CEO Message

Every day, a small army of women and men rise to meet the needs of the tens of thousands of Californians — many of them children, seniors, veterans, or those experiencing mental health and substance use disorders — who live on the streets of our cities and towns.

Our hospital association — and I’d like to emphasize “our” here because it’s you, our members, who drive all we do — exists for one reason: to support your mission of care in California.

Last week, Gov. Newsom announced his 2020-21 state budget proposal, a $222 billion spending plan with three key priorities:

Homelessness
Health care affordability
Wildfires

The Homelessness Crisis

Next week, your CHA team will represent hospitals and health systems in Washington, D.C., as we meet with several members of the California congressional delegation to make sure lawmakers understand the most important policy issues facing California’s hospitals in 2020.

We start the new year following some good news from the end of 2019. Congress delayed cuts to Medicaid disproportionate share hospital (DSH) funding and postponed action on some concerning proposals to address surprise medical billing.

The delay in DSH funding cuts was, in part, a result of our advocacy to protect vulnerable patients served by our safety-net hospitals. DSH payments offset the cost of the uncompensated care hospitals provide to the uninsured and underinsured, and the cuts proposed would jeopardize access for millions of Californians. As those cuts are delayed only until May of this year, we’ll need to reinvigorate efforts to eliminate them once and for all.

While we managed to avoid passage of some problematic proposals to end surprise billing in 2019, the delay is temporary, as multiple efforts in different House and Senate committees — and strong public pressure — mean this issue will continue to be a priority. In 2020, it will be at the top of our list to ensure Congress understands that hospitals support eliminating surprise billing, but that fixed “benchmark” rates are not the answer.

We need a solution that protects patients, not one that compromises critical resources for their care.

In November, the Centers for Medicare & Medicaid Services published a proposed rule, the Medicaid Fiscal Accountability Regulation, that will have far-reaching significance for how the Medi-Cal program is funded by the federal and state governments. Because this program is so critical to nearly half of California’s children and millions of adults and the hospitals that care for them, CHA is working hard with our state and federal partners to oppose the proposed changes.

Also in 2020, as threats to the Affordable Care Act continue to arise, we’ll work — both in Congress and in the courts — to protect coverage and access. Hospitals’ steady voice and influence will be more important than ever as the law’s various components are questioned.

Major events and other significant national concerns have taken center stage in our nation’s capital at the moment, so we don’t expect any sudden moves on health policy. We do know that, given the presidential election is just 10 months away, lawmakers are looking toward May as a potential deadline to wrap up many key health care issues — including prescription drug pricing, surprise billing, and Medicaid DSH cuts.

Between now and then, we won’t let up in our advocacy to advance and protect your work in caring for patients.

— Carmela

Earlier this week, we asked California’s hospital leaders to raise their voices to urge congressional leaders not to set a benchmark rate as a way of addressing surprise billing.

The need to push back arose late last week after committees in both the Senate and the House of Representatives announced they had reached an agreement on legislation to tackle the high-profile issue of consumers receiving surprise medical bills. The package — which could be voted on as soon as next week — includes both a benchmark rate and an independent dispute resolution process for claims over a certain amount.

Fortunately, on Wednesday, the House Ways and Means Committee offered another bipartisan alternative. As Congress grapples with this important issue, it’s more important that they thoughtfully consider all of the complexities than rush to a hastily crafted legislative solution.

Thank you to all who have already reached out to your representatives, helping to continue the drumbeat we began last year to make clear to lawmakers that hospitals support eliminating surprise billing, but that fixed “benchmark” rates are not the right solution and threaten critical resources for patients.

Protecting patients is what hospitals do, so for you as leaders, it’s simple: People seeking necessary medical care should be protected from unexpected bills, and no patient should ever pay more for emergency care just because their insurance company chooses not to contract with a hospital. Giving patients the peace of mind to heal includes removing them from payment negotiations between insurers and providers, and creating safeguards from the gaps in insurance that result in surprise bills.

We need to keep reminding policymakers that, while benchmark rates offer financial protections for insurers, they offer none at all for consumers.

As leaders, you also know that caring for patients includes protecting their access to care. It is incumbent on all of us to make sure Congress understands that creating a benchmark payment rate threatens access – both by reducing available resources and by giving health plans less incentive to enlist facilities and physicians in their networks.

What lawmakers need to do – and they need our help – is to prevent patients who have received needed health care services from getting surprise bills for that care. Once that assurance is in place, payments made from the insurer to the provider become irrelevant to patients.

As we learn more about details of the different federal proposals, we will share them with you. This issue, of vital importance to patients and hospitals alike, requires our vigilance now and in the near future.

We cannot afford to miss a beat.

— Carmela

Amid the grand legislative battles that play out at the Capitol, along with other street fights like those over public ballot initiatives, it’s important to take a moment to call attention to the quiet, steady, and often unheralded work that goes on to help hospitals.

A fair amount of this work is related to regulatory bodies, like the California Department of Public Health, an agency hospitals have expressed frustration over due to what has felt like inconsistent interpretation and application of state rules.

That’s why we’re grateful for two occasions last month that we hope will herald a different working relationship between hospitals and the department. On Nov. 19 in Sacramento and on Nov. 21 in Pasadena, we facilitated two programs where hospital leaders had the opportunity to connect directly with regulators — to share concerns and collaborate on ideas that could improve effectiveness and efficiency.

This was the first time such meetings were held.

In all, nearly 400 hospital representatives attended, along with nearly 100 regulators from CDPH and its district offices.

A few key takeaways:

Heidi Steinecker, CDPH’s new deputy director, Center for Health Care Quality, deserves credit for bringing a fresh approach to the department in the hopes of creating statewide uniformity, reducing redundancy, and working more efficiently with hospitals. She wants input from hospitals and welcomes texts or calls on her cell phone at (916) 502-3773. 
In at least one district, CDPH seems willing to schedule visits to hospitals for facility-reported incidents — to minimize disruption to patient care resulting from unannounced visits.
Breakout sessions revealed many inconsistencies and concerns related to CDPH’s survey process; we will be working closely with the department to develop a more streamlined approach.

These inaugural two meetings were just the beginning. We intend to hold more, with agencies such as the Office of Statewide Health Planning and Development and the State Board of Pharmacy, so processes and interactions can be improved across multiple regulatory bodies.

Here’s why: We know this work will never dominate headlines like seismic safety compliance, or independent contractor laws, but it’s invaluable because it helps you focus more of your staff’s limited time in the right place — on the patients and communities entrusted to you.

— Carmela, Bryan, George, Dimitrios

This Thanksgiving, many of you might participate in a well-known tradition in which friends and family members, full of turkey and stuffing, go around the table and say aloud what they are thankful for.

Answers vary, but visit any table this Thursday and you wouldn’t be surprised at what you hear: my health, my family, food on the table each day, a warm place to sleep at night, love.

I too am deeply thankful that I have these things in my life.

It’s telling that the same themes come up at every table…perhaps because they are the building blocks of a good and happy life.

Sadly, millions of Californians don’t have this foundation.

Nearly 130,000 Californians do not know if they will sleep on the street or in a shelter tonight. Nearly 6 million Californians, including 2 million children, live in low-income households affected by food insecurity, not knowing where their next meal will come from.

You know well that these two factors alone make other life successes challenging, if not impossible. Health, family, love – are these possible without food and shelter?

Maybe, but it’s hard.

That’s why each year, when asked about what I’m thankful for, I also think of all of you – of hospitals.

For the Californians who will not be sitting at a table Thursday; for those who will sleep outdoors as temperatures dip into the low 40s; for those who struggle to answer what they are thankful for, I’m grateful they have you.

Every day, California’s hospitals demonstrate what it means to show empathy, kindness, and compassion to those in need: a social worker making a few extra calls to find an open bed for a patient experiencing homelessness; a street nurse program; an extra sandwich for someone who hasn’t eaten in a few days.

So, this year, when we go around the table at my house, and here in this message, I say thanks to you, the women and men who serve others at California’s hospitals – because often, you’re the only ones that those in need have.

From your California Hospital Association family, please know that you have our deepest gratitude for everything you do to give others something to be thankful for.

— Carmela

A proposal released last week by the Centers for Medicare & Medicaid Services (CMS) holds the potential to impact Medicaid programs in every state — one of the main reasons it’s likely to cause Medicaid agencies across the country to share their concerns with CMS.

The Medicaid Fiscal Accountability Rule could alter how Medicaid supplemental payments and related financing arrangements operate. If adjustments to current rules are made, hospital resources for patient care throughout the nation would be challenged.

While any changes to the Medicaid supplemental payments could affect California’s hospitals, it’s important to note that at this time, the proposal is quite far from becoming policy. There are multiple measures that your association, working alongside our colleagues in 49 other states and the District of Columbia, as well as the American Hospital Association (AHA), will take to protect critical Medi-Cal funds for your patients and communities.

First, we’ll be analyzing the rule and its potential impact on California.

Second, we’ll develop messages to deliver to CMS during the current 60-day comment period. Stay tuned for a request for help with this effort — we may need to ask hospital leaders to raise your voice as well, so federal regulators understand how these changes might impact the patients and communities you serve.

Finally, we’ll coordinate with other state hospital associations and the AHA on a national advocacy strategy. This rule will present challenges for dozens of governors, regardless of political party. That likely means a long and public debate about the very real dangers of the rule, where hospitals will have another chance to make clear that the proposal will do nothing to make Medicaid more fiscally accountable and will harm the low-income patients we serve.

The bottom line: this proposal could be bad news. But it’s got a long way to go, and its potential impact is so far-sweeping that there will be massive opposition to modify or defeat it altogether.

For now, we need to better understand the impact, relay our concerns to CMS, and work with our national colleagues on a sound strategy to ensure the resources you need to care for patients aren’t altered — especially as costs continue to rise.

— Carmela

“Thrive” — an excellent reminder that we and all those around us deserve the chance to flourish and prosper. It speaks to the values Bernard Tyson lived, not just as a health care professional, but as someone who cared about leaving the world a better place.

And he did.

Which is why so many of us were shocked and saddened by the news of his death last weekend. As chairman and CEO of Kaiser Permanente, he played on the largest health care stages in the country — a leader known for his vision and his compassion, and a tremendous capacity for making a difference.

Tyson worked at Kaiser Permanente for more than 30 years, and under his leadership the organization grew to 12.3 million members and 218,000 employees, but his legacy endures in so many other ways.

There are the 41 affordable apartments in Oakland that Kaiser Permanente purchased to help shelter people experiencing homelessness — a passion of Tyson’s, who tirelessly advocated for providers to address challenges like health equity and the social factors that affect people’s health.

There’s his dedication to destigmatizing behavioral health, putting it on equal footing with physical health, and shifting his organization toward integrating mental health with primary care.

And there’s his undeniable impact on health care delivery — illustrated in the way he guided his own organization, with a focus on high-quality care, delivered as affordably as possible, so it can be accessible to as many people as possible.

Tyson was a pioneer in recognizing that health care, in the truest sense of the words, is more than treating a physical ailment. With that understanding, he took on issues like racial justice, food insecurity, and workforce diversity.

We are fortunate to have learned from and been inspired by the example he set.

Personally, and in my role representing California’s hospitals, we extend our most sincere sympathies to Bernard’s wife and children, and to everyone in the Kaiser Permanente family, for the loss of a beloved partner, father, and leader.

Perhaps there is no more fitting tribute than Tyson’s own explanation of the motto he championed:

“Thrive is all about answering the question of who we are…we’re an organization that understands that every day people wake up to live the dream of America…and Thrive says, ‘That’s what you should be doing, and we want to help you achieve that with good health’.”

— Carmela