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For nearly five decades, California’s Medical Injury Compensation Reform Act (MICRA) has been a bulwark — protecting affordable access to quality care. Over the years, however, a growing concern — over the longstanding $250,000 cap on non-economic damages — began to arise from attorneys seeking greater compensation for injured patients.
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One of the hottest bills in the Legislature right now is a proposal that would codify the precedent set by a California Supreme Court decision (the Dynamex decision), effectively prohibiting independent contractor status and requiring individuals to be employed instead. The struggle over Assembly Bill 5 (Gonzalez, D-San Diego) has been framed publicly as largely a contest between technology companies, like Uber and Lyft, and labor unions.
But there’s more to it than that. AB 5 and the Dynamex decision would deny thousands of health care professionals — including nurse practitioners, social workers, certified nurse anesthetists, and others — the choice to decide how and when they work. If that happens, their ability to serve patients when and how they’re needed would be impaired.
Likewise, hospitals would lose critical flexibility to respond to patients’ needs, and to solve complex workforce issues. Outside hospitals and within our communities, access to specialty care could also be diminished, as occupational and physical therapy, home health services, and some mental health services are often provided by independent contractors.
Our message to legislators has been that eliminating employment choice for health care professionals threatens access to care. Recognizing the impact of fresh voices in Sacramento, CHA has drawn on a set of new advocacy strategies:
A full-court press “lobby day,” where nearly 60 health care professionals whose jobs would be affected met with 30 different lawmakers’ offices
A letter-writing campaign for professionals affected by the bill, asking their legislators to support an amendment
An opinion editorial in a Sacramento-based publication widely read at the State Capitol
Heading into Labor Day weekend, we are grateful for the entire hospital workforce in California — the 97% who are traditionally employed, and the 3% who choose to be independent contractors. We stand as their advocates for policies that allow them to continue to provide incredible care to their communities.
Stay tuned, as the battle over AB 5 is likely to last through the end of session in mid-September. We may yet call on you to join us in urging state lawmakers to protect the way health care is delivered in California.
— Carmela
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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
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In a little more than a month, the Centers for Medicare & Medicaid Services (CMS) will issue a final rule of significant importance for California’s hospitals: a decision that could alter the way Medicare adjusts hospital payments for geographic differences in labor costs (known as the Area Wage Index).
Their proposal? Take money from hospitals in California with high wages to give to hospitals in states with lower wages. CMS suggests this is an effort to address longstanding inequities in the wage index and to help rural hospitals.