president, hospital council of northern and central california · 2019-12-19 · 185 hospitals and...

AUGUST 26, 2011 ADVERTISING SUPPLEMENT

IMPROVING CARE IMPROVING COMMUNITIES | A1

Dear Reader,

Health care has become an important social and economic barometer of our quality of life. In the greater Sacramento region we are fortunate

to have a unique health care delivery system that is among the best in this state. Th is is due in large part to the state-of-the-art facility improvements, technological investments, and clinical advances our local hospitals and systems are providing, as well as the close integration of health care services between the region’s hospitals and physicians.

Th is Improving Care, Improving Communities supplement was created to provide you, our region’s business, opinion and community leaders who have a vested interest in the quality and cost of health care services, with a better understanding of the region’s hospitals and the issues they are addressing to continually improve the value and delivery of patient care. In the era of federal health care reform and a challenging economic climate, solutions to Emergency Department overcrowding, the underfunding of the Medicare and Medi-Cal programs, and providing access to care for more Californians have become even more crucial.

Hospitals are among the largest employers in Sacramento County, directly employing 23,000 skilled workers. Th ey are also a major economic engine, contributing $2.8 billion to the regional economy in 2009 as part of the health care and biosciences industry cluster.

Th e Hospital Council of Northern and Central California is the nonprofi t trade association proudly representing 185 hospitals and health systems in 50 of California’s 58 counties—from Kern County to the Oregon border. Our membership includes hospitals and health systems ranging from small, rural hospitals to large, urban medical centers. Our mission is to help hospitals provide high quality health care and to improve the health status of the communities

they serve. We provide opportunities for hospital leaders — and in many instances, competitors — to come together to address problems within a region in ways that they can’t solve alone.

An example of this collaboration is a unique public/private partnership several hospital systems have initiated among mental health care providers, law

enforcement, and other stakeholders to redesign the delivery of mental health services, which we believe will make the Sacramento Region a leader in this fi eld. Another powerful collaboration focuses on patient safety where hospitals are working together to identify best

practices to reduce premature births, lower sepsis/infection rates and prevent errors. We know when hospitals learn from each other, changes happen much more quickly.

Th e region’s four not-for-profi t health care systems and independent hospitals are also committed to working in the community to continually identify partnerships that will increase and improve health and social services to the underinsured populations.

As I hope you see from this supplement, our hospitals have a unique role on the frontline of our communities and economy. Th ey remain committed to providing and improving quality health care for the greater Sacramento region.

Sincerely,

Art SponsellerPresident and Chief Executive Offi cer,Hospital Council of Northernand Central California

Open letter from Art SponsellerPresident, Hospital Council ofNorthern and Central California

Hospitals have a unique role on the frontline of our commu-nities and economy.

By C. Duane Dauner President/CEO,California Hospital Association

Th e spotlight is shin-ing on health care costs. It’s an issue that generates newspaper

headlines and debate among business leaders, policymakers and consumers. But for all of the arguments — and accu-sations — that emanate from this discus-sion, the facts are more complex than the dialogue oft en refl ects.

California’s community hospitals are on the front-lines of our health care system. Hospitals deliver care to every patient in need — anytime of the day or night — whether or not the person has health insurance or the ability to pay.

Hospital charges were established more than fi ft y years ago to cover the

cost of patient care services, with an additional amount allocated to cover charity care, bad debt and future capi-tal needs. When Congress created the Medicare and Medicaid programs in 1965, the federal government covered the cost of delivering services to the enroll-ees of both programs. Since that time, however, state and federal actions have been implemented, resulting in signifi -cant payment shortfalls, especially in the Medi-Cal (Medicaid) program. Medi-Cal reimburses hospitals only 78 percent of the cost to provide hospital care to the Medi-Cal benefi ciaries. California ranks 51st nationally in Medicaid payments to health care providers per enrollee.

Over the years, the basis upon which hospital charges are established has evolved. Today, hospital prices are based on many factors — including govern-mental payment shortfalls, discounted health plan reimbursements, charity care, bad debt, county indigent patients, new technologies, labor costs and unfunded state and federal mandates.

In 2010, California hospitals provided $12.5 billion in uncompensated care. Of that amount, more than $3.6 billion was the result of Medicare payment short-

falls and $4.8 billion was attributable to underpayments from the Medi-Cal program. Th ese inadequate governmental payments are set by the federal and state governments. Th ese payment levels are expected to get even worse in the coming years as the federal government contin-ues to ratchet back hospital payments in order to pay for health care reform and the state grapples with its own budget defi cits.

When governmental programs fail to pay hospitals for the actual cost of caring for their benefi ciaries, hospitals and other health care providers must shift these unreimbursed costs to the private sector by negotiating higher payments from private insurers and individuals who pay their bills directly. Th is “cost-shift ing” is not a new phenomenon. It has existed for decades as Medi-Cal and Medicare have repeatedly reduced payments to

hospitals and other providers. It is what former Governor Arnold Schwarzeneg-ger termed the “hidden tax” and it aff ects every Californian who pays his/her bill directly or who has private health insurance. Th is hidden tax costs every California family more than $1,200 per year in extra health insurance premiums or in direct payments by the self-insured who have the ability to pay their bills.

California hospitals also face chal-lenges posed by unfunded state mandates such as the state’s earthquake compliance standards — estimated by the inde-pendent RAND Corporation to cost as much as $110 billion. Th e rising costs for personnel, health information technol-ogy, medical equipment, prescription medications, medical education, special services such as trauma care and research generally are paid for by private insur-ance and self-insured individuals.

Compensation to labor is the largest factor aff ecting hospital costs. According to a recent report by the American Hos-pital Association (AHA), nearly 60 cents of every dollar spent by hospitals goes to pay for wages and benefi ts to individuals

Governmental underpayments, regulations combine with medical advances to drive rising hospital costs

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Last year, California’s hospitals were underpaid more than $8 billion from the Medi-Cal and Medicare programs. Privately insured Californians—employers, employees and individuals—are paying the costs for the government’s underfunding of these programs. Stopping this “cost shift” will help hospitals continue to provide vital health care services to everyone and lower premium increases to privately insured Californians.

Tell your state Senator and Assembly member to stop shifting Medi-Cal costs to privately insured Californians.

California ranks 51st nationally in Medicaid payments to health care providers per enrollee.



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A4 | IMPROVING CARE IMPROVING COMMUNITIES ADVERTISING SUPPLEMENT AUGUST 26, 2011

who directly care for patients or support their care. In California, these fi gures are higher in part because of the state’s rigid nurse-to-patient ratio law — the only such universal mandate in the nation.

Other factors that drive up the cost of hospital care include an aging population, obesity, chronic conditions and behavior-

induced illnesses. Th e acuity of hospital patients is rising as a result of these forces, thereby putting more pressure on the cost side of the health care equation.

Despite all of these cost drivers, hos-pital care as a percent of total spending on health care services and supplies has actually declined from 43 percent in 1980 to 32 percent in 2010. Growth in spending in hospitals is less than the rise in costs for

pharmaceuticals, home health and other services.

Many factors aff ect the consumption of health care services, which in turn lead to increased costs. Th e solution to this perplexing dilemma lies in collaborative eff orts to bring together key stakeholders and patients in innovative ways to improve the availability and quality of care in a safe, cost-eff ective manner; improve healthy

behavior in all individuals; and align incentives so that every person, whether he/she uses or provides health care, has a stake in changing the demand and supply sides of health care.

Th is challenge is not for the faint of heart. It requires visionary and practical solutions, alignment of fi nancial and clini-cal incentives, commitment, collaboration, coordination and accountability. ■

Health care reform, health care costs and jobs in your community: An executive perspectiveThe implementation of health care reform continues to take shape in California. Employers, employees and health care consumers will see many changes in the way they access and pay for health care services in the future.

Hospitals in the Sacramento Region are both providers of health care services as well as large employers. We asked fi ve top hospital and health care executives to share their perspectives on how they are working to increase access to health care services, control rising health care costs, and address future shortages of trained health care professionals.

Q: Last year the Aff ordable Care Act (ACA) became law. Some insurance reforms have already gone into eff ect, but many more reforms have yet to be implemented. For employers in Sacramento’s business community, what are the greatest challenges and opportunities to be aware of in the next three to fi ve years?

Pat Fry, Sutter Health: In 2014, states will introduce insurance exchanges that will make buying health coverage easier and more aff ordable. Th e exchanges will allow individuals and small businesses to compare health plan prices and benefi ts and enroll in a health plan that meets their needs. It’s likely that many of these new health plan products will be narrower in terms of the providers that participate. We also foresee a future where employees bear greater fi nancial and personal responsibil-ity for their health care.

Sister Bridget McCarthy, Mercy/CHW: Employers will face uncertainty because the insurance market is going to undergo tremendous change and their challenge will be to fi nd the best care at the best cost for their employees. Employers will need to decide whether they provide coverage to employees through a direct relationship with insurance companies or work with insurance companies through the Califor-nia Health Benefi t Exchange. Healthcare’s

challenge will be to provide quality aff ord-able care to all.

Q: What do you believe are the ma-jor changes the ACA will have on our current health care system?

Pat Fry: Our greatest challenge is to fi nd ways to continue to serve growing num-bers of government-sponsored patients in the baby boom generation at a cost close to what Medicare insurance pays us. Under federal health care reform, the government will provide health coverage to 32 million uninsured Americans, and it will cover the cost in large part by pay-ing health care providers less. Medicare, which has for years underpaid doctors and hospitals, will reduce its reimbursement to Sutter Health by nearly $2 billion over the next decade. While we have concerns about reimbursement reductions that can aff ect patients’ access to care, we believe in the core components of health care reform. Sutter Health supports increased access and coverage — as well as account-ability for high quality, aff ordable care.

Robert Carmen, Adventist Health: Hos-pitals and other health care professionals will, as a natural consequence of ACA, work together in ways that better coordi-nate care. We have to acknowledge that the

US health care “system” is not as systematic as it could be. Better coordination of care should mean fewer unneeded repeat tests, quicker transfers to appropriate sites of care, and so on — and these improvements can result in less-costly care. Patients will appreciate this streamlining of care.

Q: There is a great deal of attention being paid to reigning in rising health care costs. The ACA will cut

reimbursements to hospitals by an additional $17 billion by 2020. How will your hospital or health system adapt to more cuts in reimbursements while continuing to improve access and quality of care?

Ed Glavis, Kaiser Permanente: One of the challenges with health care reform is that

Continued from preceding page

Robert G. CarmenPresident & CEO, Adventist Health

Ann Madden RiceCEO, UC Davis Medical Center

Sister Bridget McCarthySenior Vice President, OperationsMercy/Catholic Healthcare West

Patrick E. FryPresident & CEO, Sutter Health

Ed GlavisSenior Vice President & Area Manager, Kaiser Permanente, Sacramento and Roseville

Continued on next page

we know we’ll need to take care of more people and do so with less money. To do that, we will continue to build on what we already have in place and modify our system as needed to create an even more effi cient, high-quality health care delivery organization in the health care reform era.

Improving the quality of care and increasing effi ciency are the keys to controlling costs. Quality care at its core is also effi cient and aff ordable, and we are continually creating effi ciencies through our internal improvement processes.

Robert Carmen: “Bending the cost curve” has been the mantra in Washington for a long time now, and we know we can’t sustain the growth curve in U.S. health care. On the other hand, labor costs, mate-rial costs, and all other costs associated with hospital operations keep going up. Th at fact won’t be cured simply by cutting hospital payments. Th at being said, we are doing our best to reduce operating costs while maintaining safe and eff ective care.

A very large majority of our patients are covered under government health plans - Medicare, Medi-Cal or TriCare (for veterans). Budget constraints continually lead policy-makers to reduce payments in these programs. Hospitals and physicians are taking the brunt of the reductions.

Q: As health care costs continue to rise, can you talk about what the true drivers of rising costs are and how they can be curtailed or even reduced?

Sister Bridget McCarthy: Part of Mercy/CHW’s mission is to provide quality care to all, including the underserved. Th e number of uninsured has certainly risen during recent diffi cult economic times. Th is has increased the amount of unre-imbursed care provided by all healthcare systems, which leads to cost shift ing. Cost shift ing results in insured families paying more for commercial insurance.

Ann Madden Rice: As a hospital executive, I see increasing pressure put on hospitals to absorb shortfalls, whether in the under-funding of residency training, which pre-pares new physicians to begin practicing medicine, or in reduced reimbursements for government-sponsored care. Th ese two factors alone have a heavy infl uence on the cost of care. Yet, unfunded mandates, such as the seismic standards in California; mandated reporting; regulatory compli-ance; and staffi ng ratios cause signifi cant added burden. Rising costs certainly have to be addressed but I believe the cost of care needs to be tackled in a comprehen-sive way to ensure individuals have access to the quality care they need.

Q: Health care reform will bring an estimated 3.6 million more Califor-nians into our state’s health care sys-tem, mostly by expanding Medi-Cal. How is your organization planning to adapt and provide access and services to this huge infl ux of people by 2014?

Robert Carmen: People forget that in general terms, we are taking care of those people already today. Many of whom have little or no coverage. In some ways the additional coverage will mostly mean that patients will more likely have coverage. If Massachusetts is any indication, we will probably see a spike in demand as people come on the health plan roles, and take care of health issues they have neglected. And a lot of the care for these new health plan members will be done in medi-cal clinics. Th e planned increase in our capacity for medical-offi ce care will help patients — and help the system absorb the newly insured.

Ann Madden Rice: Th e approximately 30 million more people who will be covered by health insurance under the ACA pose a number of challenges to the entire national health-care system. One of the most serious is a longstanding and growing shortage of primary-care health professionals. UC Davis is working with a coalition of state and federal organizations to implement the California Telehealth Network. Th is network will link more than 850 clinics and hospitals around the state to enable them to consult via video chat in real time with specialist physicians from the fi ve UC medical centers, as well as a few private hospitals. Th is network will improve access to specialty care and other services that improve the quality of health care services.

Sister Bridget McCarthy: Mercy/CHW is the largest private provider of Medi-Cal services in the state, serving 10 percent of all Medi-Cal discharges. As part of our mission to care for the underserved, we are proud of our partnership with the state and we are committed to continu-ing this partnership. As the Medi-Cal base expands, Mercy/CHW will work to maximize our community partnerships to promote preventive care and to provide greater access to primary care.

Q: Unemployment rates keep rising and there have been many stories about health care being the bright spot in this dismal jobs market. Is there a shortage of health care workers in California and are there jobs available?

Ann Madden Rice: With shortages of health professionals looming, UC Davis serves a unique role in the region in which it educates and trains the next generation of health professionals. However, we are not producing simply more health profes-sionals but care providers with the right skills for working in a new collaborative environment envisioned by health-care reform. By emphasizing interprofessional education, we leverage the synergies of multiple disciplines to enable our gradu-ates to work in diverse teams of health professionals and community organiza-tions to provide care, improve health and conduct science. We focus on graduating students who refl ect the populations they serve and preparing health leaders who can help drive change.

Ed Glavis: Kaiser Permanente is a very large organization, with approximately 68,000 employees in Northern California alone. At any given time, we have a variety of jobs open that need to be fi lled. Like most employers, we look internally fi rst when we have jobs to fi ll. Internally or externally, we always are interested in hir-ing the best candidates. Kaiser Permanente is a “destination employer,” that is, it is a place where many in the health-care fi eld want to work. As a result, we have many candidates from which to choose for every job posting.

With all that said, we are concerned, just like every health care provider, about the shortage of qualifi ed health workers, in-cluding physicians, nurses and technicians. To address the problem, we are contribut-ing signifi cantly to training and education programs, with a special focus on commu-nity-based safety-net providers. ■





Hospitals throughout California are making signifi cant strides in their ongo-ing eff orts to reduce the risk of infection for patients — an essential component of providing high-quality care and keeping patients safe during their hospital stay. Implementing a wide range of innovative programs aimed at preventing infections and early treatment helps to avoid com-plications and means better results for the patient, shorter hospital stays and lower health care costs.

Preventing infection: A top priority California’s hospitals are working ag-

gressively to advance patient safety in sev-eral clinical areas, including the preven-tion of central line-associated bloodstream infections and early identifi cation and treatment of sepsis.

“Central line” refers to a type of cath-eter placed into a large vein, which is used to administer medication and fl uids. Cen-tral line-associated bloodstream infections occur when bacteria or other germs infect the catheter, and they are one of the most deadly hospital-acquired infections, with a mortality rate of up to 25 percent.

Sepsis aff ects 750,000 people in the United States each year. It is a severe illness in which the bloodstream is

overwhelmed by infection. Any type of infection can trigger sepsis, which can lead to widespread infl ammation and blood clotting. Because sepsis can progress very quickly, it is critical to diagnose and treat it immediately.

Best practices and early treatment are keyTh roughout the Sacramento region,

hospitals are implementing a variety of programs to prevent central line-associ-ated bloodstream infections and sepsis. At UC Davis Medical Center, an eff ort launched in 2006 has reduced the central line infection rate by 84 percent.

According to Carol Robinson, chief nursing offi cer at UC Davis, the key to success is regular communication and a cross-functional team approach.

“Our physicians and nurses really work together as a team,” Robinson said.

Th e initiative also includes regular communication with key staff ers through-out the medical center, along with a daily review of patient charts and intensive root-cause analysis.

Encouraged by the success of its eff orts to reduce central line-associated blood-stream infections, UC Davis last month rolled out a sepsis initiative.

According to Marci Hoze, a nurse man-

ager at UC Davis, the initiative leverages the resources of the hospital’s electronic medical records system.

“Our electronic medical record system alerts us to patients who might be at risk for sepsis,” Hoze noted. “When an elec-tronic alert is issued, a nurse immediately evaluates the patient, requests appropri-ate lab tests and notifi es the physician. Early intervention and treatment greatly increase the patient’s chance for recovery.”

UC Davis’s sepsis initiative also in-cludes a team of seven nurses who serve as patient safety “champions.” Th eir primary objective is to monitor and facilitate staff compliance with patient safety initiatives.

At Sutter Health, more than 1,100 staff members have been trained in advanced skills to improve patient care and patient safety over the past 10 years, according to Gordon Hunt, M.D., senior vice president and chief medical offi cer. Th is training has focused on identifying and implement-ing evidence-based best practices found at hospitals throughout Sutter’s Northern California network and in use at other hospitals across the country.

“We’ve found that central line-associat-ed bloodstream infections can be reduced signifi cantly when clinicians use the same sterile techniques as are used in operating rooms to insert or remove a catheter,” Dr. Hunt said. “Based on our practices, we’ve had a remarkable reduction in these infec-

tions. Th e national average is about 2 per 1,000 and currently we’re at 0.2 per 1,000. Reductions in central line blood stream infections, ventilator associated pneumo-nia and aggressive prevention and treat-ment of sepsis have saved approximately 1,500 lives.”

“Our goal is to eliminate all of those infections over time,” Dr. Hunt added.

Another component in Sutter’s ef-forts to reduce hospital-acquired infec-tions is its Electronic Intensive Care Unit, which allows specially trained physicians and nurses to keep an even closer eye on critical-care patients 24 hours a day, seven days a week through the use of early warning soft ware and advanced video and remote monitoring.

Over the past four years, Sutter Health’s infection prevention programs have saved more than $43 million in health care costs.

In addition to UC Davis and Sutter, other hospitals throughout the greater Sacramento region also are focusing signifi cant resources on eff orts to reduce hospital-acquired infections.

Th e Hospital Council of Northern and Central California’s Beacon Collaborative brings hospitals together in peer-to-peer learning networks to address sepsis and other patient safety initiatives. Beacon is a part of the Patient Safety First…a California

Sacramento hospitals committed to patient safety


Preventing and reducing infections



Health care coverage is one of the most expensive benefi ts paid for by employ-ers. Whether you’re a small start-up, large multi-national or something in between, you’re well aware of the aff ects that health care insurance costs have on your busi-ness, employee retention and productivity.

Nationally, the United States spends an estimated $2 trillion annually on health care expenses, more than any other indus-trialized country in the world. According to a report by the Council on Foreign Relations, many U.S. businesses are less competitive globally because of balloon-ing health care costs. In addition, the annual Milliman Medical Index (MMI) reported that the annual cost of health care coverage for a typical family of four in a preferred provider plan (PPO) rose 7.3 percent in the past year, from $18,074 in 2010 to 19,393 in 2011.

No one can deny that our current health care system is getting more costly, more fragmented and is unsustainable. Premium increases are at an all time high which is severely impacting both employer-spon-sored and individual coverage. In addition, the severe economic downturn also has dramatically aff ected California’s health care system. According to UCLA’s Center for Health Policy Research, nearly two mil-lion Californians lost their health insurance in 2008 and 2009 because of the recession, bringing the state’s total number of unin-sured to more than 8 million people.

Th e long-term goal of federal health care reform — the Aff ordable Care Act (ACA) — is to change the way care is

delivered and paid for. Th e law was de-signed to make it easier for more people to obtain, pay for and keep health care coverage through a variety of government, individual, and employer-based mecha-nisms. What is not clear about the ACA is the impact the law will actually have on the rising cost of care.

Some elements of health care reform — such as incentives for improved quality and preventive care — may help stem the tide of rising costs. On the other hand, increased utilization, resulting from the elimination of lifetime benefi t limits and expanded access to care, may continue to drive costs upward. So what does all this mean for employers in California?

“Hospitals throughout California are both providers of health care services as well as major employers and we uniquely see the potential challenges and oppor-tunities of health reform,” said Joseph P. Harrington, president and chief execu-tive offi cer of Lodi Memorial Hospital. “Reforming health care is going to create periods of uncertainty and fl uctuation, but I encourage large and small employers alike to not let the uncertainty paralyze them. Employers can look to their com-munity hospital as a trusted partner in getting educated on what the impacts and opportunities are,” said Harrington.

In 2010, insurance market reforms and coverage provisions for small busi-nesses were enacted, and over the course of the next three years a series of coverage expansion and fi nancial changes will be rolled out.

Two provisions in the law can benefi t small busi-nesses. Th e fi rst is a tax credit to help small busi-nesses cover the costs of health care for their employees. Th e second is the health ben-efi t exchange which is designed to give small businesses and individuals easy access to aff ordable plans. California’s insurance exchange is expected to be up and running in 2014.

Under the law, small business employ-ers qualify for the tax credits if they have less than 25 full-time equivalent employ-ees with average annual wages less than $50,000. Th ey must also cover 50 percent or more of employee premiums. Accord-ing to the U.S. Small Business Admin-istration, there are about 500,000 small businesses in the state eligible for the tax credits.

For large employers, the law intends a smooth transition for those already providing health coverage by exempting employer-based coverage that was in eff ect on March 23, 2010 from certain provisions in the Aff ordable Care Act, so current coverage can continue. It creates the Early Retiree Reinsurance program, which provides fi nancial assistance to continue employer- based health insurance for early retirees ages 55 to 64 that are not yet eligible for Medicare. Th is program is a bridge to 2014, when early retirees will be

able to purchase aff ordable coverage in the new health insurance exchanges.

By 2014, employers that have 50 or more full time workers and do not provide aff ordable health coverage must pay an assessment based on the number of full time

workers they employ. Th e law also creates an option for employees

who spend between 8 percent and 9.8 percent of their income on premi-

ums to use those contributions toward their coverage as a voucher in the health exchanges, at no additional cost to their employer.

While community hospitals develop and implement best practices to improve the quality and effi ciency of care, health care reform opens the door for purchasers

— California’s employers and workforce — to drive market changes that will cre-ate a high-performing health care system,

according to Harrington.“Th e key is employer education and

engagement,” said Harrington. “Employ-ers can implement health and wellness programs that reward employees for tak-ing action to maintain and improve their health and they can choose health plans that reward providers for better health outcomes. Many communities will be able to take advantage of educational opportu-nities hosted by their community hospital so employers and employees can make intelligent choices from their health cover-age options,” he continued.

Federal health care reform was a catalyst for policymakers, businesses, health care providers and other stakehold-ers to start addressing an unsustainable and costly health care system. Creating real reform in the future however, means creating a system that supports exist-ing employer-based coverage, provides adequate access to health care services by covering more Californians, and reduces costs for everyone. ■

The uncertainty and benefi ts of health care reform for California businesses

Partnership for Health, funded by Anthem Blue Cross. Lives are being saved every day due to this focused and collaborative eff ort.

One of the most innovative Beacon programs being implemented in the Sacramento Region is a simulation-

based training program of health care professionals. Th e Medical Simulation Corporation’s SimSuite Mobile Simulation Lab has trained more than 600 multi-disciplinary hospital staff members on the early identifi cation and treatment of sepsis. To date, this mobile simulation facility has helped trained teams of

health care providers from Rideout Memorial Hospital in Marysville, Sutter Auburn Faith Hospital, Marshall Medical Center in Placerville, UC Davis Medical Center, Shriners Hospital for Children in Sacramento, Mercy Folsom Hospital, and Kaiser Permanente in South Sacramento and in Roseville.

Hospitals are dedicated to providing patients with highest quality care possible. By making patient safety a top priority and implementing innovative infection identifi cation and prevention programs, hospitals throughout California are help-ing to save lives and keep our communi-ties healthy. ■



By Marcus Godfrey, RN, President-Elect California Council,Emergency Nurses Association

If you’ve been to a hospital emergency room (ER) lately, you may have seen a crowded waiting room or had to wait to see an ER physician. Th at’s because there have been a record number of people visit-ing California’s hospital emergency rooms. In 2009, there were more than 12 million visits to California’s community hospital ERs. Th at’s an increase of 74 percent since the beginning of the decade. During that same time period, more than 70 hospitals and ERs closed. With more patients and less emergency rooms available, Cali-fornia’s ERs are becoming increasingly overcrowded. ERs are now seeing more than 32,000 patients every day or nearly 1,400 patients every hour. As California’s population continues to grow and age, the situation is expected to get worse before it gets better.

Emergency rooms are open 24 hours a day, 7 days a week to care for everyone who enters their doors. As an emergency room nurse, I can tell you fi rsthand that we’re on the front lines every day — caring for you, your family, your friends, for the seriously ill and injured, for the uninsured, and for the millions of Medi-Cal patients who can’t fi nd a primary care physician to see them. Hospitals emergency rooms are truly the ‘safety net’ provider for the communities they serve, and they are facing increasing challenges.

Due to our nation’s slow economic recovery, jobs and employer-based insurance coverage continues to decline. Government-sponsored health care programs are also cutting back due to budget shortfalls, including counties that are reducing mental health services and the number of available beds for psychiatric patients. As these and other cutbacks in the health care system occur, California’s population continues to grow

and age. In short, we’re looking at the perfect storm of more patients, requiring more services and fewer hospital and emergency room beds.

California now has 7 million unin-sured people who regularly use expensive ER services because they have no regular physician to care for them. In addition, patients with insurance are using ER services for the convenience of the 24/7 availability of services especially aft er hours when doctor’s offi ces are closed. And fi nally, the 8 million people covered by Medi-Cal — children, low income and the disabled — are also adding to the overcrowding problems. Medi-Cal patients are the most frequent users of emergency room services because most private practice physicians will not accept the substantially low reimbursements rates to treat these patients. Routine medical conditions that we care for from all these patient groups could have been more effi ciently and more cost-eff ectively treated by primary care physicians and other lower-cost care settings like clinics.

Hospitals also feel the pain of the underfunded Medi-Cal program.

California currently ranks 49th out of 50 states in the level of reimbursements to hospitals. Last year, hospitals lost $4.8 billion in under-payments from Medi-Cal. Th is fi nancial burden threatens hospitals’ ability to provide critical ER and other services to their communities.

Lastly, California has a dwindling number of available beds for all the patients coming through the doors. In my Emergency Department, we oft en say that the overcrowding issue is not a numbers problem but a real estate problem. Approximately one-third of the beds that are available in an average ER are occupied by patients awaiting inpatient hospital beds or by mental health patients who no longer have services provided in their counties. Th ese patients oft en stay in the ER for over 24 hours until another hospital or psychiatric bed becomes available. For example, my 34-bed ER shrinks to only 24 available beds while the 200 patients we treat every day continue to arrive.

Today, the average wait time in a California hospital ER is just over four hours. Using innovative design and

operational changes, hospitals and ER professionals are working together to more eff ectively manage the the fl ow of patients ERs and insure the highest quality patient care for everyone.

For example, hospitals that have recently renovated or rebuilt hospital buildings to meet new earthquake safety standards are increasing the number of ER beds whenever possible and designing “fast-track” systems. A fast-track system allows patients with non-life threatening conditions to be cared for in a separate section of the Emergency Department designed to quickly care for minor emergencies such as sprains, lacerations, fevers, etc.

Other hospitals are reducing wait times and increasing patient satisfaction by streamlining their patient assessment and admitting processes. Th is includes a Rapid Medical Examination® process which has a physician stationed at the very front of the ER to quickly assess and then direct an incoming patient. Th is reduces the wait time for patients to see a physician and be directed to the appropriate care. Still other hospitals are authorizing nurses at the front of the ER to order lab and X-ray tests, as well as treat pain, all in an eff ort to reduce the time the patient spends waiting.

It’s no secret that wait times in emergency rooms are challenging for everyone, but emergency room nurses, other providers and hospitals all over California are implementing a variety of new and innovative practices to reduce wait times for their patients and their communities.

Emergency room nurses and physicians see patients at their most vulnerable, worst moments. It is our mission to provide the highest quality care and comfort in those times. ■® Rapid Medical Examination is a registered trademark of California Emergency Physicians.

Emergency rooms visits at an all-time highHospitals innovate to ease overcrowding

Much has been written about the predicted shortage of primary care physicians and nursing professionals within the next few years. Just as critical, but less well-known, is the shortage of allied health professionals — those clinicians who work both at the bedside and behind-the-scenes to provide laboratory, imaging and other critical services needed to diagnose and treat patients.

While California’s community hospitals today employ more than 440,000 highly skilled and trained health care workers, a recent survey of California hospitals, analyzed by researchers at the University of California at San Francisco’s Center for the Health Professions, indicates alarming rates of retirements expected over the next fi ve years. According to the report, a large number of retirements

of health care workers will lead to serious shortages of clinical laboratory scientists, respiratory therapists, physical therapists, radiological technologists and a host of specially trained imaging professionals, including ultrasound and MRI technologists.

Th is expected workforce shortage comes at the same time as the Baby Boom generation enters their senior years requiring increased health care and

as the nation prepares for fundamental changes in the health care delivery system driven by the implementation of health care reform beginning in 2014.

One might be tempted to assume — given the current high levels of unemployment driven by the recession — that fi lling these well-paying jobs would be easy. Th e unfortunate reality,

Health care workforce shortages pose access-to-care challenges for patients and hospitals


however, is not so simple.“It’s a complex equation we’re trying

to solve,” said Cathy Martin, director of the California Hospital Association’s (CHA) Healthcare Workforce Coalition. “Nationwide, the health sector is one of the very few sectors adding jobs in today’s economic climate. However, California hospitals have been particularly hard hit with a combination of factors including the recession and payment cuts from Medicare and Medi-Cal that have forced them to engage in short-term cost-cutting strategies. Th ose strategies include workforce reductions or consolidations. While at the same time, in some hospitals, especially those in California’s rural communities, positions are available but vacancies remain due to lack of professionals to fi ll them,” she added.

Martin adds that health care jobs are expected to be “an economic engine for California in the future,” with demand for services driven by our growing and aging population. On the fl ip side, however, is the reality that many professionals currently making up our health care workforce are Baby Boomers — the very people who will be retiring in the next few years.”

According to Anette Smith-Dohring, workforce development manager at Sutter Health and a member of the CHA Workforce Committee, it is anticipated

that the fastest growing area of health care employment will be in allied health, with a projected 63 percent increase between 2010 and 2030.

“Hospitals across the state are investing millions of dollars to help educate health professionals, but cuts to education budgets by the state and other funders are creating fi nancial gaps that can’t be fi lled by hospitals alone,” said Smith-Dohring. “It is now more important than ever that strong workforce partnerships be developed that leverage ever diminishing resources more eff ectively,” she added.

Th e looming shortages in the future are bringing a new sense of urgency for all stakeholders to develop innovative solutions that will improve access to education and training for these professions. Funding for education should be a top priority. Other solutions for closing the gap require California’s policymakers and educational leaders to:

• Ensure health science curriculum is more closely aligned with the needs of health care employers;

• Standardize prerequisite courses across all educational institutions so students transferring between colleges are not required to retake courses, and;

• Address barriers to clinical training such as streamlining the application process for becoming an approved clinical laboratory training site and replacing paper applications forms with online documents.

CHA formed the statewide Healthcare Workforce Coalition in 2007 for the purpose of developing strategic solutions to the shortage of non-nursing allied health professionals. Th e coalition includes a broad cross-section of stake holders including the University of California, California State University, California Community

Colleges Chancellor’s Offi ce, California Labor and Workforce Development Agency, California Health Workforce Alliance, UC San Francisco Center for the Health Professions, California Institute for Nursing and Health Care, Offi ce of Statewide Health Planning and Development, and the California Primary Care Association. ■



Total employees eligible for retirement by occupation and eligibility period (age 62)*

OCCUPATION

NUMBER ELIGIBLE FOR RETIREMENT

2010 2013 2015 Total

Clinical lab scientist 217 189 438 844

Respiratory therapist 92 99 280 471

Pharmacist 76 80 260 416

Radiological technologist 41 51 205 297

Pharmacy technician 21 27 140 188

Physical therapist 19 15 139 173

Total expected retirements 466 461 1,462 2,389

*2010 CHA Allied Health Workforce Survey; 125 California hospitals responding


Th e costs to provide health care are rising at the same time advances in medicine, an aging population and rising burden of chronic disease are increasing demand for care, according to the American Hospital Association (AHA) and their new Trend-Watch Report titled, “Th e Cost of Caring: Drivers of Spending on Hospital Care. Ac-cording to the report, issues and trends af-fecting rising health care costs also include investments in new clinical technology, adoption of electronic health records, the growing levels of uncompensated care for the uninsured and underinsured, and the health care’s workforce shortage.

While hospitals grapple with these com-plex and overlapping cost factors, they are working to make health care more aff ord-able and provide quality patient care.

Medical advances such as new proce-dures, devices, imaging technology and pharmaceuticals have enabled people to live longer. Th ese advances are responsible for 70 percent of the improvement in survival rates for heart attack patients and two-thirds of the reduction in mortality for those suf-fering from cancer, according to AHA. Less invasive surgery means patients can be dis-charged and recover faster, missing less time from work. Th ese advances lead to higher standards of care and increased utilization, which can drive up costs.

While technological advances are lead-ing to better patient outcomes, demograph-ic changes are leading to increased use of all health care services, including hospital services. Th e number of people over age 65 will more than double by the year 2050. As people age they have more health problems, and consequently, require more health care services. Nearly half of all Medicare benefi -ciaries have three or more chronic condi-tions that are very expensive to treat. Th e

most common of these are hyper-tension, arthritis, heart conditions, cognitive or mental impairments, and diabetes.

Also driving up costs is the highly trained and highly skilled health care workforce. About 60 cents of every dollar spent by a hospital goes to pay for wages and benefi ts of health care workers who

directly care for patients before, during and aft er their hospital stay.

Finally, hospitals are absorbing the cost burden for caring for uninsured and underinsured. As the nation’s uninsured population continues to grow, hospitals are caring for more patients who are unable to pay for the care they receive. Hospitals are

therefore providing more fi nancial assis-tance and accruing more bad debt. At the same time, Medicaid (Medi-Cal in Califor-nia) enrollment is increasing, yet payments from this government program to providers fall well short of hospitals’ costs.

“Understanding these cost drivers is critical to developing strategies to contain costs,” said AHA President and CEO Rich Umbdenstock. “With need for hospital services on the rise, now is not the time to cut health funding for vital health care pro-grams. Hospitals have been, and will con-tinue to be, part of the national conversa-tion on changes that will reduce costs and improve care for all patients,” he added.

While health care costs continue to rise, hospital care is shrinking as a share of total health care spending, according to AHA’s TrendWatch Report. Hospital care costs ac-counted for 33 percent of total health care spending in 2009, compared to 43 percent in 1980, as health spending continued to rise. It remains the largest single category of health care spending, illustrating hos-pitals’ central role in caring for the most acutely ill and injured patients.

Despite the myriad of factors driving health care spending and costs for every-one, hospitals are seeking new approaches to reduce costs without compromising care. Some of these opportunities include forming partnerships among hospitals, physicians and other care providers to better coordinate care; implementing performance improvement and other “best practice” initiatives, and developing new and more coordinated delivery models to improve care for patients as they transition between care settings.

For additional information or to see the full AHA TrendWatch Report, please go to www.AHA.org. ■

The cost for caring: Drivers of spending on hospital care

Spending on hospital care has lagged growth in health insurance premiums and pharmaceuticalsCumulative percentage change in national spending for hospital services, health insurance premiums1 and pharmaceuticals, 2000-2009

2000 2001 2002 2003 2004 2005 2006 2007 2008 20090%

20%

40%

60%

80%

100%

120%Hospital care

Insurance premiums

Pharmaceuticals

Sources: Centers for Medicare & Medicaid Services, Office of the Actuary, National Health Statistics Group, (2011). National Health Expenditures Aggregate, Per Capita Amounts, Percent Distribution, and Average Annual Percent Growth, by Source of Funds: Selected Calendar Years 1960-2009, and The Kaiser Family Foundation and Health Research & Educational Trust, (2009). Employer Health Briefing 2009 Annual Survey, Washington, DC.1Average annual premiums for family coverage.

Advances in medicine contribute to longer livesU.S. life expectancy at birth, 1940-2007

1940 1950 1960 1970 1980 1990 2000 2007

Source: National Center for Health Statistics, (2010). Deaths: Final Data for 2007. Hyattsville, MD. Access at www.cdc.gov/NCHS/data/nvsr/nvsr58/nvsr58_19.pdf.

Age

in Y

ears

62.9

68.2

69.7

70.8

73.7

75.476.8

77.9



Imagine a fi ve-foot tall robot helping to diagnose a stroke victim in a small, rural California hospital. Or you suddenly become ill on a business trip hundreds of miles from home and the emergency room (ER) physician needs immediate access to your medical records. With a simple click of a mouse, your entire medical history now appears on an ER computer screen so physicians can check your last treatments and current prescriptions.

21st century technological innovations are happening all around us, and these advances are transforming how commu-nity hospitals deliver high-tech, high-quality patient care throughout Califor-nia. For example, technology is helping bring urban-based specialists to patients in rural communities through remote robots and mobile video conferencing. In addition, comprehensive electronic health record systems are enabling providers to make quicker and more informed medi-cal decisions to improve patient care.

“California hospitals are leading the nation in adopting new technology-based clinical and management tools to improve the safety, eff ectiveness and effi -ciency of patient care,” said Pamela Lane, Vice President, Health Informatics at the California Hospital Association. “As California’s population continues to grow, age and require more health care services, an eff ective health care delivery system is critical to ensuring that everyone gets the care they need when and where they need it,” said Lane.

Th e use of technology in a hospital setting is not new but a tangible change is occurring in how it can now reach more people, help lower costs, and reduce the time patients and doctors have to spend treating medical conditions.

“Th e types of innovations hospitals are deploying are improving patient outcomes. Th is translates to better value for the health care dollar and enables the delivery system to shift from treating disease to creating wellness,” said Lane.

Hospital leaders understand that large and small businesses in California are be-coming more discerning with the health care expenses for their employees and themselves and are choosing providers that are improving effi ciencies and value.

Among the most cost-eff ective and valuable technological advances hospitals are implementing are telemedicine and electronic health records (EHRs). Both enable hospitals to break down the physi-cal and geographic barriers of proving and managing care for more people.

With the current shortage of specialists, primary care doctors, lab technicians and those with the cultural competency to care for diff erent ethnic populations, hospitals are using these technologies to continue delivering the right care at the right time

and prevent costly medical conditions and treatments that drive up health care costs for California’s business community.

Hospitals with telemedicine capabili-ties are enabling physicians to provide real-time clinical care to patients without physically being with them. Eliminating transportation and other barriers leaves more time for physicians to attend to medical matters and increases the ability of patients to get examinations and con-sultations from specialists they may not otherwise be able to access.

For example, where phone calls used to be the only remote tool available for specialists to connect with patients in remote areas, more and more hospitals have video capabilities to diagnose medi-cal conditions. An example is life-sized robots with fl at screen monitors that help doctors in metropolitan areas treat patients hundreds of miles away. Mo-bile video conferencing at the hospital bedside or in doctors’ offi ces enable doctors and other members of the care team to interact with the patient and family members to assess symptoms, ask questions and discuss treatment options in real time.

Hospitals with telemonitoring services for blood pressure and blood sugar levels are helping to reduce the need for people to go to the doctor’s offi ce, thereby reduc-ing employee absences.

California’s community hospitals have also been at the forefront of implement-ing comprehensive EHRs with a patient’s

medical record, including important clin-ical data such as medications, vital signs, past medical history, immunizations, laboratory data and radiology reports.

EHRs are the next step in the con-tinued progress of health care that can strengthen the relationship between patients and their health care providers. For example, EHRs can reduce the risk of medical errors by improving the accu-racy and clarity of medical records. Th ey also give patients direct access to their records, making health information avail-able to help reduce delays in treatment and empowering them to make more informed decisions.

EHRs also allow all members of a pa-tient’s care team to securely and confi den-tially access patient fi les to reduce unnec-essary duplication of paper and lab work as well as improve collaboration among doctors and the entire medical team.

According to Lane, the long-term vision for EHR is that a complete record will be available to every patient and his or her medical team no matter where they are located. To that end, the U.S. Department of Health Services has cre-ated national guidelines for EHRs and initiated $1.2 billion in federal grants for hospitals and doctors to invest in these advanced record systems. Th is is the fi rst wave of funding under the health care reform plan to create vast records-sharing networks aimed at cutting costs and im-proving care in the coming decade.

California’s hospitals are also support-

ive of the launch of the California Tele-health Network, the $30 million statewide high-speed, broadband network dedi-cated to health care.

“Federal offi cials have been very im-pressed with the progress that California’s hospitals have made to adopt telehealth technologies to improve safety and qual-ity,” said Eric Brown, president and CEO of the California Telehealth Network. “Th e hospitals that have been able to take advantage of federal grants are adopting new technologies and breaking down the gaps in availability of care gap between urban and rural areas. Hospitals through-out the state have embraced the national health policy of improving access and wellness,” said Brown.

California also has received nearly $40 million to help create a statewide health information exchange that will make it possible for patients and providers to securely share medical information. Th e network will require entities like health plans, hospitals, pharmacies, labs and doctors to become certifi ed before they are authorized to exchange data. Once authorized, these entities can use the network like the yellow pages to route messages to the appropriate provider.

“Th e state is seeing hospitals take a more prominent role in the delivery of health care and make the necessary technological improvements to enhance the eff ectiveness of care for patients and increase the value for purchasers,” said Lane. ■

California hospitals using advanced technology to improve access and patient care

president, hospital council of northern and central california · 2019-12-19 · 185 hospitals and...

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