Legislative Summary and Policy Previe...As you read this year’s Legislative Summary, you’ll see that our work continues on legislative issues connected to the implementation of

Washington StateHospital Association

Legislative Summaryand Policy Previews e p t e m b e r 2013

state budget: protecting Health Care Funding3 Overview3 Medicaid Expansion4 Hospital Safety Net Assessment4 Critical Access Hospital Funding4 Payment Reform5 Mental Health5 Washington Health Benefit Exchange6 Hospital Tax Exemptions6 budget summary Chart

policy bills: Improving Quality and Increasing Access9 Electronic Health Records9 Peer Review and Quality Improvement10 Telehealth 10 Staffing Regulations11 Physician Orders for Life-Sustaining Treatment (POLST)11 Certificate of Need12 Health Care Confidentiality12 Property Tax Exemption Requirements 12 Confidentiality of Health Care Contracts13 Health Care-Associated Infection Rate Reporting13 Mental Health14 Association of Washington Public Hospital Districts (AWPHD) 15 WsHA policy bill summary Chart17 AWpHD policy bill summary Chart

tA b l e o F Co n t e n t s

policy preview: the road Ahead19 Overview20 Coverage is Here: Enrollment Opportunities and Challenges21 Protecting Access to Essential Care, Everywhere22 Quality and Patient Safety 22 Patient Safety Results 24 Health Reform: Transparency, Payment Models and More 25 Mergers and Certificate of Need

other resources26 Policy Development Calendar27 Policy and Advocacy Team Contacts28 Washington Hospital PAC

1

WA

sH

Ing

to

n s

tA

te

Ho

sp

ItA

l A

ss

oC

IAt

Ion

LE

gIS

LA

TIv

E S

uM

MA

Ry

AN

D P

OL

ICy

PR

Ev

IEW

2013

WSHA members,I want to thank all of you for your support this legislative session. It was a difficult session and a long one, but also very successful. Meeting our goals required an enormous amount of work on your part: you helped develop our policies, responded to our calls to action, coordinated your lobbying efforts, supported the PAC, and worked with us through some treacherous waters.

This year will be an important one in the history of health care in Washington State. Although it initially looked like it would be a real battle, the debate about Medicaid expansion ended with bipartisan success: the full expansion of the program, and solid policy choices backing it up.

That expansion was our foremost priority this session, and was an essential victory for hospitals and patients. It will bring $350 million in new funding to Apple Health, opening it to hundreds of thousands of adults in this state, many of whom are living and working without any health coverage. The expansion of Medicaid coverage and the availability of subsidized private insurance are necessary layers of protection for hospitals, who will be taking more than $3 billion in Medicare and DSH payment cuts over the next 10 years to finance the expansion.

While we should celebrate that victory, we don’t think for a minute that the rest of the implementation of the Affordable Care Act will be easy. In addition to meeting the clinical needs of hundreds of thousands of newly insured patients, hospitals are managing the changing marketplace, new state and federal regulatory requirements, new payment models, and the growing need for more price and quality transparency.

These questions don’t end with the legislative session — far from it. As you read this year’s Legislative Summary, you’ll see that our work continues on legislative issues connected to the implementation of the Affordable Care Act, patient safety, price and quality transparency, mental health access, and more.

We don’t presume to have all the answers, but we know that by working voluntarily and collaboratively, we can help our hospitals and our communities improve their health.

It is a true pleasure to serve you.

Thank you,

scott bondPresident & CEO, Washington State Hospital Association

Washington StateHospital Association

WsHA’s over-arching budget goals this year were to

secure Medicaid expansion and ensure that hospitals and

health care services did not suffer disproportionate cuts

in the budget. As hospitals work to manage the changes

brought about by the Affordable Care Act, having stable

state funding is an important part of ensuring the fiscal

stability and sustainability of our institutions.

State Budget: Protecting Health Care Funding ith a divided Legislature, it was inevitable that the budget writing process would be difficult. However, even the most experienced Olympia watchers did not predict the last minute nature of this year’s negotiations. The budget deal was announced on Friday, June 28, just before the new fiscal year, narrowly averting a government shutdown.

In addition to the political uncertainty and the very real philosophical differences in how lawmakers felt about raising revenue, the Legislature faced budget-specific challenges.

• The session began with a $1.3 billion shortfall in the operating budget;

• The state Supreme Court made it clear in the McCleary decision that the state must significantly increase education spending; and

• A State Supreme Court decision on the voter-approved estate tax meant the potential loss of $160 million if the law was not corrected in time.

WSHA’s over-arching budget goals this year were to secure Medicaid expansion and ensure that hospitals and health care services did not suffer disproportionate cuts in the budget. As hospitals work to manage the changes brought about by the Affordable Care Act, having stable state funding is an important part of ensuring the fiscal stability and sustainability of our institutions. It allows hospitals to focus on implementing change and working with their communities to expand health care coverage and access to quality health services.

By almost any measure, this was a very successful legisla-tive session. We secured the expansion of Medicaid, forged a new Hospital Safety Net Assessment that provides new protections and real benefits to our members, preserved Critical Access Hospital funding, and maintained hospital tax exemptions.

WsHA’s 2013 budget priorities were as follows:

Medicaid Expansiong oAl: Extend Medicaid to cover at least 325,000 new Medicaid enrollees as part of the Affordable Care Act

o u tCo m e: Successful

The session began with a serious debate about whether Medicaid-funded health programs should be expanded in Washington State. Some lawmakers believed that only those states participating in the expansion would be required to help finance it by having their Medicare reimbursement rates cuts. WSHA, member hospitals, and partner organizations focused significant time on educat-ing lawmakers that hospitals in Washington State face $3 billion in federal cuts over the next 10 years, whether or not we expand. We made sure legislators understood that the sustainability of our hospitals depended on a dramatic expansion of health care coverage.

After intense lobbying and significant debate, the expan-sion was ultimately included in both House and Senate budgets. WSHA continued to lobby on the accompanying policy provisions, and was successful in fighting off pro-posals for unaffordable premiums and cost-sharing. These

3

WA

sH

Ing

to

n s

tA

te

Ho

sp

ItA

l A

ss

oC

IAt

Ion

LE

gIS

LA

TIv

E S

uM

MA

Ry

AN

D P

OL

ICy

PR

Ev

IEW

2013

s tAt e b u D g e t: P R O T E C T I N g H E A LT H C A R E F u N D I N g

Hospital Safety Net Assessmentg oAl: Establish a hospital safety net assessment program that supports Washington hospitals through improvements in Medicaid payments, and ensure that hospitals receive more in net benefit than they pay in assessments

o u tCo m e: Successful After hundreds of hours of staff work, dozens of amend-ments, and countless negotiation sessions, the Washington State Legislature enacted a new assessment program that meets all of the criteria outlined by the WSHA Board of Trustees.

Without the approval of a new assessment program, the sunset of the first program on June 30, 2013 would have left a $270 million hole in the state’s general fund budget. This budget gap likely would have led to further Medicaid cuts, leaving safety net hospitals in jeopardy.

The board charged WSHA staff to develop a new program under which: • The bulk of funds are used to provide hospital care

for vulnerable Medicaid patients; • The tax rate stays within an acceptable range; • There are legal protections; and • There is another sunset date.

The new program accomplishes all of these goals.

In state Fiscal Years 2014 and 2015, the new assessment program will provide approximately $220 million in net benefit to hospitals and $200 million to the state. Beginning in state fiscal year 2016, the law begins a five year phase down where assessments and payments decrease. The law sunsets in 2017, before the phase-down is complete; it must be re-enacted at that time if it is going to continue.

The new law contains two years of contractual protections that will exist outside of the legislative arena, significantly improving protections from a future raid. Hospitals have the opportunity to enter into an independent contract with the Health Care Authority that entitles them not to pay any future assessments in the event the legislature changes the law and reduces hospital payments.

Critical Access Hospital Fundingg oAl: Protect funding for Critical Access Hospitals to provide essential care for their communities


Washington State’s 38 Critical Access Hospitals are a vital link in the state’s health care infrastructure, often providing most or all the health care in their communities. State policy makers have recognized the essential role these facilities play in assuring local access to care through explicit statutory language.

Continuing cost-based payment is essential for maintaining access to health care in these communities, and payment cuts would lead to loss of services or even total hospital closures in some areas. While this funding has been targeted for cuts in the past, no cuts were even introduced this year. In the meantime, rural hospitals are working together to develop innovative approaches to care delivery that allow them to continue to meet the changing needs of their communities.

Payment Reform g oAl: Support a structure to integrate care and reduce growth of health care costs

o u tCo m e: Good initial steps, but ongoing

Medicaid Quality Incentive: Hospitals in Washington State were among the first in the country to have the opportu-nity to earn a Medicaid bonus payment based on the achievement of several quality measures. During the 2010 incentive program, 90 percent of eligible hospitals qualified for and received the incentive.

This year, legislators approved a new Medicaid Quality Incentive. To earn the incentive, hospitals need to maintain the gains achieved during the first incentive and improve in several other quality metrics. This approach — collabo-rative, positive, and evidence-based — engages hospitals and caregivers, and will improve the care delivered to all patients. More information is available at www.wsha.org/qualityincentive.cfm.

WSHA also advocated for the passage of legislation that allows for community-wide use of a single electronic medical record system, which will help advance the goal

policies would have discouraged people from seeking needed medical care. Cost sharing is also often uncollect-able from struggling families, and turns into bad debt.

4

WA

sH

Ing

to

n s

tA

te

Ho

sp

ItA

l A

ss

oC

IAt

Ion

L

Eg

ISL

AT

IvE

Su

MM

AR

y A

ND

PO

LIC

y P

RE

vIE

W 2

013


5

WA

sH

Ing

to

n s

tA

te

Ho

sp

ItA

l A

ss

oC

IAt

Ion

LE

gIS

LA

TIv

E S

uM

MA

Ry

AN

D P

OL

ICy

PR

Ev

IEW

2013


of better care integration for patients when they get care at multiple locations.

WSHA will continue to support meaningful efforts to advance paying for value and quality, and looks forward to these conversations with members and policy makers.

Mental Healthg oAl: Support improvements to the mental health system

o u tCo m e: Mostly successful, but ongoing

Mental health is one of the most seriously underfunded areas of health care in our state, with significant cutbacks, year after year. It will take significant effort to provide adequate mental health services in this state.

That said, this budget is a step in the right direction, as it includes $28 million to fund the increases in demand expected from changing the Involuntary Treatment Act standards. This money will pay for hospitalizations, expanded community-based outpatient treatment, mobile crisis teams, and peer support services.

In addition, the budget provides $2.8 million to allow some patients at Eastern and Western State Hospitals to move into enhanced community-based facilities. This could then open beds for patients with long term mental health service needs.

Even these investments should be treated with cautious optimism. The state is assuming that it will save money in mental health spending as a result of Medicaid expansion. However, because some necessary services are still not covered by Medicaid, the state may have assumed too large a savings from this shift.

There are also concerns from some legislators about where services are provided. Larger adult psychiatric hospitals do not qualify for federal Medicaid funds and therefore the state’s costs for treating Medicaid patients at these facilities are higher. If state action results in these hospitals seeing fewer Medicaid patients, more patients would be “boarded” in community hospitals, which are not set up to care for their acute psychiatric needs.

Mental health care is an area that needs attention, and WSHA is actively engaged with our partners in the mental health system and with state agencies as we all work towards increased access to services.

Washington Health Benefit Exchangeg oAl: Ensure the health benefit exchange is funded through a reasonable mechanism that does not unfairly impact hospitals and health systems


Washington State is among one-third of states that has chosen to operate its own Health Insurance Exchange (in Washington, it is called the Washington Health Benefit Exchange). The online marketplace for individuals, with a web-based electronic enrollment and eligibility system, received federal grants to start operations, but needs to be self-supporting by 2015. The Exchange’s annual operating budget for 2015 is $40 million. An initial proposal included a tax on hospitals to fund the Exchange, based on the mistaken perception that hospitals benefit greatly from reductions in charity care. WSHA worked to educate the Exchange stakeholders about how the ACA already cuts billions from hospital reimbursement rates to fund the expansion of insurance options, and the proposed hospital tax was dropped from consideration. For 2015, the Exchange will be funded through a combination of taxes on health insurers and a one-time transfer of funds from the Washington State Health Insurance Pool.

6

WA

sH

Ing

to

n s

tA

te

Ho

sp

ItA

l A

ss

oC

IAt

Ion

L

Eg

ISL

AT

IvE

Su

MM

AR

y A

ND

PO

LIC

y P

RE

vIE

W 2

013 Issue FInAl buDget

medicaid expansion • ExpandsMedicaid,with$350millioninsavingstothestate. • FoldsinTakeCharge,BasicHealthPlan,BreastandCervicalCancerandotherprograms

into the Medicaid program. • IncludessomeexpansioninMedicaidbenefits. • ProvidesfundingtocontinuetodevelopafederalBasicHealthPlanoption.

medicaid Cost-sharing • Doesnotimposecost-sharingontheMedicaidexpansionpopulation. • Doesnotincreasepremiumsforchildren.

medicaid expansion • Includescircuit-breakerlanguageinthebudgetbill,whichisineffectfortwoyears.Circuit breaker Circuit-breaker would reduce state funding and cut the Medicaid expansion program if

federal funding for the Medicaid expansion falls below the promised 90% match.

Hospital safety net • IncludestheHospitalSafetyNetAssessment.Assessment program • Setstheprogramatahighlevelforthefirstbiennium. • Insubsequentyears,ratchetsdowntheassessmentandbenefitstothestateandhospitals

by 20 percent per year. • Includescontractualprotectionsagainstafutureraidoftheassessmentforthefirsttwoyears. • Sunsetsinfouryears.

mental Health • Allocates$2.8millionforenhancedcommunity-basedservicesfacilities,allowingEastern and Western State Hospitals to serve more patients.

• Provides$28millioninfundingfortheJuly2014implementationoftheInvoluntary Treatment Act.

• Createsastudyofruralhospitaldeliveryofinpatientmentalhealthservices.

Hospital Tax Exemptionsg oAl: Maintain important tax exemptions for hospitals


Nonprofit hospitals and health systems in Washington State provide significant community benefits ranging from community services such as immunization clinics and health education to the unreimbursed costs of providing care to charity care, Medicaid, and other low-income patients. State law provides some property tax exemptions and some revenue tax deductions to hospitals. WSHA successfully maintained these exemptions for our state’s nonprofit hospitals, and ensured no new taxes were applied to nonprofit or for-profit hospitals.

BuDgET SuMMARy

non-medicaid • Assumes$50.7millioninsavingsinnon-Medicaidmentalhealth.mental Health

mental Health • Createsa$5millioncompetitivecapitalbudgetfundtoincreaseinpatientmentalhealthbeds.Capital budget • Createsanexpeditedregulatoryreviewprocessforhospitalsormentalhealthcenters

that receive funding.

rural Health • DoesnotcutpaymentsforCriticalAccessHospitals.

rural Clinics • DoesnotcutenhancementpaymentstoFederallyQualifiedHealthCentersandRuralHealthCenters, but sends the money through the plans.

• Providesfundingtoreduceamountsowedtothestateforrecoupmentofpastpayments.

Adult Dental • Allocates$72.5milliontofullyrestoredentalservices,suchasfillings.

managed Care • DoesnotcutmanagedcarepaymentsforblindanddisabledMedicaidenrolleesenrolledpayments in managed care plans.

sole Community • Provides$1.8millioninincreasedfundingforMedicaidservicesatthreeHospitals Sole Community Hospitals.

payment for services • Callsforastudyoftheissueofthecostandpaymentofinmatecare,butdoesnotmandateto Inmates that hospitals will be forced to receive at most Medicaid rates for inmate care.

payment updates • FundsacontractortoworkonrestructuringtheMedicaidinpatientandoutpatient payment system.

• ProvidesfundingforICD-10codeimplementation.

Children’s Health • Reducesthefamily’sshareofpremiumsforimmigrantchildrenwhoreceivepremiums state-funded insurance.

Healthpath Washington • Assumes$4.2millioninsavingsfromcontinuedimplementationofcoordinatedcarefor “dual eligibles,” individuals enrolled in both Medicare and Medicaid.

newborn screening • Increasesnewbornscreeningfeeto$8.10perbaby($1.4million).

prescription monitoring • Provides$1millioninongoingfundingtomaintainthisprogramandensuresafer program drug prescriptions

bree Collaborative • Provides$250,000infundingtoadvanceevidence-basedmedicalpractice.

Autism services • ProvidesfundingforMedicaid-enrolledchildrenwithautism.

Apple Health Hotline • RestoresfundingtoHotline,whichprovidesaccesstoresidentswhohavequestions about eligibility.

support for • Preservessupportforpeoplewhoreceivestatemedicalcare,programsthatcreatehousinglow-Income Adults for the homeless, and the Temporary Assistance to Needy Families program. Cuts to these

programs have the potential to create more instability in the lives of Medicaid enrollees and increase the difficulty of discharging them safely from the hospital.

primary Care • Providesfundingtoincreaseprimarycarepaymentsfornursepractitionersand expand school nursing.

Issue FInAl buDget


7

WA

sH

Ing

to

n s

tA

te

Ho

sp

ItA

l A

ss

oC

IAt

Ion

LE

gIS

LA

TIv

E S

uM

MA

Ry

AN

D P

OL

ICy

PR

Ev

IEW

2013

6

p o l I C Y b I l l s : I M P R O v I N g Q uA L I T y A N D I N C R E A S I N g ACC E S S

safety problems. Both federal and state law have recog-nized the benefits of protecting professional peer review bodies and their participants against lawsuits by health care providers who have lost privileges. unfortunately, recent court cases have eroded the confidentiality of peer review and quality improvement programs.

9

WA

sH

Ing

to

n s

tA

te

Ho

sp

ItA

l A

ss

oC

IAt

Ion

LE

gIS

LA

TIv

E S

uM

MA

Ry

AN

D P

OL

ICy

PR

Ev

IEW

2013

Policy Bills: Improving Quality and Increasing Accesssb 5601

Electronic Health Records(Supported, Enacted)

In order to meet the goals of patient safety, quality improvement, and cost control, federal law allows laboratories and hospitals to donate electronic health record systems to independent physicians. In 2012, however, the Washington State Attorney general issued an opinion about donations from laboratories to physicians, concluding that those donations violated the state’s anti-kickback laws. WSHA understood the opinion would apply to hospital donations as well.

WSHA’s bill, SB 5601, amended the state law (RCW 19.68) so it is consistent with federal law, allowing the donation of electronic health records. The law now ensures hospitals can continue to donate electronic health records tech-nology to physicians. The new law also ensures that if a practice is allowed under the federal anti-kickback statute, it will also be allowed under state law. This not only affects electronic health record donations, but other practices such as rural physician recruitment incentives.

sb 5666

Peer Review and Quality Improvement(Supported, Enacted)

Peer review is an essential tool for hospitals to ensure quality care. Within the confidentiality of the peer review committee, providers can share their concerns, identify patient safety problems, and formulate a plan to address concerns.

The confidentiality of the process is essential to quality improvement. Without the ability to ensure confidentiality, hospitals risk losing the ability to freely discuss patient

WSHA and the Washington State Medical Association developed SB 5666 as a response to several court cases decided in 2012. The bill:

•Limitstheremediesaplaintiffphysiciancanseekagainst a peer review committee when federal immu-nities are not found to not apply.

•Clarifiesthathospitalsmayoperatemorethanone

“ The Institute of Medicine has recognized the peer review privilege as the most promising source of legal protection for collecting data on medical errors. Without this protection, we are severely limited in our ability to reduce medical errors and make health care safer.”

sarah patterson Executive vice President and Chief Operating Officer virginia Mason Medical Center

A physician’s time and expertise is just as valuable when delivered via telehealth, but payment for telehealth services has been inconsistent. WSHA and the Washington State Medical Association both supported HB 1448, which would have ensured that as long as a service was covered by the patient’s plan, the telemedicine provider would be reimbursed the same as for a face-to-face service.

The payment parity language applies to reimbursement for professional services, but does not provide additional payment for the facility. This mirrors how Medicare pays for telehealth. Despite the fact that the bill did not expand services beyond those normally covered, or change the deductible, co-payment or utilization rules the insurers have in place, this bill was perceived by some legislators as an insurance mandate, and they defeated the bill.

Hb 1095, Hb 1152, Hb 1153

Staffing Regulations (Opposed, Not Enacted)

Nurses and other highly technical staff are essential to the safety and satisfaction of patients. Hospitals in Washington State are proud of the many successes we have attained by working together. Their compassion and professionalism are important to our shared success.

Washington State is one of the leaders in developing nurse-staffing committees. The committees are staffed jointly by nurses and managers, and they are charged with designing and implementing nurse staffing plans that incorporate all aspects of patient care. By law, all hospitals are required to have an active nurse-staffing committee.

Three staffing-regulation bills were introduced this year: mandated nurse staffing ratios (HB 1095), mandated uninterrupted breaks and rest times (HB 1152), and restric-tions on overtime and on-call shifts (HB 1153).

WSHA objected to all three bills because they would undermine the nurse-staffing committees and move the state away from patient-focused, collaborative solutions. The only state that uses rigid staffing ratios is California, and the ratios have not lead to significant improvements in patient safety or patient satisfaction.

Moving forward, WSHA will continue to advocate for effective nurse staffing committees in our hospitals. These committees are working well in many hospitals, and hospi-tal and system leaders should regularly monitor their use

10

WA

sH

Ing

to

n s

tA

te

Ho

sp

ItA

l A

ss

oC

IAt

Ion

L

Eg

ISL

AT

IvE

Su

MM

AR

y A

ND

PO

LIC

y P

RE

vIE

W 2

013


quality improvement committee and that those committees may have different areas of focus.

•Addsprofessionalconductasamattertobeconsid-ered during the medical staff review and sanction procedure, and requires sanction procedures to comply with medical staff bylaws.

•Reducestherequired“look-back”forpriorprivilegesand employment to five years, but allows the granting facility to ask for information going back greater than five years.

•Requiresaphysiciantoansweranumberofquestionsbased on those asked in the Washington Practitioner Application.

These changes are an important first step, but they only partially restore the protections eroded by recent court decisions.

Hb 1448

Telehealth(Supported, Not Enacted)

Telehealth, or telemedicine, is when doctors or other health professionals use video technology to diagnose, consult or treat patients who are in a professional setting. This is not email, phone calls or texts: Telehealth brings specialists and patients face-to-face for real clinical treatment.

Technology is making exciting things possible in the medical field, and telehealth is an increasingly important and prevalent tool for ensuring access to high quality care locally. Whether patients are in a rural or urban setting, telehealth promises to help us meet the challenge of provider shortages by using clinicians’ time more efficiently and removing geographic barriers.


11

WA

sH

Ing

to

n s

tA

te

Ho

sp

ItA

l A

ss

oC

IAt

Ion

LE

gIS

LA

TIv

E S

uM

MA

Ry

AN

D P

OL

ICy

PR

Ev

IEW

2013

of nurse staffing committees, evaluate what is working, and make plans for improving their effectiveness. WSHA has also encouraged the Department of Health to vigorously enforce the existing law, and we are also exploring ways of combatting the issue of staff fatigue more directly.

Questions to ask about your nurse staffing committee:

• Howhasitbeenworking,bothfromthemanagement and nurse perspective?

• Doyouuseovertimeormandatorycall?Howmuch? Under what circumstances?

• Whatarethelongestshiftspeoplework?• Arestaffmembersgettingtheirbreaks?Aretheytaking

them? Are the breaks interrupted? How often?• Howdoyouknowyourstaffmembersaregettingtheirbreaks?Doyouhaveasystemfortrackingbreaks?

• Doyourstaffmembersknowhowtospotfatigueinthem-selvesandothers?Dotheyknowhowtoreportit?

Hb 1000

Physician Orders for Life-Sustaining Treatment (POLST)(Supported, Not Enacted)

The failure of the POLST bill to move out of its Senate Committee was a significant disappointment. Bills were introduced in both the House and the Senate, and received bipartisan support in both houses. The good news is that it seems that the public understands that patients have the right to make end-of-life decisions, and that those wishes should be respected in all care settings. The POLST form is an effective tool for communicating those wishes in many health care settings.

The POLST form is already widely used by patients, doctors and surrogates to define and communicate a patient’s last wishes. This bill (HB 1000) would not have changed any

of that: it would have only provided legal protection for health care providers who follow the patient’s directives as they are expressed on the form. This protection already exists for emergency medical technicians.

The legislative debate hinged on concern about surrogates. Current state and federal law already protects patients from irresponsible surrogates, and federal law also requires hospitals to find out whether there is an advanced directive to help ascertain the wishes of the patient. We will continue to work to educate lawmakers and the public about their choices and the work we do to ensure their directions are followed in any environment.

sb 5017 and sb 5225

Certificate of Need(SB 5017: Opposed, Not Enacted; SB 5225: Neutral, Not Enacted)

The state describes the Certificate of Need (CoN) program as “a regulatory process that requires certain health care providers to get state approval before building certain types of facilities or offering new or expanded services… (It) is intended to help ensure that facilities and new services proposed by health care providers are needed for quality patient care within a particular region or community.”

The Certificate of Need program was developed in the 1970s, with the purpose of discouraging the presence of redundant, expensive services within a service area. In 1987, the federal government stopped requiring states to use a Certificate of Need process, and 23 states have dropped the program for acute care hospitals. Some of those states have eliminated Certificate of Need programs completely.

end of life planningThe Washington State Hospital Association, in partnership with medical officers from across the state, is working to ensure patient’s wishes for treatment at the end of life are honored. WSHA is collaborating with medical providers and partner organizations and engaging patients to develop best practices bundles for end of life care within the inpatient setting as well as expanding access to resources in primary care settings to provide community members with the information and tools they need to plan and make their wishes known.

12

WA

sH

Ing

to

n s

tA

te

Ho

sp

ItA

l A

ss

oC

IAt

Ion

L

Eg

ISL

AT

IvE

Su

MM

AR

y A

ND

PO

LIC

y P

RE

vIE

W 2

013


sb 5041

Property Tax Exemption Requirements(Opposed,Defeated)

Every year, nonprofit hospitals report financial community benefits to the Internal Revenue Service (IRS). This report and other IRS reporting requirements provide opportuni-ties for the public to better understand the kinds of community benefits provided by their local hospital.

SB 5041 would have required hospitals to provide essen-tially the same information, but on a completely different schedule. This would have created a cumbersome and duplicative reporting process, without providing any new information to the public. The bill also came with a penalty that was unusually heavy for a simple financial filing: Hospitals that were late or failed to comply would lose their property tax exemption.

sb 5434

Confidentiality of Health Care Contracts(Supported, Enacted)

As part of its responsibilities under the Affordable Care Act, the state Office of the Insurance Commissioner is collecting contracts and supporting documentation (primarily payment exhibits) from health plans and providers. We were concerned that under these new regulations, propri-etary information could be made public. SB 5434 allows the Insurance Commissioner to keep this proprietary price information confidential in the case of Public Records Act requests.

Two bills reducing the reach of the Certificate of Need process were introduced this year: SB 5225 would have exempted public hospital districts from the requirements, and SB 5017 would have eliminated the process completely for all health care facilities except for hospitals. Both of these bills would have resulted in a much smaller CoN program.

It is WSHA’s position that hospitals should have access to a level playing field when it came to the CoN process. SB 5017 would have put hospitals at a serious disadvantage compared to other types of health care facilities — even when those facilities were providing the same services. While the Certificate of Need process has not been without controversy, WSHA members have generally supported the program. At the same time, members have serious concerns about the inconsistent decision-making, delay, and expense associated with the program.

The Certificate of Need program emerged from the 2013 session as a topic for further member discussion. Shortly after the end of the session, the issue became more urgent and more complicated because the governor directed the Department of Health to use its rulemaking authority to address questions related to mergers and affiliations. We are now actively working on this regulatory issue, as well as identifying what kind of improvements could be made to streamline the CoN process.

Hb 1679

Health Care Confidentiality (Supported, Enacted)

Statutes that guide the practice of health care confidential-ity were previously located in multiple different locations of the state code, and this bill consolidates these statutes into a single place, RCW Chapter 70.02. While seeming to be a simple housekeeping matter, the bill raised a number of hot topics, including the accounting of disclosures; establishing the standard of disclosure for mental health treatment records; and maintaining the ability to make a disclosure in the case of imminent danger to the patient or another person.

The goal of hospitals and physicians was to maintain, as much as possible, the current legal standards for disclosure. This was mostly achieved; however, additional areas remain for clarification during the 2014 legislative session.

13

WA

sH

Ing

to

n s

tA

te

Ho

sp

ItA

l A

ss

oC

IAt

Ion

LE

gIS

LA

TIv

E S

uM

MA

Ry

AN

D P

OL

ICy

PR

Ev

IEW

2013

In response to the concerns raised by WSHA and other stakeholders, the legislature pushed the implementation date to July 2014 and funded $28 million for community based outpatient treatment, mobile crisis teams, and peer support services to help prevent hospitalizations and pay for those that will occur as a result of this change. This was an adequate short-term solution, but even with these increases, the mental health system remains underfunded, especially around inpatient capacity.

sb 5732 makes a number of changes to the mental health system. It creates a steering committee to inform the state agencies on ways to improve the mental health system. The bill also establishes an adult behavioral health legisla-tive task force that will begin work in May 2014. A hospital representative will sit on the steering committee, which is charged with working on reforms to care delivery, the boarding of psychiatric patients in inappropriate beds, and cross collaboration of providers. The bill also requires more extensive discharge planning between the Regional Support Networks and the state hospitals. Finally, the bill allows for the movement of patients with traumatic brain injury and dementia into enhanced community-based settings — thereby opening up beds at Eastern and Western Washington State Hospitals.

This is only a short-term fix: the law will expire in four years. In the meantime, we will continue to work on the many policy issues related to pricing transparency. Once mean-ingful transparency measures are in place, they will likely lessen the need for the state to collect and manage this information through the Insurance Commissioner.

Hb 1471

Health Care Associated Infection-Rate Reporting(Mixed, Amended, Enacted)

The goal of this bill was to update and align state reporting requirements with federal requirements for health care-associated infection rate reporting. Washington State was an early adopter of infection rate reporting requirements and the infection measures that were chosen in our state are different from the later-adopted federal requirements. The Department of Health strongly supported aligning state and federal reporting standards. The hot topic was whether to maintain Washington State-specific reporting requirements for an additional four years or simply move to the federal reporting requirements now. Despite WSHA’s advocacy for a direct move to the federal reporting standards, the four year overlap was maintained.

sb 5480 and sb 5732

Mental Health(SB 5480: Mixed, Enacted; SB 5732: Supported, Enacted)

Although the state continues to struggle with balancing the budget, lawmakers recognized the need to bolster access to mental health services in our communities. It will take a robust and coordinated effort to improve these services, but hospitals and many other organizations are committed to working in this area.

The legislature considered several policy bills related to mental health, and also included some mental health funding in the budget.

sb 5480 eases the Involuntary Treatment Act’s detention standards to make it easier to detain someone who is in a mental crisis. While supporting the intent of the bill, WSHA initially opposed the timeline, as there was not enough time to increase inpatient psychiatric capacity before the law went into effect.


14

WA

sH

Ing

to

n s

tA

te

Ho

sp

ItA

l A

ss

oC

IAt

Ion

L

Eg

ISL

AT

IvE

Su

MM

AR

y A

ND

PO

LIC

y P

RE

vIE

W 2

013


2013 sunshine Committee bills

The Public Records Act requires that most records of public entities, including public hospital districts, be open and available for public review. The law contains a number of exemptions from disclosure. The law also establishes the Public Records Exemptions Accountability Committee, aka the Sunshine Committee, to systematically review and recommend to the legislature the elimination of those exemptions that in the Committee’s wisdom are unnecessary.

This year, the Sunshine Committee proposed legislation to eliminate two exemptions which were important for public hospital districts. We were able to stop both exemptions from being eliminated.

The first, included in sHb 1298, would have required disclosure of the names and resumes of applicants for the “highest paid management position” in the agency. Had this passed, it would have seriously limited hospitals’ ability to recruit qualified CEO candidates.

Second, contained in sHb 1299 was language to eliminate the Public Records Act exemption that allows medical malpractice closed claims to be reported without naming specific providers. This would have had serious implications for privacy and potentially would have led to disclosure of patient information, in violation of federal and state law.

Construction legislation

This session saw a spate of bills aimed at construction by public agencies. Several bills would have increased the cost of public works construction by requiring additional regulation or by increasing labor costs. There were also bills that would have severely limited public agencies’ ability to condemn property. Due in large part to the different viewpoints of the House and Senate, none of those bills passed.

An important bill that did pass was Hb 1466 which reau-thorized the alternative public works contracting process. used by several public hospital districts, this alternative streamlines the construction process resulting in significant

savings. The program, which has an oversight board with hospital district representation, was reauthorized until July 1, 2021.

other legislation

A package of three bills, intended primarily to impact one specific public hospital district, could have had a significant negative impact on all district hospitals. We were able to stop two of the bills and limit the scope of the third.

The first bill, sb 5746 would have allowed hospital districts, whose population exceeds 285,000, to dissolve their district upon a majority vote of the voters in the district. The decision to call such an election could occur either by a vote of the board of commissioners or by a petition of 10% of qualified voters in the district. We felt that this option for an expedited dissolution was unnecessary since the law already contains an effective and tested way to dissolve districts.

sb 5747 would have allowed boards of commissioners of hospital districts with a population over 285,000 to opt to elect all commissioners by sub-district (commissioner district). Current law allows representation by sub-district but election is at-large. This would have led to greater politicization of commissioner elections and may have led to commissioners being concerned more about the health issues of their sub-district than of the district as a whole.

The third bill, sb 5748 would have extended campaign contribution limits to candidates for all public hospital district boards of commissioners and required campaign finance reporting for these elections. (Current law limits contributions to $900 per election to a candidate for the legislature, county office, city council office, mayoral office, or school board office.) The initial bill would have put the same requirements on all public hospital district elections, but AWPHD successfully worked to amend the bill to apply only to public hospital districts with populations over 150,000. The bill, as amended, passed the legislature and was signed into law by the governor.

Association of Washington Public Hospital Districts (AWPHD)


15

WA

sH

Ing

to

n s

tA

te

Ho

sp

ItA

l A

ss

oC

IAt

Ion

LE

gIS

LA

TIv

E S

uM

MA

Ry

AN

D P

OL

ICy

PR

Ev

IEW

2013

bIll # DesCrIptIon WsHA posItIon outCome

sb 5601 This bill allows hospitals to donate electronic medical record systems Strong Support Enacted to community physicians, thus improving patients’ ability to have their health care information available in multiple care settings. It also protects other practices, such as rural physician recruitment, from prosecution under state anti-rebate laws.

sb 5666 This bill helps ensure a strong system of quality improvement and Strong Support Enacted peer review.

Hb 1000 This bill would have given immunity to all hospitals and other health Strong Support Defeated care providers honoring a patient’s wishes as expressed in the Physician Orders for Life Sustaining Treatment.

Hb 1095 This bill would have mandated nurse staffing ratios to be maintained Strong Opposition Defeated at all times, undermining the effectiveness of nurse staffing committees, and creating unsafe care situations.

Hb 1152 This bill would have mandated uninterrupted breaks and rest times, Strong Opposition Defeated which would have forced inflexible staffing plans and increased hiring just to cover breaks.

Hb 1153 This bill would have restricted the use of scheduled overtime and Strong Opposition Defeated on-call shifts, with serious risks to patient safety.

Hb 1679 This bill consolidates all health care privacy laws into one section of the Support Enacted code so providers can more easily identify relevant statues. The new law will not go into effect until July 2014, allowing time for a small number of fixes that remain to be made.

sb 5017 This bill would have eliminated Certificate of Need (CoN) for all health Oppose Defeated care providers except hospitals, creating an uneven playing field.

sb 5480 WSHA initially opposed this bill, which makes it easier to detain a person Mixed, Enacted in mental crisis under the Involuntary Treatment Act. The concern was Supported Final there was not enough time to increase inpatient psychiatric capacity. The legislature pushed the date to July 2014 and allocated funding.

Hb 1471 This bill was originally intended to align state and federal infection Mixed Enacted reporting and WSHA strongly supported it, but WSHA opposed later amendments that continued state reporting requirements.

Hb 1448 This bill would have required payment parity for medical services Strong Support Defeated provided via telemedicine or telehealth technology if they were already an existing covered benefit.

sb 5434 This bill maintains the confidentiality of negotiated price information Support Enacted that health plans submit to the state.

WSHA POLICy BILL SuMMARytop priority bills

sb 5225 This bill would have exempted Public Hospital Districts from Neutral Not Enacted Certificate of Need.

sb 5732 This bill creates a legislative task force to explore options for reforming Support Enacted the community mental health system. The steering committee for the task force will include a hospital representative.

Hb 1911/ These bills addressed health care payment rates for city, county, and Oppose Defeated sb 5792, regional inmates. They proposed to require hospitals to contract for sections services provided to county, city, and regional jail inmates at no of sb 5892 more than the Medicaid rate as a condition of state licensure.

Hb 1753/ These bills proposed to expand the state’s collective contracting of Mixed Enacted, sb 5833 interpreters for Medicaid, Department of Labor and Industries, and other services. It would have constrained how hospitals provide interpreter services under the Medicaid administrative match program.

Hb 1299/ This bill would have eliminated the exemption from public disclosure Oppose Defeated sb 5171 of malpractice closed claims data.

Hb 1555 This bill would have established new education requirements for Oppose Defeated surgical technologists, but applied only to those working in hospitals.

sb 5041 This bill would have established a state framework for community Oppose Defeated benefits reporting to maintain hospital property tax exemption. WSHA opposed it as duplicative of federal reporting requirements.

sb 5211 This bill prohibits employers from requiring employees to give them Neutral Enacted their social media login information.

sb 5265 This bill would have required every hospital and provider to post Oppose Defeated information on prices for the uninsured on their websites. WSHA’s concern was that because many uninsured patients are eligible for charity care, a list of full charges could dissuade patients from seeking the care they need.

sb 5288 This bill proposed to expand the requirement that hospitals contract Oppose Defeated with the Washington State Department of Corrections at Medicaid rates to all health care providers.

sb 5305 This bill expands existing state law requiring hospitals to report bulletin Oppose, Enacted wounds, gunshot wounds, and stab wounds of unconscious patients to Neutral as law enforcement, so the requirement now applies to all patients. Originally Amended the bill placed specific obligations on hospitals for how domestic violence victims are identified and treated. After amendment the bill requires that

16

WA

sH

Ing

to

n s

tA

te

Ho

sp

ItA

l A

ss

oC

IAt

Ion

L

Eg

ISL

AT

IvE

Su

MM

AR

y A

ND

PO

LIC

y P

RE

vIE

W 2

013


top priority bills (continued from previous page)

other Important bills

but final bill includes an

exception for public hospitals

WsHA bIll # DesCrIptIon posItIon outCome


Hb 1299/ This bill would have eliminated the exemption from public disclosure of Oppose Defeated sb 5171 malpractice closed claims data.

Hb 1037 This bill would have allowed hospital districts to recover costs from record Support Defeated requests that were done for commercial purposes.

Hb 1128 This bill would have protected public agencies from records requests that Support Defeated the courts deem burdensome, retaliatory or threatening to staff safety.

Hb 1198 This bill would have required the state Attorney general’s Office to provide Support Defeated Public Record Act training to elected officials and staff officers.

Hb 1298 This bill would have required public disclosure of names and resumes of Oppose Defeated applicants for the highest paid administrative position.

Hb 1466 This bill reauthorized alternative public works contracting program for Support Enacted public agencies and maintains public hospital district representation on the program oversight board.

Hb 1714 This bill would have allowed Executive Sessions to be recorded. The Oppose Defeated recordings would have been exempt from disclosure, except at the discretion of the governing body.

sb 5225 This bill would have exempted Public Hospital Districts from Certificate Neutral Not Enacted of Need.

sb 5746 This bill would have allowed large public hospital districts to be Oppose Defeated dissolved by a majority vote or small number of petitioners.

sb 5747 This bill would have forced large hospital districts to elect board members Oppose Defeated by commissioner district instead of at-large.

sb 5748 This bill would have extended campaign contribution limits to candidates Oppose Amended for large public hospital district boards. and Enacted


17



WA

sH

Ing

to

n s

tA

te

Ho

sp

ItA

l A

ss

oC

IAt

Ion

LE

gIS

LA

TIv

E S

uM

MA

Ry

AN

D P

OL

ICy

PR

Ev

IEW

2013

AWPHD POLICy BILL SuMMARy

sb 5305 per existing hospital processes information on available resources must be provided to those who state injuries resulted from domestic violence.

sb 5537 These bills would have required insurance companies to provide price Oppose Defeated and quality information to the Office of the Insurance Commissioner and to large purchasers, but the bills left too many unresolved questions, including questions of access, governance and maintenance costs.

(cont.)

our state is counting on our hospitals and systems

to improve the health of all our communities. It is WSHA’s

vision to effectively collaborate to be national leaders in

ensuring access to safe, high-quality, cost-effective health

care, and this isn’t just work for the legislative session.

p o l I C Y p r e v I e W: T H E R OA D A H E A D

19

WA

sH

Ing

to

n s

tA

te

Ho

sp

ItA

l A

ss

oC

IAt

Ion

LE

gIS

LA

TIv

E S

uM

MA

Ry

AN

D P

OL

ICy

PR

Ev

IEW

2013

Policy Preview: The Road Ahead e knew this was going to be a challenging legislative session, and it was. A divided legislature with many new legislative leaders faced a significant budget shortfall and a host of contentious policy issues. It ended up being the longest series of sessions in anyone’s memory, and it brought us to the brink of a potential government shut-down.

Throughout the extended session, we stayed focused on our goals of enhancing hospital and health system stability and improving patient safety. Because of our unity and commitment to our shared goals, we were able to secure the expansion of Medicaid, protect funding for Critical Access Hospitals, improve the Hospital Safety Net Assessment Program, avoid disproportionate budget cuts to health care, protect the relevance of nurse staffing committees, improve the professional peer review process, and meet many other goals as well.

So what’s next? A lot of hard work.

Our state is counting on our hospitals and systems to improve the health of all our communities. It is WSHA’s vision to effectively collaborate to be national leaders in ensuring access to safe, high-quality, cost-effective health care, and this isn’t just work for the legislative session.

To keep the conversation going, we wanted to provide a little more insight in several key areas:

•Thechallengesandopportunitiesoftheexpandedhealthinsurancemarket, including our efforts around outreach and enrollment;

•Ruralissues,andoureffortstoensureessentialcare,everywhere; •Healthcaresystemimprovementstopriceandqualitytransparency; •WSHA’songoingworktoimprovepatientsafetyinhospitals;and •CertificateofNeed,mergers,andaffiliations.

It’s been an honor to work with you and to help your organizations continue to care for Washington residents with high-quality services.

Cassie sauer Claudia sanders mary Kay Clunies-rossSenior Vice President Senior Vice President Vice PresidentAdvocacyandGovernmentAffairs PolicyDevelopment CommunicationsandPublicAffairs

20

WA

sH

Ing

to

n s

tA

te

Ho

sp

ItA

l A

ss

oC

IAt

Ion

L

Eg

ISL

AT

IvE

Su

MM

AR

y A

ND

PO

LIC

y P

RE

vIE

W 2

013


Coverage is Here: Enrollment Opportunities and Challenges

While passage of the expansion of Medicaid was a tremen-dous success, it is now time to focus on the work of getting people in our state enrolled in health coverage.

The Affordable Care Act (ACA) expands the ability of residents at low to mid income levels to access affordable health insurance. By expanding Medicaid and providing subsidies for individuals and families to enroll in commer-cial coverage, the ACA opens doors to affordable coverage.

the exchange and medicaid

The Washington Health Benefit Exchange will serve as a single portal for Medicaid and commercial coverage for individuals and families who are shopping for health insurance.

The Exchange will verify income electronically so residents can compare health plans and enroll in a plan during the same website visit. All the individual plans offered by the Exchange are structured like employer-funded health plans, and they all have 10 essential benefits.

Washington residents who qualify for free coverage will be automatically enrolled in a Medicaid “Apple Health” managed care plan. Because income is verified electroni-cally, their enrollment process will be much faster than it is today — for most applicants, enrollment will be same-day.

the importance of coverage and the new opportunities available.

With that in mind, WSHA has been active in working with the Exchange and other statewide partners on the “Coverage Is Here” campaign. This is an exciting project with a lot of active member involvement, and we look forward to continuing to work on it in the coming year.

the evolving Health plan marketplace

The newly insured in Washington will be covered by both Medicaid and commercial exchange plans, and the expand-ing marketplace will bring a number of new policy issues to the forefront.

Medicaid enrollees, including the blind and disabled, will be served by one of five Medicaid managed care plans. Three of the five plans are relatively new to Washington State. These three new plans are for-profits with a national presence.

Individuals who qualify for commercial insurance through the Exchange, with or without a subsidy, will choose from more than 45 plans offered by eight insurers. Next year, small businesses may be able to shop for group coverage through the Exchange.

The Exchange is a dramatically new way of making health care accessible, and health care advocates, including WSHA, are concerned about issues such as affordability, continuity of coverage in cases when an enrollee’s income changes, and adequacy of coverage. New market rules may be neeeded to ensure network adequacy and access to care for residents in our community.

WSHA has been working with stakeholders across the state to help the community learn about their new options for health coverage and connect with the Exchange.

For a list of the resources available to hospitals, please visit www.wsha.org/coverageishere.cfm or contact Barbara gorham at [email protected].

www.WAHealthplanFinder.org

the enrollment Challenge: no Wrong Door

The creation of a single online marketplace for both commercial and public health insurance programs has never been tried before, and reflects a huge change compared to how people have traditionally enrolled in coverage.

While the Exchange is responsible for developing the “No Wrong Door” website and call center infrastructure to ensure all qualified people can easily access the informa-tion they need to enroll, it is all of our responsibility to engage the public and increase their understanding of


21

WA

sH

Ing

to

n s

tA

te

Ho

sp

ItA

l A

ss

oC

IAt

Ion

LE

gIS

LA

TIv

E S

uM

MA

Ry

AN

D P

OL

ICy

PR

Ev

IEW

2013

The state’s 42 rural hospitals provide far more than acute hospitalization for people living in or visiting the state’s rural areas. They also employ physicians, provide primary care, operate laboratory services and home health, and often run the ambulance services.

rural health care is not simply urban health care in miniature.

Because rural areas have more uninsured and publicly insured patients than urban and suburban areas, state support is especially important to the existence of a hospital in these communities. Rural hospitals need stable funding as they transform health care delivery in their communities. Simply cutting the rural health budget would lead to hospital closures and limited access to health services. State support is necessary to maintain access to essential care while hospitals and state agencies look at new models.

rural hospitals are uniquely positioned to provide patient-centered care, and many are already innovating to meet the changing needs of their communities.

• ProsserHospitalreceiveda$1.5millionfederalinnova-tion grant to fund a Community Paramedic Program, in which paramedics proactively visit patients in a successful effort to improve health and reduce hospital admissions.

• InDavenport,robotslinkprimarycaretospecialists in Spokane and elsewhere.

• InLeavenworthandElma,hospitalshavebeen redesigned to use the person-centered health-home model.

• MasonGeneralHospitalinSheltonjoinedwithPublicHealth to form “Mason Matters,” which addresses community health issues.

• HospitalsinMt.Vernon,AnacortesandArlington collaborated to develop a regional Health Information Exchange connecting more than 200 doctors and 40 long-term care facilities.

• TheCriticalAccessHospitalNetworkandtheWesternWashington Rural Healthcare Collaborative are partner-ships that share staff, integrate care and co-develop health information technology.

• ThroughtheRuralHealthQualityNetwork,allof Washington’s critical access hospitals are working to improve quality with a focus on nationally defined “rurally relevant” quality measures. Washington’s rural hospitals were among the first to participate in the Medicare Beneficiary Quality Improvement Project to improve rural quality care access for Medicare benefi-ciaries served by critical access hospitals.

Several of these innovations are highlighted in videos created by WSHA to help spread the ideas to other communities. videos can be found at www.wsha.org/rural.

Protecting Access to Essential Care, Everywhere

rural health care is essential to maintain.

Our state benefits from a strong network of hospitals who work together to ensure appropriate care for every patient. Our entire health care system would suffer without a strong network of rural hospitals, and the existence of many communities would be threatened without access to health care.

22

WA

sH

Ing

to

n s

tA

te

Ho

sp

ItA

l A

ss

oC

IAt

Ion

L

Eg

ISL

AT

IvE

Su

MM

AR

y A

ND

PO

LIC

y P

RE

vIE

W 2

013


DID yOu kNOW?Did you know that WSHA publishes hospital charges for more than 500 different services and treatments? Did you know that WSHA also publishes quality data on more than 65 metrics, including several that are not publicly reported anywhere else?

Learn more at www.wsha.org/Qualitysafety.cfm

Quality and Patient Safety

Through WSHA’s Patient Safety Program, hospitals and health systems voluntarily collaborate and dedicate resources to improving care for all patients in Washington State. Hospitals have set competition aside and now work together to share best practices and measure improve-ments in areas as diverse as hand-washing, surgical infections, re-hospitalizations, and early deliveries.

Our goal is to ensure the right care is delivered, at the right time, to every patient, every time.

WSHA’s “Safe Table Learning Collaboratives” are central to this process. They are called “Safe Tables” because they allow hospital employees to share information and insight about how to improve care based on the most up-to-date research in a confidential forum. Hospital managers and staff can learn from local and national experts how to accelerate change for improved results.

partnering to Achieve Health Care Without Harm

WSHA is one of 26 health care organizations in the u.S. to be awarded a federal Hospital Engagement Network (HEN) contract in 2011. As a Partnership for Patients HEN, WSHA and the Washington State Medical Association (WSMA) have partnered to improve hospitals and medical practices in Washington, Alaska and Oregon. Key focus areas include:

•Adversedrugevents •Catheter-associatedurinarytractinfections •Centralline-associatedbloodstreaminfections •Injuriesfromfallsandimmobility •Safedeliveries •Pressureulcers •Surgicalsiteinfections •Venousthromboembolism •Ventilator-associatedpneumonia •Preventablereadmissions •Leadership,patientandfamilyengagement

Patient Safety Results

This is just a sample of some of the results from our patient safety work. For more, visit www.wsha.org/qualitysafety.cfm

preventing rehospitalizations

To ensure that patients are getting the care and support they need after leaving the hospital, hospitals are partner-ing with physicians, skilled nursing homes, state agencies and other health care organizations to support smooth care transitions. WSHA, WSMA, and the Puget Sound Health Alliance worked together to develop a toolkit to help foster safe, timely, and effective communication between health care settings. Washington State has significantly lower readmission rates than other states.

safe Deliveries

More babies are being born at full term in Washington State, thanks to work by physicians, hospitals, and patients. The number of early elective deliveries (babies born between 37 and 39 weeks by induction or C-section) plunged from 15 percent to 3.5 percent in just two years.

WSHA is expanding its efforts to ensure safe deliveries through the development of the Safe Deliveries Roadmap. Working in partnership with obstetrical leaders, WSHA is working to make deliveries as safe as possible for mothers and to optimize the health of newborns by applying the best evidence for all phases of maternity care, pregnancy, delivery, and post-partum. The goal is to reduce unneces-sary C-sections and optimize the healthy outcomes for both mother and baby.

23

WA

sH

Ing

to

n s

tA

te

Ho

sp

ItA

l A

ss

oC

IAt

Ion

LE

gIS

LA

TIv

E S

uM

MA

Ry

AN

D P

OL

ICy

PR

Ev

IEW

2013


eArlY eleCtIve DelIverY rAte

16%

14%

12%

10%

8%

6%

4%

2%

0%Q3

2010Q1

2011Q2

2011Q3

2011Q4

2011Q1

2012Q2

2012Q3

2012Q4

2012

Elec

tive

Del

iver

y Ra

te

Baseline (Q3–2010): 15.5%

15.5%

9.4%

6.7%

6.8%

5.2%4.8%

3.1%2.9%

2.8%

81.9% reduction in early elective deliveries between 37 to 39 weeks.Over 1,500 early deliveries prevented.

Definition: The Joint Commission, PC-01 Elective Delivery: patients with elective vaginal deliveries or elective C-sections at ><37 and <39 weeks of gestation.

DataSource: Washington State Hospital Association (WSHA) Quality Benchmarking System (QBS).

er is for emergencies

Over the last year, Washington’s hospitals and emergency room physicians have worked to reduce inappropriate emergency room use and help patients get care in the right place at the right time.

A report by the Washington State Health Care Authority contains good news: the first six months of data indicated the savings could reach $31 million for the fiscal year. The chart shows the percent of Medicaid patients with

coordinated care plans has grown from 28 percent to 87 percent. In addition to cost savings, the program offers other benefits to patients and hospitals. Patients are more likely to receive appropriate care from a physician who is able to follow a cohesive care plan for their ailments. Prescription drug abuse has decreased. Hospitals are able to compare their performances with their peers, identify and share best practices, and help patients receive care in the most appropriate and cost-effective setting. A second HCA report is due out in October 2013.

er is for emergenCIes Washington Hospitals Reporting Data Over the Past 12 Months

100%

90%

80%

70%

60%

50%

40%

30%

20%

10%

0%Sep2012

Oct2012

Nov2012

Dec2012

Jan2013

Feb2013

Mar2013

Apr2013

May2013

Perc

ent o

f PRC

Pat

ient

s

55%

These data come from the 29 early adopter hospitals that have adopted the Emergency Department Information Exchange as of June 1, 2012. Hospitals were not required to implement their electronic information exchange system until October 1, 2012.

Jun2013

Jul2013

Aug2013

98%

513569

656706 719 722

769791 792 798 807 822

850800750700650600550500450400350300250200150100500

Patients with Com

pleted Care Guidelines

Percent of complete treatment plans for PRC patients Count of patients with completed care guidelines

The PRC Program is a care coordina-tion program for Medicaid clients who overuse or inappropriately use medical services.

DataSource: Collective Medical Technologies, Emergency Department Information Exchange.

24

WA

sH

Ing

to

n s

tA

te

Ho

sp

ItA

l A

ss

oC

IAt

Ion

L

Eg

ISL

AT

IvE

Su

MM

AR

y A

ND

PO

LIC

y P

RE

vIE

W 2

013


Health Reform: Transparency, Payment Models and More

One of the most exciting aspects of the transformation of health care right now is the increasingly important role that individuals are taking in their own health. Patients are making more choices for themselves about what doctors they want to see, what tests they want to have done, and where they want their care to be delivered. Heath insur-ance carriers and large employers are also looking for quality and price value in health care spending.

transparency in the state of Washington

To aid in these decisions, WSHA publishes an extensive amount of information about hospital charges and quality.

•Thequalitydataisacombinationofpatientsafety metrics and patient satisfaction scores for every hospital in the state. Hospitals also provide extensive quality and patient safety data to the state and federal governments, which also publish that data. WSHA’s website, www.wahospitalquality.org, includes the publicly reported data and other key measures.

•Thechargedataincludeswhateachhospitalchargesfor more than 500 different inpatient services and treatments. Although this information is extensive, it is somewhat limited in use. While it allows compari-sons of charges among hospitals, it cannot predict what a consumer will actually pay for the service because it does not reflect the insurer’s discounts or the individual’s deductibles, co-pays, or charity care discounts. There is not currently a readily available data source for this information and hospitals are only one piece of the puzzle.

WSHA believes more information about health care costs and quality is essential. That’s why we continue to work with state agencies, lawmakers and organizations such as the Puget Sound Health Alliance to help get our state to a place with better information.

value transparency in other states

The states continue to be the laboratories of innovation, and there are several transparency models that combine quality and price data for consumers, purchasers, and hospitals. To ensure total and consistent participation, some states have mandated that insurers report patient claims data to either a state agency or private organization operating under the state’s authority. At least 15 states have enacted legislation to establish a patient claims repository.

There are three huge “lifts” on a project like this: develop-ing an easy to use, comprehensive infrastructure; getting the data needed (usually from payers); and determining how to fund the operation on a sustainable basis. There are also implementation questions on whether the database is run by the state or a private agency, what information will be made public, and whether there is an opportunity to review the data prior to its publication.

It is going to take an extended cooperative effort on the part of WSHA and other stakeholders to take on the many difficult and important questions around how to improve the public’s access to value information.

payment and Delivery system reform

Efforts to improve the transparency of cost and quality information are one component of current health care reform efforts, but there is also a lot of work being done to move away from a purely fee-for-service model, and towards a system that focuses on the efficient delivery of high quality of care.

For example, bundled payments would combine all the costs associated with an entire episode of care into a single price, which could help patients and purchasers easily compare value for these bundled services across care systems. The bundled payment also encourages cost control for all of the components.

Another example of payment and delivery system reform centers around the idea of medical homes and primary-centered care. Medical homes will also help patients more effectively manage their own health by giving them more access to preventive care and more help managing chronic conditions, which could reduce the incidences of more intense and expensive interventions.

Health reform at the state level

While the Affordable Care Act may still be getting a lot of the health reform headlines, the State of Washington is also working to improve health outcomes in our state. The Health Care Authority is developing a comprehensive state health care innovation plan. The plan is in development, but the development of the model is grant-funded and is bringing together a group of stakeholders to transform the care delivery system to ensure better outcomes. It is an exciting and ambitious project, and WSHA and our members are excited to be part of it.

25

WA

sH

Ing

to

n s

tA

te

Ho

sp

ItA

l A

ss

oC

IAt

Ion

LE

gIS

LA

TIv

E S

uM

MA

Ry

AN

D P

OL

ICy

PR

Ev

IEW

2013

Mergers and Certificate of Need

The Certificate of Need (CoN) program was developed in the 1970s with the goal of discouraging redundant, expensive services within a service area. It has not been used to mandate that a certain set of services be offered, either over the course of single ownership or after the transfer of ownership. Currently, a CoN is only required at the time of construction, development or establishment of a new facility, or the sale, purchase or lease of part or all of an existing hospital.

This process is no longer required by the federal govern-ment and is no longer used in many states. It has been a challenging process and several bills were introduced this legislative session to decrease the scope of the CoN program. WSHA opposed those bills because they would have created an uneven playing field, but many people recognize that there are problems with the program and the way that it is implemented.

At the same time, many leaders are considering the utility of the CoN program, the number of hospital mergers and affiliations has increased, thereby putting these relation-ships under increased scrutiny.

There are a variety of reasons why these mergers and affiliations are happening:

• Improving the quality of care withinin a sustainable health system. Health care that is coordinated between doctors, clinics, hospitals and other providers benefits patient health. Payment changes in the Affordable Care Act incentivize care coordination. In addition to making large cuts to hospitals (approximately $3.1 billion over 10 years), the ACA promotes payment changes that encourage more coordination among providers. Some hospitals are finding that the best way to achieve coordi-nation is to join a health care system.

• Increased operational efficiencies. Hospitals joining a system can reduce administrative costs by sharing services such as payroll or financial record keeping. Joining with another hospital may help them operate more efficiently and put more resources into patient care.

•Access to funding for service improvements. Many hospitals do not have extra funds to update their build-ings and patient rooms, to invest in quality and safety innovations, to expand services, or even to compete for top-quality doctors and nurses. By joining with another hospital or a health system, a hospital can get access to more resources that will help serve patients.

Without another hospital partner, some hospitals will have to either dramatically cut services or close. When hospitals reduce services or close, the entire community is put at risk.

Some members of the public and state leaders are con-cerned the mergers and affiliations are reducing access to certain services, particularly reproductive and end-of-life care. A group of 10 advocate organizations asked governor Jay Inslee to place a six month moratorium on mergers and affiliations. Instead, he issued a directive to the Washington State Department of Health to engage in rulemaking to “modernize” the CoN process to potentially address some of these issues. The governor’s directive indicated he would like to see a rule applying the CoN process to many more kinds of affiliations and relationships and potentially address provision of services.

The future of our health care delivery system is a significant issue that is likely to be debated well beyond the CoN rulemaking process. While everyone involved in this conversation has sincere perspectives, we are committed to ensuring that the community’s need for hospital services remains at the center of the conversation.


Massachusetts has an all-payer claims database that includes commercial, Medicaid, Medicare and third party administrator. http://hcqcc.hcf.state.ma.us

utah has an all-payer claims database that includes commercial, Medicaid, Medicare and third party administrator. https://health.utah.gov/myhealthcare

Colorado has an all-payer claims database that includes com-mercial and Medicaid payments now, with Medicare and third party administrator to be added later. www.civhc.org

New Hampshire has an all-payer claims database that includescommercial, Medicaid and third party administrator. Medicare data will be added. www.nhhealthcost.org

Policy Development CalendarAugust: PAC Campaign begins

september 24: Public Policy Advocacy group meeting

september 25: Public Policy Committee meeting

october 1: Exchange begins enrolling Washington residents in health coverage!

october 16: Washington Hospital PAC dinner

october 16–17: Washington State Hospital Association Annual Meeting – Patients First: Moving Beyond the Norms

september/october: Establishment of legislative priorities

november/December: Meetings with local legislators

January 2014: Legislative session begins;Inside Olympia resumes

27

WA

sH

Ing

to

n s

tA

te

Ho

sp

ItA

l A

ss

oC

IAt

Ion

LE

gIS

LA

TIv

E S

uM

MA

Ry

AN

D P

OL

ICy

PR

Ev

IEW

2013

o t H e r r e s o u r C e s

Other Resources e very much appreciate each of you who testified, supported other hospital representatives in their testimony, called and emailed your legislators, or talked to your local media and other community leaders about these many important issues. All of us on the WSHA staff appreciate your willingness to take our calls, to give us feedback and insight, and to reach out to legislators time and again. your active involvement is what makes our efforts successful.

We know that the next legislative session is right around the corner, and we are already getting ready for it. Please contact us with any questions or comments about this past or this next legislative session. We work for you, and we want to make sure we are doing all we can to support your work in caring for our communities.

The policy and advocacy team and the many WSHA staff who support this work represent hospital and health system interests before federal, state, and local governments on legislative and regulatory issues. They also serve the association and its members as policy experts and advisors.

Policy and Advocacy Team Contactsteam lead: Cassie Sauer, Senior Vice President, Advocacy and Government Affairs

• AndrewBusz,PolicyDirector,Finance• BarbaraGorham,PolicyDirector,Access• BenLindekugel,Director,MemberServices,AssociationofWashingtonPublicHospitalDistricts(AWPHD)• BethZborowski,Director,Communications• CarolWagner,Senior Vice President, Patient Safety• CheleneWhiteaker,PolicyDirector,MemberAdvocacy• ClaudiaSanders,SeniorVicePresident,PolicyDevelopment• CliffDuggan,Administrative Assistant• GladysCampbell,CEO, Northwest Organization of Nurse Executives• JeffMero,ExecutiveDirector,AWPHD• LenMcComb,WSHA/AWPHDLobbyistonBudgetIssues• LisaThatcher,WSHA/AWPHDLobbyistonPolicyIssues• LoriMartinez,Policy/Advocacy Coordinator• MaryKayClunies-Ross,Vice President, Communications & Public Affairs• PeggiShapiro,Director,DisasterReadiness• RobinRobertson,Vice President, Washington Hospital Services• TayaBriley,General Counsel, President Washington Hospital Services• VergilCabasco,PolicyDirector,ClinicalIssues

www.wsha.org

o t H e r r e s o u r C e s

28

WA

sH

Ing

to

n s

tA

te

Ho

sp

ItA

l A

ss

oC

IAt

Ion

L

Eg

ISL

AT

IvE

Su

MM

AR

y A

ND

PO

LIC

y P

RE

vIE

W 2

013

The Washington Hospital Political Action Committee (WHPAC) and the American Hospital Association Political Action Committee (AHAPAC) are important ways for hospital and health system leaders to elect champions and engage with elected officials. Hospitals and health systems have much at stake in the political process on issues including regulation, patient access to care, reimbursements, health quality reporting, improving patient safety, and more. your support helps us elect strong lawmakers and build relation-ships with them. These conversations ensure they under-stand how their policies affect our ability to provide safe and quality health care.

It’s up to You

All Washington State residents, including legislators, depend on hospitals for their health care. Hospitals provide essential health services and jobs to the state. But health care policy is complicated, and lawmakers and their staff need to work with hospital leaders to ensure that we can continue to improve the quality of care and maintain the fiscal sustainability of our hospitals.

By donating to the PAC, you help ensure that we elect legislators who understand and care about their local hospitals. The PAC also creates opportunities for hospital and health system leaders to build relationships with legislators.

2013 pAC Campaign

your contributions are key to our advocacy success in Olympia and Washington D.C. PAC contributions help elect champions for hospitals, build relationships with legisla-tors, and provide the opportunity to discuss the impact of legislation on hospitals, staff, and patients.

We continue to look to you for support of the PACs and encourage your active personal involvement.

Thanks to the broad support we received from hospitals and health systems throughout the state, our 2012 PAC campaign was very successful. There were 476 donors from 87 hospitals, health systems, and other supportive organi-zations, and they gave more than $166,000 to the state and federal PAC campaigns. In addition to donations from hospital and health system leaders, our PAC was strength-ened by donations from WSHA and the Association of Washington Public Hospital Districts (AWPHD) staff, and organizations that provide services to hospitals.

To make your PAC donation online or for more information about last year’s campaign leaders and how PAC funds are spent, visit www.wsha.org/whpac.cfm.

The PAC represents the unified voice of hospitals and health systems, and the collective voice is always a stronger voice.

Washington Hospital PAC

Thank you for Testifying in Olympia!your Policy and Advocacy Team would like to thank everyone who testified on bills on our behalf in Olympia this session. your presence, your stories, and your insight help legislators and the public better understand the impact of health care policies on patients and the sustainability of local hospitals.

barbara A. shickich, RiddellWilliams P.S.

bethany sexton, MultiCare Health System

bill berko, Seattle Children’s

Cara towle, UW Medicine

Cindy mayo, Providence Centralia Hospital

Darcy Jaffe, UW Medicine, Harborview Medical Center

David tauben, mD, UW Medicine Primary Care

roy Colven, mD, UW Medicine

eric moll, Mason General Hospital & Family of Clinics

gene peterson, mD, UW Medicine / UW Medical Center

george Williams, mD, MultiCare Health System

James mcDowell, mD, Providence St. Peter Hospital

Jeff tomlin, EvergreenHealth

Joan Ching, Virginia Mason Medical Center

rev. John F. tuohey, phD, Providence Center for Health Care Ethics

John White, Klickitat Valley Health

Kate bechtold, MultiCare Health System

Katherine Flynn, rn-C, Seattle Children’s Olympia Clinic

Kathryn beattie, mD, UW Medicine, Valley Medical Center

Kirk Harper, Kadlec Health System

Kristen rogers, Providence Health & Services

laird pisto, MultiCare Health System

laurie brown, Franciscan Health System

lisa Westlund, UW Medicine

mark Adams, mD, Franciscan Health System

mark Delbeccaro, mD, Seattle Children’s

michael menen, mD, Providence Health & Services

mike glenn, Jefferson Healthcare

patty Cochrell, Harrison Medical Center

robert st. Clair mD, LincolnHospital

sarah schwen, rn, Virginia Mason Medical Center

sarah patterson, Virginia Mason Medical Center

shelly pricco, St. Elizabeth Hospital

steve becker, Coulee Medical Center

steve Cabrales, PeaceHealth St. John Medical Center

tammy Cress, Providence Health & Services

tom martin, LincolnHospital

Washington StateHospital Association300 Elliott Avenue W, Suite 300Seattle, WA 98119

Documents

Legislative Summary and Policy Previe...As you read this year’s Legislative Summary, you’ll see that our work continues on legislative issues connected to the implementation of