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CALIFORNIA HOSPITALS PRIORITIES AND GOALS

STATE HOSPITAL ASSOCIATIONS AND ORGANIZATIONS POOL RESOURCES TO DELIVER MEANINGFUL PRIORITIES AND GOALS FOR CALIFORNIA HOSPITALS

Combining their resources last year, the California Healthcare Association, the Healthcare Association of Southern California, the Hospital Council of Northern and Central California, and the Hospital Council of San Diego and Imperial Counties, as well as several individual hospitals and affiliated organizations developed a list of recommended “Priorities and Goals” in the form of an action plan to be considered and shared among hospitals statewide.

According to the California Healthcare Association (CHA), the driving vision behind these goals is “the achievement of an optimally healthy society.” It is the belief of the CHA that realizing the vision requires, ” teamwork among many public and private interests. Communities must change; incentives of providers must be aligned; public and private financing must be fair and adequate; and accountability, which is balanced among patients, providers and payers, must become a reality.”

Several of the key priorities and goals from the CHA’s list follow below. Some of the goals have already been partially achieved.

State Priorities and Goals for Hospitals

* ELIMINATE BARRIERS TO INTEGRATION AND SUPPORT RESPONSIBLE REFORMS

Priority: Support the development of community-based health care organizations that deliver coordinated care, in which incentives are aligned to promote an optimally healthy society. Eliminate roadblocks to delivering efficient, cost-effective, high-quality care.

Goals: Enable health care delivery systems with appropriately aligned incentives to accept full financial risk for services, subject to reasonable financial requirements and other safeguards. Encourage and enable the use of capitated and other bundled payment arrangements for delivering comprehensive health care services. Authorize provider-sponsored networks (PSNs) to contract directly with Medicaid and qualified employers for services.

Remove barriers to coordinated care and physician-hospital partnerships through amendment of patient-referral, antitrust professional restrictions, and other impeding laws and regulations.

Preserve the Medical Injury Compensation Reform Act of 1975 (MICRA) and support complementary tort reform legislation.

Support incremental health reform legislation which moves California toward an optimally healthy population and ensures that every California resident is entitled to equitable access to medically necessary, affordable, quality health care, building on private-public partnerships. This should include expanding employed and self-employed groups able to obtain coverage from the Health Insurance Plan of California and expanding reforms which assure portability, guaranteed issue and open-enrollment periods which mitigate against adverse selection, guaranteed renewability and limitations on pre-existing conditions.

* PROTECT HEALTH CARE FUNDING

Priority: Prevent or mitigate health care funding cuts and other state budget-related actions which adversely affect funding for medically necessary health care.

Goals: Protect funding for the delivery of medically necessary health care, including traditional Medi-Cal programs, coordinated and managed care programs, pilot projects and other state programs.

Improve the Medi-Cal managed care program by establishing adequate minimum capitation rates that reflect the cost of efficiently providing care.

Require county governments to maintain their existing levels of funding for health services in all subsequent years.

Support funding for safety-net/essential community hospitals, rural hospitals, teaching institutions and specialty services, and, in cooperation with other stakeholder organizations, provide leadership in restructuring California’s health care safety net.

* ASSURE ACCOUNTABILITY FOR PERFORMANCE AND QUALITY

Priority: Develop consensus on responsible, standardized reporting of accurate and quality financial and performance data that can be easily understood by the public and does not place unnecessary burdens on health care providers and plans.

Goals: Redesign the Office of Statewide Health Planning and Development (OSHPD) hospital discharge and data system to eliminate unnecessary and outdated data elements, streamline the reporting requirements and modernize the data collection, analysis and reporting systems.

Provide leadership with other key stakeholders, including physician organizations, health care service plans, insurers, business alliances, major public purchasers and regulatory agencies to:

Support development of an agreement on valid and meaningful measures of quality.

Support development of a cost-effective process for data collection, analysis and distribution of information to the public and others.

Establish accountability principles and standards for providers; create community and public accountability criteria for outcomes and quality.

Consistently gather feedback from providers to determine their satisfaction with health plans, including clarity, timeliness, benefits, payment practices, administrative requirements and responsiveness. Publish the results for the public.

* IMPROVE AND UPDATE REGULATIONS

Priority: Support changes to laws and regulations which create a climate for health care providers to deliver efficient, cost-effective, quality services.

Goals: Support work redesign initiatives, efficient use of health care personnel, and other health care delivery innovations in light of changing technology and medical advances, demands for health care cost containment and a shift to outpatient treatment and recovery.

Eliminate unnecessary operational and licensing burdens, including revision of regulations to permit staffing flexibility, flexibility for alternative rural delivery systems, and treatment of outdated pharmaceuticals as medical rather than hazardous waste.

Advocate for fair and reasonable building code construction and renovation standards, including structural and nonstructural seismic-safety requirements for inpatient and ambulatory care facilities. Streamline OSHPD review of small construction/renovation projects.

* PREVENT ARBITRARY MEDICARE AND MEDICAID FUNDING REDUCTIONS

Priority: Support Medicare and Medicaid savings through delivery and payment reforms which build on aligned incentives within community-based health systems that deliver affordable, high-quality, coordinated care.

Goals: Support redesign of the Medicare program through the establishment of and participation in an independent commission.

Assure the Medicare and Medicaid inpatient and outpatient changes reduce inequities among the states and are equitable to both urban and rural hospitals.

Increase California’s per capita share of federal Medicaid funds, in dollars as well as relative position among the states.

Preserve federal authorization for Medicaid intergovernmental transfers and similar programs which provide funds to safety-net, disproportionate-share, specialty and academic/teaching hospitals.

Require states to maintain existing levels of financial effort for Medicaid and maintain minimum requirements for Medicaid payments to providers.

Lead intrastate and interstate coalitions to obtain payment for health care provided to undocumented persons and uninsured residents.

* ELIMINATE BURDENSOME REGULATIONS

Priority: Advocate rational and equitable federal health care legislation, regulations and policies in collaboration with AHA and others.

Goals: Reduce Medicare and Medicaid red tape, including cost report streamlining of outpatient reimbursement, and elimination of arbitrary delays in payment and other ineffective or overly burdensome conditions of participation in Medicare.

Modify or eliminate regulations which are unduly burdensome or outdated by health care financing and delivery changes or new technologies.

Support work redesign initiatives and efficient utilization of the health care work force, including legislation to eliminate daily overtime for all industries except agriculture, to significantly revise current ergonomic requirements and to eliminate excessive Department of Labor reporting.

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