centers for Medicare & Medicaid Services (CMS), Medicare reimbursement to California hospitals amounted to almost $58 billion in 2004, comprising Read more »	TRICARE TRICARE is the insurance product offered by the Department of Defense (DoD) to active duty military, their families and military retirees for payment in civilian facilities. Since 2000, DoD has been mandated by Congress to base TRICARE reimbursement rules and rates on those incorporated within the Medicare prospective payment systems (PPS) “to the maximum extent practicable.” Read more »
Undocumented Immigrant Programs Hospitals and physicians will always care for all patients in need who come to emergency departments, regardless of their ability to pay or their immigration status. CHA has long advocated that the federal government acknowledge the cost of providing care to undocumented patients, and appropriate sufficient funds to cover the cost of their emergency and follow-up care. Read more »	Workers' Compensation The Division of Workers' Compensation (DWC) monitors the administration of workers' compensation claims, and provides administrative and judicial services to assist in resolving disputes that arise in connection with claims for workers' compensation benefits. Read more »

Topics A-Z

10 Percent Rate Cut Lawsuit	Geographic Variation in Patient Care	Occupational Health & Safety
Adverse Events	Graduate Medical Education	OSHPD
Area Wage Index	Health Care Reform	OSHPD Quality Data
Bad Debt	Health Informatics and Technology	Palliative Care
Behavioral Health	Healthy Families / SCHIP	Patient Rights
Billing & Collection	Home Health	Patient-Safety Collaboratives
Budget	Hospice	Pay for Quality Reporting/Performance
California Hospital Patient Safety Organization	Hospital Compare	Pharmacy
Capital Financing & Access to Capital	Hospital Fee Program	Post-Acute Care
Charity Care	Hospital Topics	Privacy/HIPAA
CHART	Human Resources	Prospective Payment System
Clinical Care	Immigration	Provider Designation
Clinics	Infection Control	Public Reporting of Quality Data
Commercial Insurance / Managed Care	Inpatient Rehabilitation Facilities	Quality & Patient Safety
Compensation & Benefits	Labor	Records Retention
Compliance	Laboratory	Recovery Act
Consent	Language Access & Translation	Recovery Audit Contractor Program
Construction / Renovation	Leaves of Absence	Reimbursement
Cost Reporting	Legal	Respiratory Therapy
County Medical Services Program	Limited-Service Hospitals	Seismic Mandate
DataSuite	Litigation	Skilled-Nursing Facilities/Distinct-Part Nursing Facilities
Discrimination / Harassment	Long-Term-Care Hospitals	Staffing and Workforce Legislation/ Regulations
Disproportionate-Share Hospital Program	Managed Care Litigation & Enforcement	State Budget
Emergency & Post-Stabilization Rate Lawsuit	Medi-Cal / Medicaid	Subacute Care
Emergency Department/Trauma	Medi-Cal Managed Care	Tax-Exempt / Nonprofit
Emergency Preparedness	Medi-Cal Rate Cut Lawsuit	Telemedicine & eHealth
Federal Budget	Medicaid Waivers	TRICARE
Federal Budget	Medical Staff Bylaws	Undocumented Immigrant Programs
Federal Budget	Medicare	Value-Based Purchasing
Fee-for-Service	Mental Health Law	Wage & Hour
Finance	MICRA	Workers' Compensation
Financial Data Reports	Nursing	Workforce

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Hospital Topics

Hospital Topics

Overview

Clinical Care

Construction / Renovation

Emergency Preparedness

Finance

Health Care Reform

Health Informatics and Technology

Human Resources

Legal

Quality & Patient Safety

Reimbursement

Topics A-Z