1	Do You Want More Money or More Regulations? Issues Facing Hospitals and How You Can Make a Difference Brenda Suiter, MHA Vice President, Rural and Public Health Washington State Hospital Association brendas@wsha.org Stephen J. Grose, CHFM Administrative Director, Corporate Kaizen Promotion Office Virginia Mason Medical Center Stephen.Grose@vmmc.org
2	Outline Hospitals in Washington State Big trends facing hospitals Role of the Washington State legislature and political environment Regulatory issues affecting facilities Importance of your participation in advocacy Q & A
3	Washington Hospitals Basic Facts Provide excellent care every day and at any hour Hospitals don’t turn emergencies away – everyone gets treated regardless of ability to pay Hospitals are one of the largest employers in the state Hospitals are major contributors to Washington’s economy
4
5	Hospitals cluster in the Seattle, Spokane, and Tacoma areas
6
7	Washington hospitals are relatively small
8
9	As the population has grown, available beds have decreased
10	Occupancy Rates
11	Construction in Progress
12	Average Age of Plant
13
14	Inpatient Discharges and Outpatient Visits
15	Outpatient Percent of Total Revenue
16
17	Wide Range of Operating Margins
18	Bad Debt and Charity Care as a Percent of Patient Revenue
19	Who Regulates Hospitals
20	The Ten Big Trends Safety and Quality Health Care Workforce: Personnel Shortages Physician/Hospital Relations Diversity and Health Care Disparities Public Policy Issues: State Budget Pressures Hospital Costs Transparency Growth in Union Power Nonprofit Hospital Accountability Health Care Reform
21	(1) Safety and Quality Increasing concern from the public about hospital safety Increasing concern from hospital leadership about hospital safety Sicker, more vulnerable patients Growth in drug-resistant organisms
22	Perceived Likelihood of Getting an Infection is Very High
23	Programs to Prevent Mistakes Increase Confidence
24	Talking About Infection Prevention Is Very Positive
25	Safety and Quality: Strategies Safe Table programs Infections and Hospital Compare Quality Benchmarking System 5 Million Lives Campaign Board education and tool kits Communications templates Materials for patients
26	"Personnel Shortages" Personnel Shortages Hospital/Physician Relations Diversity and Health Disparities
27	(2) Personnel Shortage Nursing and other shortages are significant now Projected to get more severe: Health worker retirements Baby boomers needing care – and demanding good service Sicker patients
28	Personnel Shortage Growing: Gap in Nursing
29	Personnel Shortages: Strategies Health Work Force Institute – since 2004 Increasing educational opportunities Help existing hospital workers advance Creating new opportunities for youth and all ethnic groups WSHA work: Redesigning the delivery system to ensure existing workers can focus their attention on patient care
30	(3) Hospital/Physician Relations: Physician Shortages Difficult to recruit and retain physicians Shortage of primary care physicians Inadequate medical school slots in the Northwest Lifestyle pressures mean physicians do not want to take call
31	Hospital/Physician Relations – Strategies Continue to work with Washington State Medical Association WSHA support for physician issues Engage with UW Medical School on strategies to increase medical school slots and other issues
32	(4) Diversity and Health Care Disparities Diversity in Washington State growing Health outcomes worse Difficult for hospitals Language access Cultural differences/view of medicine Health workforce does not reflect population
33	Diversity and Health Disparities – Strategies Increase language access (hospital interpretation service?) Advocacy for insurance and access for everyone Hospitals forming partnerships with community groups from major ethnic groups they serve HWFI focus on recruiting more diverse workforce
34	Public Policy Issues State Budget Pressures Hospital Costs Transparency Growth in Union Power Nonprofit Hospital Accountability Health Reform
35	(5) State Budget Pressures Three sources of pressure: Increasing costs Decreasing revenues Desire for Democrats (who control state government) to not look like tax-and-spenders
36
37	State Budget Pressures - Strategies Advocacy program Direct lobbying Grassroots advocacy by hospitals Educating policy makers about what cuts mean to health access Building coalitions with other groups
38	(6) Hospital Costs
39	Hospital Costs – Strategies Oppose across-the-board cuts, but . . . Support areas where cost reduction makes sense Reduce unnecessary emergency room use Pay for performance Not billing for adverse events Reduce readmissions Reduce unneeded imaging Increase access to care so people get care when and where they need it
40	(7) Transparency WSHA has a transparency web site: Quality Pricing Information about billing and financial assistance Publicly available information at www.wsha.org
41	Many New Possibilities Financial/Pricing: Charity care policies Cost to charge ratios Community Benefits report New IRS information Allowing comparisons Quality/Safety: Hospital-specific adverse events Infection rates Nurse sensitive quality indicators Changing display format
42	Transparency – Strategies Engage members in discussions of next steps Continue to expand our transparency site
43	(8) Growth in Union Power Union strength in Washington is growing Political and political contribution power is growing in particular Focus for growth in health care sector
44	Growth in Union Power - Strategies Work together on areas of shared interest – we can do great things Coverage for all kids Training existing health care workers State budget and revenues Negotiate compromise if possible Fight if fighting is necessary – requires high engagement from our members! Increase our own political power
45	Compromise with Nursing Unions Ensure nursing legislation supports patient access to quality and safe care Defeated House Bill (HB) 1809 Agreement reached with nursing unions Enacted HB 3123 (staffing committees, posting) Memorandum of Agreement (quality indicators, committee education) Continue mediated Ruckelshaus Center process
46	(9) Nonprofit Hospital Accountability Under fire: Property tax exemption for nonprofit hospitals (worth $47 million) Continued access to tax exempt bonds for nonprofit capital projects Federal scrutiny IRS forms require community benefit reporting
47	Nonprofit Accountability - Strategies Educate policy makers Legal research Encourage transparency (pricing web site) Community Benefits Report Voluntary charity care pledge Monitoring its implementation
48	(10) Health Care Reform? National reform with Obama/McCain? State incremental reforms successful Should we pursue comprehensive state reform or expand current successful efforts? Multiple state proposals for reform made this session, none enacted Process created – potential for success unclear
49	Insurance Status in Washington State
50	Health Care Reform: The Process Legislature established a process to evaluate health care reform proposals Senate Bill 6333 establishes the Citizens’ Work Group on Health Care Thirteen members: nine public, four legislators Actuarial analysis in 2008 Public process in 2009
51	Health Care Reform: The Proposals Reduced benefits or rating requirements to groups with lower rates of coverage Plan similar to Massachusetts Plan with universal coverage and standard benefits Guaranteed preventive and catastrophic coverage Single payer system Other
52	Health Care Reform - Strategies Continue strong focus on effective strategies Cover All Kids Mental Health Parity Basic Health Successfully lobbied for a process with a better chance of success Lobbying for a hospital representative on the Citizens’ Work Group Unclear how much effort to put into this group Impact of the Presidential election?
53	Washington State Legislature
54	Washington State Legislature Convenes annually in Olympia Passes biennial budget - budget passed in odd numbered years (2009 a budget year) - health care is a significant part of budget Passes policy legislation - hospitals affected by a wide range of regulations
55	Washington State Legislature (2006 and 2008) 2006 2008 State Senate Democrats 26 32 Republicans 23 17 State House Democrats 55 63 Republicans 43 35
56	Democratic Leadership
57	Republican Leadership
58	Results of the 2008 Session Nurse staffing compromise reached! Several good health policy bills enacted No bad health policy bills enacted WSHA’s top four budget priorities funded!
59	Hospital Budget Priorities Provide adequate Medicaid funding for Healthy Options Maintain Medicaid funding for public hospitals Implement the Cover All Kids law Secure $3 million to train health care workers Provide $300,000 for education on POLST forms Provide $300,000 for telehealth Increase the state’s health professional loan repayment program by $3 million
60	Hospital Policy Priorities Ensure nursing legislation supports patient access to quality and safe care Maintain property tax exemption for nonprofits Ensure continued access to tax-exempt bonds Prohibit counties/cities from “dumping” patients Enact liability protection for the POLST form Report adverse events in an appropriate context Assure the state Department of Health continues to survey hospitals for fire/life safety
61	WSHA 2009-2011 Legislative Priorities (?) Policy Nurse staffing Property tax Inmate care POLST liability Imaging services Health care reform Budget No cuts Medicaid inflator CPE funding Mental health Trauma Kids health
62	WSSHE and WSHA Advocacy Fire Life Safety surveys Hospital construction standards Federal pharmacy requirements Department of Labor & Industries electrical review program additional staff request – 2 FTEs added Department of Health Construction Review Services Program additional staff request – 4 FTEs included in 2009 proposed budget
63	Fire and Life Safety (SB 6170) Legislation ensures that the state fire marshal will integrate hospital fire life safety surveys with the Department of Health licensing survey New construction standards will not be used on existing buildings Hospitals will be surveyed consistent with NFPA by state (and local agencies) WSSHE, WSHA and State Fire Marshal working together to assure smooth implementation
64	Hospital Construction Standards In March 2008, the Department of Health proposed rules that would make it more difficult for hospitals to build semi-private rooms WSHA and WSSHE educated the department on why the proposed rule would not work in the real world of hospital financing and construction The department adopted AIA guidelines effective in July with language that allows hospitals to build semi-private rooms Thank you for commenting on the proposed rules
65	"Thank You" Thank You!