2015 CHA Member Value Report
A Year of Accomplishment

We are proud to share with you the significant accomplishments we produced in 2015. This report highlights many of the successful advocacy and representation 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 2015, the hospital associations generated more than $280 of value.

Retaining Meal Period Waivers for Hospital Employees

Avoiding Retroactive Payments

CHA-sponsored SB 327 was signed by the Governor, allowing meal period waivers to continue for hospital employees. Without the law, hospitals may have been subject to retroactive meal period premium payments and costs for employees working 12-hour shifts. Savings for hospitals: At least $4.3 billion.

Preserving Meal Period Waivers Going Forward

SB 327 also protects waivers for more than 50,000 hospital employees on a prospective basis, allowing tens of thousands of hospital employees statewide to continue to waive one of their meal periods when they work 12-hour shifts.

Leading Ongoing Implementation Efforts for the Hospital Fee Program

Building on a new law CHA created in 2013 (SB 239), CHA continued to drive the review and approval process for the managed care portion of the 2014-16 hospital fee program, which increased Medi-Cal payments to hospitals by $3.3 billion in 2015. Ensuring that the hospital fee and federal matching funds will be used only for purposes described in the law, the new program also guarantees that Medi-Cal rates to hospitals will not be cut from current levels. Net benefit to hospitals: $10 billion (2014-16).

Protecting the Tax Status of Nonprofit Hospitals

CHA, with help from member hospitals, defeated legislation – SB 346 – that would have endangered hospitals’ nonprofit tax status. CHA’s advocacy campaigns highlighted the costs and unrealistic mandates the bill would have imposed on nonprofit hospitals, reducing their ability to carry out effective programs and meet the needs of their communities. Annual savings to nonprofit hospitals: $3.2 billion.

Advocating Hospital Payments Under the ‘Two-Midnight’ Rule

The Centers for Medicare & Medicaid Services (CMS) in 2015 finalized a number of policies for the two-midnight policy, acknowledging CHA’s argument that some hospital stays of less than two midnights may be appropriate for inpatient hospital care and, therefore, eligible for Medicare Part A payment. With strong advocacy from CHA, AHA and others, CMS will determine whether payment under Part A for stays under two-midnights is appropriate on a case-by-case basis based on the admitting physician’s clinical judgment and the medical record. In addition, quality improvement organizations, rather than Recovery Audit Contractors, are now responsible for conducting medical reviews and educating hospitals about claims denials under the two-midnight policies.

Stopping Medicare Payment Reductions

Congress overwhelmingly passed the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015, permanently repealing the sustainable growth rate formula and ending decades of uncertainty for Medicare payments to physicians. CHA supported the legislation primarily based on the many proposals to reduce Medicare payments to hospitals that were not included in the bill. Due to strong advocacy, the bill did not include cuts to graduate medical education, critical access hospitals or Medicare bad debt. It also did not include a delay in the implementation of ICD-10 or a repeal of the Affordable Care Act’s ban on physician-owned specialty hospitals.

Most notably for California, it did not include a provision to change the calculation of the rural floor component of the area wage index, which would have reduced payments to California hospitals by more than $190 million in fiscal year 2015, more than any other state. Cuts averted for hospitals: $190 million.

Promoting Population Health Management

Recognizing the importance of health care professionals and organizations understanding the many facets of population health management, CHA offered a five-part certification education program on population health management. More than 200 hospital leaders learned how to plan for and implement population health initiatives through the webinar series and accompanying issue briefs.

Creating Ongoing Funding for Quality and Patient Safety

To advance California as the national leader in quality and patient safety, CHA and the Regional Associations secured ongoing funding for the Hospital Quality Institute (HQI). More than 4,000 hospital employees and physicians have received education on quality and safety topics. Hospitals achieved a 58 percent reduction in pressure ulcers; a 57 percent reduction in ventilator-associated events; a 28 percent reduction in sepsis mortality; a 43 percent reduction in central line blood stream infections; and a 65 percent reduction in early elective deliveries.

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. CHA supported legislation for individual hospitals that had completed a majority of their projects but needed additional time to obtain a certificate of occupancy.

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.

Member-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.