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Performance Improvements Underway for CDPH Licensing and Certification Program

For Chief Legal Counsel, Licensing and Certification Staff, Quality and Patient Safety Staff

At a recent CHA Certification and Licensing Committee meeting, representatives from the California Department of Public Health (CDPH) shared updates about their work to transform the program. The update responded to CHA’s concerns about CDPH’s continued steep increases in hospital licensing fees, which increased on July 1 up to 20% statewide and up to 35% in Los Angeles County, for a fifth consecutive year of fee increases.

During the state budget process, CHA conveyed concerns about the fee increases, which prompted legislators in the Senate and Assembly Budget Subcommittees on Health and Human Services to, in April, press CDPH about not only when the fee increases will level off, but also about the return on investment.

CHA’s June 26 Certification and Licensing Committee meeting featured a presentation from CDPH Deputy Director, Center for Health Care Quality (CHCQ), Heidi Steinecker, who responded directly to CHA’s concerns that these hospital fee increases have not yielded improvements in CDPH’s efficiency or performance. Steinecker identified numerous significant efforts underway at CDPH to transform CHCQ, summarized below. In short, CDPH heard the hospital message loud and clear, and CHA is optimistic about the direction CDPH is heading.

Summary of June 26 Presentation by CDPH on its Licensing and Certification Program

Former CDPH Director Dr. Karen Smith brought in new leadership to oversee CHCQ. Dr. Charity Dean was appointed assistant director in October 2018, reporting directly to Dr. Smith. Steinecker was appointed as deputy director for CHCQ, reporting to Dr. Dean, in December 2018.

Their efforts to transform CHCQ include:

  • Internal leadership for a performance improvement management program: CDPH is implementing a robust performance improvement management program that moves away from relying on outside consultants to developing the internal structure and executive sponsorship to support this change management.
  • Workstreams already underway: Currently, CDPH has three performance improvement management workstreams for which we are beginning to see results:
    • Mobile Technology: CDPH is equipping its surveyors with smartphones, tablets, wireless routers for their offices, and virtual private network access to allow them to do more work in the field.
    • Applications: CDPH has developed application packets for general acute care hospitals, and will do so for the remaining provider licensure types. The packets identify the forms hospitals must complete to apply for certain CDPH approvals.
    • Electronic Roadmap: Our sponsored bill from last year, AB 2798, requires CDPH to create an online system for submitting applications by Dec. 31, 2019. CDPH plans to meet that deadline, and has developed a broader vision to build out that functionality to all provider types and to become a portal for providers to engage with CDPH on licensure.
  • Future workstreams planned: In addition, CDPH shared that it is planning additional workstreams to address:
    • Standardization: It will centralize program flexes (which allow CDPH to waive licensing regulations on a case-by-case basis) at CDPH headquarters in its Central Applications Branch, rather than district offices.
    • Complaint/Requests for Information Backlog: The department aims to work through its backlog of complaints and be “debt free” by 2021.
    • Training: CDPH seeks to re-engineer its surveyor training, with a training and onboarding program across the CHCQ and a high-tech/high-touch approach for surveyors.
  • Organizational changes at headquarters and district offices: Steinecker shared that the department is seeking to implement a new organizational chart for the CHCQ in January 2020. In addition, it is looking at district office boundaries to see whether they make geographic sense given how far surveyors have to travel in many cases.  
  • Los Angeles County contract oversight: CDPH executed a new three-year contract with Los Angeles County, effective July 1. The new contract includes performance metrics that will be phased in over three years and enables CDPH to withhold funding and assess penalties if Los Angeles County does not meet these metrics.

CHA will continue to work with CDPH on seeing through these commitments, but it is all very promising.