Hospital Topics

Overview

CDPH Licensing & Enforcement

The California Department of Public Health (CDPH) Licensing and Certification surveyors may visit a hospital at any time to determine whether the hospital is in compliance with state licensing requirements. Visits may result from a complaint by a patient, employee or other third party; a newspaper article; or a report by the hospital itself regarding an unusual occurrence, privacy breach or adverse event.

CHA News Article

CDPH Issues Hot Weather Advisory for Hospitals

The California Department of Public Health (CDPH) has released the attached All Facilities Letter (AFL) as a hot weather advisory to remind health care facilities that elderly patients and individuals with high health risk are more vulnerable in extreme heat and at risk of dehydration. The advisory outlines precautionary measures and informs health care facilities that they must have a contingency plan for facilitating patient safety during fluctuating high temperatures and any loss of air conditioning. CDPH also notes that health care facilities must report emergency/disaster-related occurrences, including extreme heat conditions, that could harm a patient’s health and safety, necessary evaluation, transfer or discharge. 

CHA News Article

CDPH Begins Pilot Testing for Hospital Relicensing Survey Process

The California Department of Public Health (CDPH) has announced the beginning of Phase II pilot testing for a new general acute care hospital relicensing survey process.

According to CDPH, its new survey process will evaluate general acute care hospitals’ compliance with state statutory and regulatory licensure requirements, including requirements previously evaluated through the Medication Error Reduction Plan and patient safety licensing surveys. The goal of the pilot-testing phase is to ensure the process will produce consistent, fair and useful information for both facilities and consumers before statewide implementation. For more information and for resources facilities may use to assess their readiness for the upcoming surveys, see the attached All Facilities Letter.

CHA News Article

CDPH Re-Issues AFL Related to California Hospital Fair Pricing Policies
Outlines recent changes to law under SB 1276

On Dec. 4, the California Department of Public Health (CDPH) re-issued an All Facilities Letter (AFL) notifying hospitals of recent changes to hospital fair billing policies — including charity care and discount payment plans — as a result of the enactment of SB 1276 (Chapter 758, Statutes of 2014). CDPH’s previous AFL 14-25 (dated Nov. 3) inaccurately stated that SB 1276 expands the availability of charity care and discount payment plans to all patients with high medical costs, including patients with third-party coverage. Under current hospital fair pricing policies, all uninsured patients or patients with high medical costs who are at or below 350 percent of the federal poverty level (FPL) are eligible to participate under a hospital’s charity care or discount payment policy (Health & Safety Code Section 127405(a)(1)(A)). The revised AFL clarifies the meaning of “patients with high medical costs” as “a person whose family income does not exceed 350 percent of the federal poverty level.”

CHA News Article

CDPH Guidance Emphasizes CDC Ebola Recommendations

The California Department of Public Health (CDPH) has issued the attached All Facilities Letter (AFL) to acute psychiatric hospitals and general acute care hospitals, sharing recent recommendations from the Centers for Disease Control and Prevention (CDC) for Ebola preparedness and recourse.

CHA News Article

CDPH Launches Open Data Portal

The California Department of Public Health (CDPH) has launched its Open Data Portal, a tool that allows user-friendly access to the data it collects about important health issues. The first data tables available through the portal include birth profiles, poverty rates, the location of vendors who accept vouchers from the Women, Infants and Children program, health care facilities data, and surveillance for West Nile virus and asthma. Upcoming data will include newborn screening disorders, licensed medical device retailers and leading causes of death. Eventually, CDPH will offer data from other state departments within the California Health and Human Services Agency. For additional information, visit the CDPH Open Data Portal.

Overview

Community Benefit Programs
Hospitals give back to their communities

Health care is undergoing tremendous change and uncertainty as California implements the federal Affordable Care Act (ACA). Hospitals are working to ensure there will be enough beds and an adequate supply of health care professionals to meet the demands of the millions of Californians who are signing up for health insurance coverage under the ACA. In addition, California hospitals are meeting the needs of their communities through locally developed community benefit plans by supporting health care programs that provide preventative care to those in need.

Tax-Exempt Status of Nonprofit Hospitals

The tax-exempt status of nonprofit hospitals is being reviewed by policymakers, regulators and public interest groups. There are various proposals to impose burdensome and inflexible standards on nonprofit hospitals in order to obtain tax-exempt status and financing. CHA supports the development of appropriate guidelines that are not unduly burdensome and will allow sufficient flexibility to ensure nonprofit hospitals are able to carry out their mission. They must be based on broad measures of community benefit without establishing rigid formulaic thresholds.

CHA News Article

CDC Announces New Community Health Improvement Navigator Framework and Tool
Website designed as one-stop-shop of tools and resources

The Centers for Disease Control and Prevention (CDC) recently launched a new website to support hospitals, health systems, public health and other community organizations interested in improving the health of their communities. Called the Community Health Improvement Navigator (CHI Navigator), the site is also intended for tax-exempt hospitals complying with the IRS final rule on community health needs assessments for charitable hospitals. 

CHI Navigator was designed as a one-stop-shop of expert-vetted tools and resources for individuals who lead or participate in CHI work within hospitals and health systems, public health agencies and other community organizations, to assist with:

General information

MOMS Orange County Provides Care to Low Income Pregnant Women

MOMS Orange County provides access to prenatal care, health screenings, health education, and referral services to more than 3,500 low income pregnant women annually in underserved communities in Orange County. Its services are offered at no cost to those who qualify, thanks in part to community benefit dollars from St. Joseph Health.

General information

Project Dulce Helps Diabetics Live Healthier Lives

Diabetes, which is especially prevalent among Latinos, often strikes fear in those who are newly-diagnosed.  To counter that, and to break through cultural misunderstandings, Scripps Health provides funding for a community benefit program called Project Dulce.  The program, which has been operating in San Diego County since 1997, provides diabetes-trained nurses and registered dieticians who work with patients to manage their disease and thus live longer, healthier lives.  It is especially effective since it uses peer counselors, fellow diabetics who can build trust since they are living with the disease themselves.  In this CHA video, a look at how the program works at one clinic in Escondido.

General information

Community Benefit Programs

California’s not-for-profit hospitals support a diverse array of community benefit programs across the state that are tailored to meet specific local health care needs. Those programs would be strengthened by Assembly Bill (AB) 1046 by Assemblymember Matt Dababneh (D-Encino), which provides greater transparency and accountability in the reporting of these programs. These community benefit programs, which provide help to millions of vulnerable Californians, are the subject of a new video produced by the California Hospital Association.

CHA News Article

CHA Video Highlights Community Benefit of Interactive Cooking Lessons in San Diego

To help promote its sponsored bill AB 1046 (Dababneh, D-Encino), CHA has released a short video highlighting the effectiveness of nonprofit hospital community benefit programs. AB 1046 provides for greater transparency in nonprofit hospitals’ reporting of their community benefit programs such as the Teaching Kitchen. Introduced this week, AB 1046 would align state and federal laws to eliminate conflicting reporting requirements, ensuring hospitals can focus on investing in their community’s needs instead of spending resources on conflicting governmental mandates.

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.

CHA News Article

Budget Gives CDPH New Investigation Timelines
Also adds L&C positions to address survey activities

The 2015-16 state budget provides the California Department of Public Health’s (CDPH) Licensing and Certification (L&C) Division with 237 additional positions to assist with its workload, including addressing “past failures to complete its survey workload and close/complete complaint investigations.” In addition, the budget increases hospital fees and adjusts the timelines for CDPH to complete investigations of skilled-nursing facilities (SNFs).

Many provider fees were increased in the budget to correspond to the associated survey activity within each type of provider (hospital, clinic, etc.). Hospitals and SNFs will likely experience increased survey and investigation activities as L&C will have additional staff to complete this work. In addition, providers fees may increase in coming years as the L&C workload continues to increase.

CHA News Article

Clinical Imperatives to Be Focus of Third PHM Webinar

The third webinar in CHA’s five-part certification series on Population Health Management (PHM) is scheduled for July 14 from 9:30 –11:30 a.m. Titled Clinical Imperatives of Population Health Management, the webinar offers valuable information for a variety of clinical professionals, including chief medical officers, chief nursing officers, quality directors, outpatient and rehabilitation services directors, and individuals with supervisory responsibility for clinical staff.

Recording

Advanced Decision Making for EMTALA Webinar
EMTALA principles, case scenario learning, surveyor compliance tips

Webinar Recorded Live on November 14, 2014

Overview

Whether you are a sending or receiving hospital, many factors must be considered when dealing with a potential EMTALA situation. Knowing the right thing to do isn’t easy, especially in a stressful or busy emergency department.

Recording

Minors Health Care — The Basics of Consent, Privacy and More Webinar
Learn about the rules, exceptions to the rules, practical solutions to common problems

Webinar Recorded Live on October 29, 2014

Overview

This scenario plays out in hospitals every day: grandmother, teacher, neighbor or concerned friend brings a minor to the hospital. No parent in sight. Now what?

Can you treat the minor? Whose consent do you need? Who should you talk to about the minor’s treatment options? These are all too common questions that often challenge the most seasoned health care providers.

CHA News Article

CDPH Issues Risk-Based Ebola Quarantine Order and Guidelines for Counties
State to assess individuals returning from Ebola-affected regions; updated federal guidelines recommend also monitoring those potentially exposed in U.S.

While there are no reported or confirmed cases of Ebola in California, the California Department of Public Health (CDPH)  took action Oct. 29 to help prevent any potential spread of the disease in the state by issuing a quarantine order and guidelines that require counties to assess individuals at risk for Ebola and tailor an appropriate level of quarantine as needed.

Overview

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.

Recording

OSHPD Proposes a New Seismic Design Category: SPC-4D
Details of the proposed SPC-4D building design category and how to determine eligibility

Webinar Recorded Live on May 12, 2015

Overview

The Office of Statewide Health Planning and Development (OSHPD) has developed proposed building standards for a new seismic design category — Structural Performance Category 4D (SPC-4D), which meets the requirements of the Hospital Facilities Seismic Safety Act and acceptable structural engineering practices. The proposed standards are under review by the California Building Standards Commission.

CHA News Article

New Behavioral Health Facilities Design Guide Released

The Facility Guidelines Institute (FGI) has released the seventh edition of the Design Guide for the Built Environment of Behavioral Health Facilities. Formerly hosted by the National Association of Psychiatric Health Systems, the guide helps behavioral health care provider organizations understand and analyze how the physical environment affects patient and staff safety, as well as offers best practices in protecting patients and staff. The guide can be accessed on the FGI website at www.fgiguidelines.org/beyond.

CHA News Article

CMS Issues Direction on Lowering OR Humidity Below 30 Percent

The Centers for Medicare & Medicaid Services has issued the attached memorandum to state survey agencies providing direction on how hospitals, critical care hospitals and ambulatory surgical care centers can obtain a categorical waiver to lower operating room relative humidity (RH) below 30 percent. The memo also addresses the need for humidity levels to be compatible with manufacturer requirements for storage and use of equipment.

Earlier this year, CHA issued a report, developed by a broad group of stakeholders, which identified issues hospitals may confront when lowering operating room humidity below 30 percent and urged hospitals to conduct risk assessments. The stakeholders who developed the guidelines were particularly concerned about manufacturers’ warnings related to RH levels lower than 30 percent – specifically regarding the impact on the integrity and functionality of equipment and supplies used in the operating room.

CHA News Article

OSHPD Showcases Online System for Plan Review and Construction

The Office of Statewide Health Planning and Development (OSHPD) Facilities Development Division (FDD) showcased its eServices Portal (eSP) and its integration with Google Earth at the 2015 Government Transformation Showcase in Sacramento earlier this month. The eSP is an online system that replaces OSHPD’s logbook and assists in expediting plan review and construction. At the showcase, it was selected as one of the top 15 examples of California government transformation. To learn more about the eSP and how it has enhanced FDD’s emergency response capabilities, see the attached report.

CHA News Article

Hospitals Should Conduct Risk Assessments When Lowering OR Humidity Below 30 Percent
Report identifies issues, offers guidance

The attached report, Relative Humidity Levels in the Operating Room Joint Communication to Healthcare Delivery Organizations, January 2015, was developed by a broad group of interested stakeholders to identify issues hospitals may confront and offers assessment guidance for lowering the operating room relative humidity (RH) below 30 percent.

Overview

Emergency Preparedness
Is your hospital prepared?

Visit CHA’s Emergency Preparedness website at calhospitalprepare.org

About

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 www.calhospitalprepare.org.

   
CHA News Article

CDC Issues Ebola Advisory on Travelers From Liberia

The Centers for Disease Control and Prevention (CDC) has issued a health advisory on the clinical considerations for evaluating ill travelers from Liberia. CDC’s advisory is consistent with two sets of guidance issued earlier this month by the California Department of Public Health (CDPH) — Planning for and Management of Travelers from Ebola-Affected Countries for Local Health Departments, and Interim Guidance for Healthcare Providers – Travelers from Ebola-Affected Countries. Both CDPH documents are available at www.cdph.ca.gov/programs/cder/Pages/Ebola.aspx.

CHA News Article

CDC Issues Modified Protocols for Liberian Travelers
CDPH releases updated guidance: June 18 call scheduled

Today, the Centers for Disease Control and Prevention (CDC) modified protocols for travelers from Liberia to the United States, stipulating that those currently under active or direct active monitoring for Ebola Virus Disease (EVD) by local health departments (LHDs) no longer need monitoring. For California, the protocol for Liberian travelers is spelled out in the attached updated guidance from the California Department of Public Health (CDPH). The guidance provides LHDs with important elements of an Ebola plan, changes in notifications and monitoring of Liberian travelers, and outlines the responsibilities of CDPH and the Emergency Medical Services Authority (EMSA) in assisting LHDs.

CHA News Article

State Adopts Emergency Drought Standards for Hospitals

The California Building Standards Commission voted to adopt emergency regulations that limit potable water use for outdoor irrigation at California hospitals and skilled-nursing facilities, making them more water efficient. Amending the 2013 California Green Building Standards Code (CALGreen), the new emergency regulations went in to effect June 1 and are enforceable by local and state agencies.

CHA News Article

Hospitals Asked to Donate Supplies to Nepal Earthquake Relief Efforts

The death toll from the Nepal earthquakes has reached more than 9,000, and the needs of the Nepalese survivors grow more urgent with each passing day.  Hospitals and health systems can contribute to the relief effort through MedShare.

CHA News Article

Office of Administrative Law Approves Emergency Water Conservation Regulation

Yesterday, the California Office of Administrative Law approved the State Water Resource Control Board’s emergency conservation regulation to achieve the 25 percent statewide potable water usage reduction ordered by Gov. Brown in his April 1 executive order. The emergency regulations are effective May 18 and will expire on Feb. 13, 2016. The Governor’s executive order required, for the first time in the state’s history, mandatory conservation for all residents and directed several state agencies, including the State Water Board, to take immediate action to safeguard the state’s remaining potable urban water supplies in preparation for a possible fifth year of drought.

The regulations also require commercial, industrial, and institutional users to implement water efficiency measures; prohibit irrigation with potable water of ornamental turf in public street medians; and prohibit irrigation with potable water, if it is not delivered by drip or microspray systems, outside newly constructed homes and buildings.

Overview

Environmental Health & Safety

CHA assists hospital environmental health and safety (EH&S) officers and other hospital personnel regarding compliance with the many — and frequently overlapping — state and federal EH&S requirements, including those related to  managing medical, hazardous and low-level radioactive waste. CHA also monitors EH&S legislation and regulation on behalf of hospitals and acts as their liaison with government agencies.  

CHA News Article For Members

CHA Provides Written Testimony on Proposed Prop. 65 Regulations
Comments on Cal EPA’s clear and reasonable warning regulations

CHA has submitted the attached comments to Cal EPA’s Office of Environmental Health Hazard Assessment (OEHHA) about proposed regulations related to Proposition 65 and prescription drug exposure warnings. CHA worked with the California Medical Association to develop new language to recommend to OEHHA, based on informed consent under prescribed conditions. In the comments, CHA also expressed concerns about the proposed regulations’ costs to California businesses — a minimum of $410 million, according to an analysis by the California Chamber of Commerce.

CHA News Article

New Amendments to Medical Waste Management Act Explained in Thursday Webinar
Still time to register for this important update

Significant new amendments — effective Jan. 1, 2015 — were made to the Medical Waste Management Act by AB 333 (Statutes of 2014). CHA will hold a webinar in conjunction with the California Department of Public Health (CDPH) on March 19 from 9 a.m. – 10 a.m. to explain the impact of those changes on the daily operations of hospitals and their handling and disposal of medical waste.

Webinar topics include CDPH and local enforcement agency inspections; new requirements for labeling, bagging and shipping forms; changes to the Medical Waste Management Plan; common violations; penalties for non-compliance; and Department of Transportation and CDPH regulations for medical haulers. The program is recommended for all staff in charge of medical waste at hospitals. For more information and to register, visit www.calhospital.org/medical-waste-management-act-web.

In addition, CDPH will hold a series of stakeholder and technical advisory meetings — beginning March 25 in San Jose — to gather input on the interaction of federal and state law for the transport of regulated medical waste.

CHA News Article

CDPH Stakeholder Meetings on Medical Waste Haulers Begin March 25

The California Department of Public Health will hold a series of stakeholder and technical advisory meetings — beginning March 25 in San Jose — to gather input on the interaction of federal and state law for the transport of regulated medical waste. The meetings are being held in accordance with AB 333 (Chapter 564, Statutes of 2014), the Medical Waste Management Act. CDPH will use the information gathered at the meetings to inform a report that must be submitted, according to AB 333, to the Legislature by Jan. 2, 2016. All individuals responsible for medical waste management at hospitals are encouraged to attend at least one of the sessions.

Technical Advisory Meetings

March 25 – San Jose
100 Paseo de San Jose, Auditorium

10  a.m.      This portion of the meeting is designated for transporters, treatment facilities, and transfer stations
1:30 p.m. This portion of the meeting is designated for generators (i.e.,  hospitals, clinics, dental offices, etc.)

Overview

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.

CHA News Article

Second Webinar in Population Health Management Series Is June 2
Still time to register for full series; catch up with access to program recording

The second of CHA’s five-part certification series on Population Health Management (PHM) continues June 2 from 9:30 –11:30 a.m., with the webinar Business Imperatives of Population Health Management. Registration remains open for all programs, including the April 28 webinar. Though the initial webinar has been held, it’s easy to catch up by viewing the recorded program.

“The value-driven approach to care delivery and financing under PHM alters the established business fundamentals,” said Anne McLeod, CHA’s senior vice president for health policy and innovation. “Hospital leaders will need to actively manage the transition and the impact on their business. This webinar will help members navigate that process.”

CHA News Article

First Population Health Management Webinar Lays the Framework for Series
Program begins April 28; includes extensive issue brief

CHA’s April 28 webinar on Population Health Management(PHM) will lay the framework for the five-part webinar series presented by a faculty of management consultants and thought leaders from Kaufman, Hall & Associates.

“CHA created this program to provide hospitals with the information and tools needed to move forward with PHM. It is the business challenge and opportunity for tomorrow’s hospitals and health systems, and it is the means to transform health care from a silo-like treatment of services to coordinated care across the continuum,” said Anne McLeod, CHA’s senior vice president, health policy and innovation. “California is at the forefront of this transformation by virtue of its size and unique demographic profile. I encourage all hospitals to consider participating.”

CHA News Article

LAO Recommends Performance Goals for Reuniting Unclaimed Property With Owners

California’s Legislative Analyst’s Office (LAO) has issued a new report on the state’s unclaimed property law. California law has long required hospitals to transfer to the State Controller’s Office (SCO) personal property considered abandoned by owners. The SCO has made important strides in reuniting this “unclaimed property” with owners, but faces budgetary and statutory constraints in reuniting even more such property. Since the 1950s, the state has accumulated more than $7 billion in unclaimed property belonging to individuals, businesses and local governments. Because hospitals spend significant time and resources transferring property to the state, it is important that the state be held accountable for reuniting more property with owners.

CHA News Article

Governor Unveils 2015-16 State Budget

Gov. Jerry Brown has released his $113 billion budget plan for 2015-16. In this year’s budget, elimination of the retroactive rate reductions imposed on hospital-based skilled-nursing facilities pursuant to AB 97 in 2011 remains a top priority for CHA.

CHA News Article

Governor Signs Bill Revising Charity Care Law

Governor Brown has signed SB 1276 (chapter 758, statutes of 2014), revising the existing law for hospital fair pricing policies. The bill changes the definition of a person with high medical costs to include those who have third-party coverage. While current charity care and discount payment policies provide hospitals and patients with the flexibility to negotiate the terms of a payment plan, this bill requires hospitals to consider the patient’s family income and essential living expenses. The bill also requires hospitals to agree to a default “reasonable payment plan” that is not more than 10 percent of a patient’s income, excluding deductions for essential living expenses, in the event the hospital and patient cannot agree on the terms of a payment plan. This bill goes into effect Jan. 1, 2015.

CHA encourages hospitals to work with their legal counsel when updating their charity care and discount payment policies. The bill is attached.

Overview

Health Care Reform

Our nation’s health care system has entered a new era with the enactment of federal health care reform. This landmark legislation is resulting in many changes in how health care is financed and delivered for years to come. For nearly two decades, CHA has been at the forefront in advocating for meaningful health care reform — and we will continue to help shape the future of hospital care far into the future. CHA’s vision of an “optimally healthy society” is now a reality within reach.

CHA News Article

U.S. Supreme Court Issues Decision in King v. Burwell
Upholds IRS regulations making subsidies available in states with federally facilitated marketplaces

 The U.S. Supreme Court issued its decision in King v. Burwell, the second challenge to the Affordable Care Act to reach the Court, upholding IRS regulations making subsidies available in states with federally facilitated marketplaces.

CHA News Article

Clinical Imperatives to Be Focus of Third PHM Webinar

The third webinar in CHA’s five-part certification series on Population Health Management (PHM) is scheduled for July 14 from 9:30 –11:30 a.m. Titled Clinical Imperatives of Population Health Management, the webinar offers valuable information for a variety of clinical professionals, including chief medical officers, chief nursing officers, quality directors, outpatient and rehabilitation services directors, and individuals with supervisory responsibility for clinical staff.

CHA News Article

Health Affairs to Conduct Briefing on California’s Medi-Cal Waiver
Experts to discuss perspectives on promoting health system improvement

Health Affairs, with support from the Blue Shield of California Foundation and the California HealthCare Foundation, will conduct a briefing on California’s Medi-Cal waiver on June 11 from 10 a.m. – noon. California’s five-year section 1115 “Bridge to Reform” demonstration waiver is set to expire Oct. 31. On March 27, the California Department of Health Care Services (DHCS) submitted its final draft 1115 Medi-Cal 2020 waiver renewal application to the Centers for Medicare & Medicaid Services for approval by Nov. 1. At the briefing, experts will discuss how waivers are being used to promote system improvement, delve into California’s experiences with and lessons from the current waiver, and explore opportunities in the latest waiver renewal application.

To register for the event visit the online registration site. The event will be recorded and available on the Health Affairs website afterward.

CHA News Article

MACPAC Report Details Early Beneficiary Experience in Duals Demonstration
Highlights feedback from California, Massachusetts and Ohio enrollees

The Medicaid and CHIP Payment and Access Commission (MACPAC) has released a study on early experiences with the Duals Demonstration in California, Massachusetts and Ohio. MACPAC conducted seven focus groups with beneficiaries in the three states over a nine-month period to obtain feedback on the enrollment process, understanding care coordination and access to services. Conducted between June 2014 and February 2015 the focus groups were comprised of 55 dual-eligible enrolled beneficiaries, most of whom had been enrolled in the demonstration for at least six months prior to the focus group. The report focuses on the findings of the focus groups and illustrates the challenges and benefits beneficiaries have experienced as these programs are implemented throughout the country.

CHA News Article

Second Webinar in Population Health Management Series Is June 2
Still time to register for full series; catch up with access to program recording

The second of CHA’s five-part certification series on Population Health Management (PHM) continues June 2 from 9:30 –11:30 a.m., with the webinar Business Imperatives of Population Health Management. Registration remains open for all programs, including the April 28 webinar. Though the initial webinar has been held, it’s easy to catch up by viewing the recorded program.

“The value-driven approach to care delivery and financing under PHM alters the established business fundamentals,” said Anne McLeod, CHA’s senior vice president for health policy and innovation. “Hospital leaders will need to actively manage the transition and the impact on their business. This webinar will help members navigate that process.”

Overview

Health Information Management & 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.

CHA News Article

CMS Seeks Volunteers for PSVA Pilot Program

The Centers for Medicare & Medicaid Services (CMS) is seeking volunteers to participate in a pilot of the Pre-Submission Validation Application (PSVA), which will allow hospitals to validate quality reporting document architecture (QRDA) Category I files for electronic clinical quality measure data submission. The pilot allows hospitals to catch and correct errors before submitting files to CMS. To be eligible, a hospital must be able to create QRDA Category I files based on the HL7 Base Standard for QRDA, as well as download and install PSVA in the hospital’s environment during the pilot period. Hospitals must also attend a 30-minute information session in June; attend two 30-minute feedback sessions in July; and record and submit feedback to CMS on their PSVA use. Hospitals interested in participating in the pilot should contact Stephanie Wilson by email at Stephanie.wilson@hcqis.org. Additionally, CHA requests that hospitals intending to participate notify CHA by email at akeefe@calhospital.org.

CHA News Article

CMS Proposes Modifying EHR Reporting Period to 90 Days in 2015

The Centers for Medicare & Medicaid Services (CMS) has released the attached proposed rule that would modify the reporting periods for the Medicare and Medicaid Electronic Health Records (EHR) Incentive Programs to a calendar year rather than a fiscal year. To accommodate the proposed changes, CMS proposes a 90-day reporting period for 2015 for all eligible hospitals and critical access hospitals, regardless of stage of meaningful use. In 2016, first-time demonstrators of meaningful use would also be allowed a 90-day reporting period. However, all returning participants would use an EHR reporting period of a full calendar year from Jan. 1, 2016, through Dec. 31, 2016. In 2017, all providers — both new and existing participants ­— would use an EHR reporting period of one full calendar year as proposed in the Stage 3 proposed rule.

CHA News Article

ONC Reports Health IT Exchange Often Blocked

In a report released last week, the Office of the National Coordinator (ONC) told Congress that some IT developers and providers are deliberately interfering with the exchange of electronic health information in ways that limit its availability and its potential to improve health and health care. ONC officials outlined a series of steps that federal agencies are considering, including new rules to discourage the blocking of health record sharing, referring any illegal business practices to law enforcement agencies and coordinating with the Health and Human Services Office of Inspector General to deter interference with record transfers.

CHA News Article

Deadline for Medicare EHR Incentive Program Hardship Exception Approaching
Hardship exception applications due April 1

CHA reminds hospitals that payment adjustments will begin Oct. 1 for eligible hospitals that did not successfully participate in the Medicare Electronic Health Record (EHR) Incentive Program in 2014. Eligible hospitals can avoid the 2016 payment adjustment by applying for a 2016 hardship exception by April 1 at 8:59 p.m. (PT). To file a hardship exception, Medicare-eligible hospitals must:

  • Show proof of a circumstance beyond the hospital’s control; and
  • Explicitly outline how the circumstance significantly impaired the hospital’s ability to meet meaningful use.

Supporting documentation must also be provided. The Centers for Medicare & Medicaid Services will review applications to determine whether or not a hardship exception should be granted. The hardship exception application and instructions for Medicare-eligible hospitals are available on the EHR Incentive Programs website.

CHA News Article

Stage 3 EHR Incentive Program Draft Rules Released
CMS proposes rules for EHR, 2015 Edition Health IT Certification Criteria

The Centers for Medicare & Medicaid Services (CMS) today released the attached notice of proposed rulemaking for the Stage 3 Medicare and Medicaid Electronic Health Records (EHRs) Incentive Programs and 2015 Edition Health IT Certification. Comments on the proposed rules are due May 29.

The Meaningful Use Stage 3 proposed rule specifies new criteria that eligible professionals, eligible hospitals and critical access hospitals must meet to qualify for Medicaid EHR incentive payments. The rule also proposes criteria that providers must meet to avoid Medicare payment adjustments (Medicaid has no payment adjustments) based on program performance beginning in payment year 2018. CHA is currently analyzing the regulations and will provide a detailed summary and solicit member input in the coming weeks.

Overview

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.

Representing hospitals and health systems in California, CHA provides leadership in HR policy on state and federal levels. In addition, CHA advocates on behalf of hospitals and health systems before the federal and state legislatures, federal and state administrative agencies and the public. CHA also provides educational opportunities, such as the annual Labor & Employment Law seminar, to help hospital leaders sharpen their skills and knowledge in health care HR. CHA members also participate on an HR executive e-mail list and receive periodic informational memoranda. 

Overview

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.

Recording

Advanced Decision Making for EMTALA Webinar
EMTALA principles, case scenario learning, surveyor compliance tips

Webinar Recorded Live on November 14, 2014

Overview

Whether you are a sending or receiving hospital, many factors must be considered when dealing with a potential EMTALA situation. Knowing the right thing to do isn’t easy, especially in a stressful or busy emergency department.

Recording

Minors Health Care — The Basics of Consent, Privacy and More Webinar
Learn about the rules, exceptions to the rules, practical solutions to common problems

Webinar Recorded Live on October 29, 2014

Overview

This scenario plays out in hospitals every day: grandmother, teacher, neighbor or concerned friend brings a minor to the hospital. No parent in sight. Now what?

Can you treat the minor? Whose consent do you need? Who should you talk to about the minor’s treatment options? These are all too common questions that often challenge the most seasoned health care providers.

CHA News Article

California Supreme Court Denies Review in Hospital Case Against Blue Cross
Case focused on calculating payment for authorized post-stabilization emergency medical services

Yesterday, the California Supreme Court denied review in Children’s Hospital Central California v. Blue Cross of California, and denied a request that the Court of Appeal’s decision be “depublished.” The case arose from a dispute between the hospital and Blue Cross over the basis for calculating the amount Blue Cross owed the hospital for authorized post-stabilization emergency medical services provided to beneficiaries enrolled in Blue Cross’ Medi-Cal managed care plan during a 10-month period when the parties were not in contract. Under the appellate court’s decision, hospitals may be paid less by non-contracted plans for authorized post-stabilization emergency medical services.

Recording

Principles of Consent and Advance Health Care Directives Webinar
A program for those new to health care or professionals seeking to refresh their knowledge

Webinar Recorded Live on October 1, 2014

Overview

Consent is more than a signature on a form
Patients have the right to make treatment decisions, but ensuring that they understand their options and associated risks is not easy. And while the responsibility for obtaining informed consent falls to physicians, your hospital is responsible for making sure that consent was obtained and documented.

CHA News Article

California Supreme Court Extends Deadline for Deciding Whether to Review Hospital Case Against Blue Cross

Last week, the California Supreme Court extended its deadline from Sept. 16 to Oct. 16 to decide whether to grant review in the Children’s Hospital Central California v. Blue Cross California case. The case arose from a dispute between the hospital and Blue Cross of California over the basis for calculating the amount Blue Cross owed the hospital for authorized post-stabilization emergency services provided to beneficiaries enrolled in Blue Cross’s Medi-Cal managed care plan while the hospital and Blue Cross were not in contract.

Overview

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.”

CHA News Article

Budget Trailer Bill Recognizes Alternative Quality Control in Clinical Laboratories

The budget trailer bill adopted as part of the state’s final 2015-16 budget amends Section 1220 of the Business and Professions Code pertaining to clinical laboratories. Specifically, the budget trailer bill allows clinical laboratories to establish an alternative quality control program that meets federal regulations under the Clinical Laboratory Improvement Act and that may include the use of alternative quality control testing procedures already recognized by the Centers for Medicare & Medicaid Services (CMS). Until now, the California Department of Public Health has interpreted regulations in a way that did not recognize federally approved alternative quality control methods, requiring labs to perform frequent quality control tests, which are substantially more expensive than the current federally recognized equivalent quality control (EQC) procedures and the impending individualized quality control plans (IQCPs).

CHA News Article

CHA Encourages Members to View FSRs for Outpatient Colonoscopy Measure
National provider calls scheduled for July 14 and 16

CHA reminds hospitals of the upcoming dry run of the “Facility 7-Day Risk-Standardized Hospital Visit Rate after Outpatient Colonoscopy” measure for hospital outpatient departments and ambulatory surgical centers. The dry run will take place from July 1 through July 31. During that time, the Centers for Medicare & Medicaid Services (CMS) will provide facilities with facility-specific reports (FSRs) for the measure. The FSR contains patient-level data, facility-specific results, and state and national results for the colonoscopy measure. CMS encourages facilities to review their FSRs thoroughly and submit any questions and comments to CMSColonoscopyMeasure@yale.edu.

CMS will hold two national provider calls to present the measure methodology and address questions. Hospital outpatient departments are asked to participate on July 14 from 11 a.m. – noon (PT), and ambulatory surgical centers on July 16 from 11 a.m. - noon (PT). Additional information about registration for the calls will be provided on QualityNet in late June.

CHA News Article

Clinical Imperatives to Be Focus of Third PHM Webinar

The third webinar in CHA’s five-part certification series on Population Health Management (PHM) is scheduled for July 14 from 9:30 –11:30 a.m. Titled Clinical Imperatives of Population Health Management, the webinar offers valuable information for a variety of clinical professionals, including chief medical officers, chief nursing officers, quality directors, outpatient and rehabilitation services directors, and individuals with supervisory responsibility for clinical staff.

CHA News Article

Hospitals Encouraged to Preview U.S. News Best Hospitals for Common Care Ratings
Preview period ends May 20

U.S. News & World Report has notified hospitals that its Best Hospitals for Common Care ratings (see previous CHA News article) are available for preview in the Best Hospitals Dashboard under embargo until May 20. The ratings place hospitals into performance tiers, with hospitals that performed consistently well rated highest. By logging into the dashboard, a hospital can access its ratings, the complete methodology report and key contacts for questions. CHA encourages hospitals to view their reports at https://hospitaldashboard.usnews.com/login?came_from=%2F during the preview period. Registration with the Hospital Dashboard is free, and more information is available on the U.S. News website.

CHA News Article

CMS Announces Strategic Vision for Physician Quality Reporting

The Centers for Medicare & Medicaid Services (CMS) has announced its Physician Quality Reporting Programs Strategic Vision. The document describes a long-term vision for CMS quality measurement for physicians and other health care professionals and public reporting programs, and how they can be optimized and aligned to support better decision-making from doctors, consumers and every part of the health care system. The strategic vision also includes five principles CMS believes will ensure that quality measurement and public reporting play a critical role in improving the health care system.  

Overview

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.

CHA believes that hospitals should be reimbursed adequately to cover the cost of care for enrollees.

CHA News Article For Members

CMS Issues CY 2016 OPPS Proposed Rule
Includes proposed changes to two-midnight rule; comments due Aug. 31

The Centers for Medicare & Medicaid Services (CMS) has issued the attached proposed rule updating the outpatient prospective payment system (OPPS) for calendar year (CY) 2016. CMS estimates that overall payments for hospitals paid under the OPPS will decrease by 0.2 percent compared to CY 2015.

In addition to the payment and quality reporting provisions expected in the rule and discussed below, CMS proposes changes to the two-midnight policy — specifically to the requirements for the expectation of two midnights. However, CMS makes no changes to the presumption that any patient who remains in the hospital for two midnights is deemed to have a medically necessary stay. Further, CMS proposes to change its approach to education and review of patient status claims and give more authority and oversight to the quality improvement organizations.

CHA News Article

DHCS to Host Webinars on Medi-Cal DRG Year 3

The Department of Health Care Services (DHCS) has scheduled two training sessions to help providers prepare for year three of the DRG payment methodology, which begins July 1. DHCS will host webinars, in conjunction with Xerox, on June 11 from 9:30 – 11 a.m. (PT) and June 15 from 9:30 – 11 a.m. (PT). Online registration is required. Once registered, attendees will receive meeting details and instructions for joining the meeting.

CHA News Article

DWC Issues Notice of Public Hearing on Revised Fee Schedules

The Division of Workers’ Compensation (DWC) has issued a notice of public hearing to revise the hospital outpatient departments and ambulatory surgical centers (HOPD/ASC) fee schedule. The hearing will be held June 17 at 10 a.m. in the auditorium of the Elihu Harris Building, 1515 Clay Street in Oakland. Members of the public may also submit written comment on the regulation until 5 p.m. that day.

The proposed amendment to the HOPD/ASC fee schedule regulation provides guidance on which HCPCS code to use when Medicare changes its coding practices – specifically, to describe comparable “Other Services” under the Centers for Medicare & Medicaid Services HOPD prospective payment system and the official medical fee schedule for physicians. The notice and text of the regulation are available on the DWC website.

CHA News Article

DHCS Seeks Comments on New Utilization Review Process

The California Department of Health Care Services (DHCS) has posted the draft Superior Systems Waiver (SSW) renewal application online for review and comment. The SSW describes the utilization review process for acute inpatient hospitals that serve fee-for-service Medi-Cal patients. Specifically, under the new waiver, private and non-designated public hospitals would transition to a utilization review system that no longer requires treatment authorization requests for the majority of acute inpatient stays. Instead, hospitals would use evidence-based medical criteria, such as Milliman or InterQual, to complete the utilization review. To ensure hospitals are appropriately using standardized medical review criteria, DHCS would review a statistically valid sample of cases approximately six months after claim submission.

The current SSW expires Sept. 30, and DHCS will submit the final renewal application to the federal Centers for Medicare & Medicaid Services no later than June 30. Comments on the draft may be submitted to DHCS no later than June 1 at SSWRenewal@dhcs.ca.gov. CHA requests that members who have comments also submit them to Amber Ott at aott@calhospital.org.

CHA News Article

Medi-Cal ICD-10 End-to-End Testing to Begin in July

The Department of Health Care Services has announced that Medi-Cal will conduct ICD-10 end-to-end testing in July. Providers and billers interested in participating in the testing can now register on the Medi-Cal website, which also includes instructions, more details about the testing and requirements for participation. The registration period ends June 5.

Overview

Workforce

California Hospitals are concerned about the need for an adequate supply of highly skilled health professionals to meet the demands for health care services now and in the future. Numerous studies have been completed that validate the need to address critical health professional shortages in nursing and the allied health occupations.  However, efforts to implement recommended strategies have been hindered by a lack of a coordinated statewide effort involving health employers, as well as other necessary partners. 

CHA News Article

Family Medicine Capitation Applications to Be Released June 30

The Healthcare Workforce Development Division’s (HWDD) Song-Brown program will release the Family Medicine Residency Capitation grant application June 30. Applications are due July 30. For those interested in submitting applications, HWDD will hold a Family Medicine Residency program webinar June 24 at 11 a.m. For more information, visit http://oshpd.ca.gov/hwdd/song_brown_prog.html.

The Song-Brown Health Care Workforce Training Act was established to increase the number of family physicians to provide needed medical services to Californians. The program encourages universities and primary care health professionals to provide health care in medically underserved areas while providing financial support to medical education programs throughout the state.

CHA News Article

CDPH Adds Staff to Assist With Delays in Phlebotomist Certification Renewals

Phlebotomist certification renewals are currently taking about 45 days to process, which is significantly longer than usual. Lab Field Services, under the California Department of Public Health, has added staff to alleviate the immediate backlog and is moving toward a more automated process to reduce future delays. Laboratory personnel can track certification renewals at https://www.cdph.ca.gov/programs/lfs/Pages/PersonnelWebsiteLookup.aspx, which is updated each Tuesday evening. An outline of the renewal process is available at https://www.cdph.ca.gov/programs/lfs/Pages/ContinuingEducation.aspx. California Code of Regulations (Title 17 CCR 1031.5 (c)) requires that renewal applications be submitted 60 days in advance of the expiration date.

CHA News Article

CDC Announces New Community Health Improvement Navigator Framework and Tool
Website designed as one-stop-shop of tools and resources

The Centers for Disease Control and Prevention (CDC) recently launched a new website to support hospitals, health systems, public health and other community organizations interested in improving the health of their communities. Called the Community Health Improvement Navigator (CHI Navigator), the site is also intended for tax-exempt hospitals complying with the IRS final rule on community health needs assessments for charitable hospitals. 

CHI Navigator was designed as a one-stop-shop of expert-vetted tools and resources for individuals who lead or participate in CHI work within hospitals and health systems, public health agencies and other community organizations, to assist with:

CHA News Article

Grants Available for Preventive Medicine Residency With Integrative Health Training Program

The Health Resources and Services Administration Bureau of Health Workforce is accepting applications through May 29 for its Preventive Medicine Residency with Integrative Health Care Training Program. With more than $5 million in funding, the program aims to improve the health of communities by increasing the number and quality of preventive medicine physicians who can address public health needs and advance preventive medicine practices, increase access to integrative health care and increase integration of the two fields into overall primary care training and practice. Grant funding will support efforts to plan, develop (including the development of curricula), operate or participate in an accredited residency or internship program in preventive medicine or public health. Eligible applicants include accredited public or private nonprofit hospitals; accredited schools of public health; schools of medicine; state, local or tribal health departments; and consortia of two or more eligible applicants. Approximately 14 grants of up to $400,000 per year for three years will be awarded. An application guide is available at www.hrsa.gov/grants/apply/applicationguide/sf424guide.pdf.

CHA News Article

Health Workforce Diversity Grants Available

The Department of Health and Human Services Office of the Assistant Secretary of Health is accepting applications through May 18 for its National Workforce Diversity Pipeline Program Grant. With approximately $2.5 million in funding, the program seeks to address health disparities among racial and ethnic minorities by supporting networks of institutions focused on increasing minority and disadvantaged students’ awareness and pursuit of careers in health care and behavioral health. Eligible applicants include hospitals, state and local governments, and universities, among others. Eight grants will be awarded, ranging from $350,000 to $500,000 per year for up to five years. For more information, visit www.grants.gov/view-opportunity.html?oppId=275242.

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