Disputed legislation threatens hospital services

A hospital hallway and emergency room. (VILevi, via Shutterstock)

Hospitals throughout California frequently contract with county governments to provide a wide range of health care services that might otherwise be unavailable to vulnerable patients throughout the state. These services include care provided to Medi-Cal and uninsured patients, people with behavioral health needs, emergency and trauma care, medical care for homeless individuals and county jail inmates, and families who can’t afford vaccinations and other preventive care.

Despite the success of these contractual agreements, Assembly Bill 1250, by Assemblymember Reginald Jones-Sawyer (D-Los Angeles), threatens to dismantle the care hospitals provide to patients who are covered through county-funded programs.

These reporting requirements are not only useless, they pose significant privacy concerns for hospital workers and managers.

Only 15 out of California’s 58 counties operate their own public health care systems.  Several of these counties currently contract with private hospitals to expand their outreach and range of services.

These partnerships have made it possible to extend health care services to vulnerable patients far beyond what the counties could do alone, by tapping into the expertise and resources that hospitals provide. Most counties, for example, contract with hospitals to provide a myriad of inpatient and outpatient mental health services.  These arrangements augment the services provided by county employees and provide crucial care to patients experiencing a behavioral health episode.

AB 1250 would jeopardize access to care for millions of Californians by scrambling the current system, burying hospitals with new bureaucratic mandates, blizzards of paperwork and unnecessary red tape. Hospitals would be forced to divert limited financial and human resources from their mission of caring for patients and instead require them to provide detailed payroll and staffing documents, patient satisfaction reports, and redundant rounds of auditing to county officials.

These reporting requirements are not only useless, they pose significant privacy concerns for hospital workers and managers. It would require that names, personal information, and salary data of all private employees who provide contracting services be made public. In addition, given the existing oversight roles of the California Department of Public Health, California Department of Health Care Services, Cal-OSHA and numerous other state and federal agencies, these reporting requirements are repetitive, pointless and burdensome.

AB 1250 is a transparent effort to force counties to utilize only county employees to deliver all public services.  Such a restriction would undermine the ability of local county officials to decide on how best to provide essential public services to their constituents.  And, it would likely result in many hospitals deciding not to enter into contracts with county governments.  The result will be decreased access to vital health care services for millions of vulnerable patients across the state.

Most counties do not provide all of the health care services that may be required for certain patients.  For example, specialized services such as burn centers, organ transplants and highly sophisticated pediatric care are not available in some county facilities.  Therefore, it is essential that counties have the flexibility to contract for services that they do not provide or which can be provided more effectively in other facilities.  Additionally, a county may experience heavy demand and need to contract for services beyond its capacity.  This overload situation can occur without notice due to unforeseen circumstances.

AB 1250 would cost California’s counties the ability to contract with a wide range of community-based groups, nonprofit organizations, and local businesses.  The bill paints a bleak future marked by huge gaps in service, along with increased taxpayer costs.  That’s why a broad coalition of local government leaders, social service groups, hospitals and public health advocates have joined together to oppose AB 1250.

A recent legislative committee analysis stated that “there is no evidence of a systemic problem” in the current contracting process.  During a time of political uncertainty over health care reform, it makes no sense to pass a new law that would place California’s counties in a strait jacket, essentially eliminating their ability to contract with hospitals and other service providers.  California’s public and private hospitals urge lawmakers to reject AB 1250.

Ed’s Note: C. Duane Dauner represents the California Hospital Association.

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