We are proud to share with you the accomplishments we produced in 2016. This report highlights many of the successful advocacy and representation efforts that, together, we achieved on behalf of California hospitals and health systems. With the support of committed members and in collaboration with the California Hospital Association, we advocated with a common voice in local, statewide and national policy discussions. For every $1 of your dues paid in 2015, the hospital associations generated more than $220 in direct value. 

Regional Successes of the Hospital Association of Southern California

The Hospital Association of Southern California (HASC) relies on the willingness of members to collaborate with other hospital organizations and the association’s excellent staff to achieve success. Together, we respond to opportunities to improve health care delivery and address regulatory, financial and operational challenges. This report highlights HASC’s many successes achieved in conjunction with and on behalf of our members.

Advocacy and Representation

• Conducted more than 100 media interviews that resulted in HASC being quoted in more than 50 news stories on a variety of issues, including community benefit, homeless discharge, hospital billing, labor issues, impacts of the Affordable Care Act, underfunding of government programs, emergency department (ED) boarding/wall time, and quality and patient safety.
• Led local community outreach campaign for Proposition 52, the Medi-Cal Funding and Accountability Act. Targeted high propensity voters on the need to support the initiative and informed thousands on the positive impacts of the initiative to local hospitals and Medi-Cal beneficiaries.
• Proactively informed and engaged the public on current issues in local health care through social media outlets and the HASC blog.
• Secured more than 50 endorsements from leading business and community groups throughout the HASC region on policy issues impacting hospitals, such as local ordinances, state legislation and ballot initiatives.
• Raised $275,000 toward the 2016 CHPAC Campaign goal of $357,000.

Inland Area

Ambulance Patient Offload Delay (APOD)

Successfully advocated for local emergency medical services (EMS) agencies in Riverside and San Bernardino counties to stop a harmful policy that would have required hospitals to assume care for all patients, regardless of acuity, within 20 minutes of arrival, or risk the ambulance crew leaving.

Behavioral Health

• Continued convening collaborative meetings between hospitals and the Department of Behavioral Health (DBH) in both Riverside and San Bernardino counties, with the goal of reducing the number of involuntary holds written and reducing ED length of stay for patients with behavioral health conditions.
• Successfully advocated for a pilot program to allow DBH staff to work with non-Lanterman-Petris-Short Act (LPS) designated hospitals in both counties to assist EDs in the care of patients with behavioral health diagnoses. The program will allow patients to receive care in community settings, preventing unnecessary, involuntary psychiatric admissions.
• Led discussions with DBH in both Riverside and San Bernardino counties on the development of an Innovations Grant project aimed at establishing innovative ways to address the mental health needs of unserved and underserved populations.

Community Benefit

Completed the first triennial regional Community Health Needs Assessment involving 11 not-for-profit and district member hospitals in Riverside and San Bernardino counties.

Safe Opioid Prescribing

Led an interdisciplinary team to publish an Inland Empire-specific safe opioid prescribing tool kit with 100 percent member hospital participation. The initiative launched September 8, 2016, with support of the Inland Empire Health Plan and both counties, and included a supporting proclamation from the Riverside County Board of Supervisors.

CDPH District Offices

Convened the fourth annual HASC-CDPH Roundtable, providing updates and insights to hospital leaders on the most current information related to infection control, licensing application processes and program flexibility applications; the event experienced record attendance.

Inland Empire Health Information Exchange (IEHIE)

• Currently, 27 hospitals exchange admission discharge transfer (ADT) information through the IEHIE — including information about diagnoses and ICD-10 codes.
• By the end of the fourth quarter, it is expected that 27 hospitals will have begun exchanging lab, radiology and discharge reports through the IEHIE.
• By February 1, 2017, all hospitals will have begun exchanging medication data through the IEHIE.

Los Angeles Area

Emergency Health

• Pharmaceutical Take Back Program: Stopped an attempt by environmental groups to require hospitals to collect unused/expired medications and sharps. The requirement would have forced 98 hospitals in Los Angeles County to spend an estimated $853,000 on collection and disposal.
• Health Care Workforce Influenza Mandate: Advocated against any effort to weaken the Public Health – Health Officer Order that would have allowed health care workers who decline a vaccination to only wear a mask during active influenza activity.

Behavioral Health

• Successfully advocated for hospital flexibility related to LPS designation of staff. Reduced the experience in an acute mental health setting prerequisite for licensed mental health professional staff from three years to 18 months, expanding the pool of mental health professionals hospitals can effectively onboard to meet the staffing requirements under their LPS designation.
• Secured approval from the Los Angeles County Board of Supervisors to implement a two-year pilot program that extends conditional authorization to hospital staff at 10 select non-LPS hospitals to involuntarily detain psychiatric patients. Pilot is expected to reduce ED boarding and crowding, and improve patient care.

Homelessness

Successfully advocated to include bridge and temporary housing in the strategic plans developed by the County of Los Angeles and City of Los Angeles for homeless patients who are discharged from hospitals.

Workforce

Six-Paid Sick Day Leave Benefit (City of Los Angeles): HASC and CHA worked with the City of Los Angeles – Bureau of Contract Administration to insert language within the Minimum Wage – Rules and Regulations that creates an opportunity for hospitals to apply for an exemption under a defined “generous benefit” for per diems that meet specified criteria.

Orange County

Behavioral Health

• Successfully advocated for the county to adopt a new policy allowing ED physicians, licensed psychologists, psychiatrists and psychiatric nurse practitioners to discontinue 5150 holds in any hospital, skilled-nursing facility or private practice as long as the individual has been designated by the county. Policy was adopted in February 2016.
• Advocated for the county to add hospital-operated outpatient crisis stabilization units (CSUs) for 5150 patients. County issued its solicitation in July 2016, and two hospitals and one hospital-affiliated provider are in negotiations to open CSU facilities in 2017.
• Supported the SB 82 grant resulting in $3.1 million for construction/renovation and start-up cost for new CSUs.
• At the request of Orange County hospitals, Sen. John Moorlach (R-Costa Mesa) authored SB 1273 to allow Mental Health Services Act (MHSA) funds to support involuntary crisis stabilization services. The California Department of Health Services (DHCS) issued its affirmative opinion in July 2016. The county added $5 million to its current year MHSA plan to support CSUs.

Emergency Health

• Supported the county’s $23.5 million application for the Whole Person Care pilot aimed at reducing ED utilization by providing more appropriate care settings for severely mentally ill patients.
• Facilitated use of local tobacco settlement revenue to draw down additional federal funding in support of ED triage staff at UCI Medical Center, St. Jude Medical Center, St. Joseph Hospital, Hoag Memorial Presbyterian Hospital, Saddleback Memorial and Orange Coast Memorial. Mission Hospital is using its funds for affordable housing vouchers. The additional funding is approximately $1 million per year through 2021.

Ventura / Santa Barbara

Behavioral Health

• Regularly convened hospital representatives and leadership from Ventura County Behavioral Health Department to discuss challenges related to serving mental health patients, timeliness of treatment, process improvements for patient flow from EDs to LPS-designated treatment facilities and improved communication between county and hospital staff.
• Collaborated with county behavioral health staff to develop and refine the protocols and process for serving minors on involuntary holds and minors experiencing a mental health crisis through the Children’s Crisis Stabilization Unit. Educated each hospital and their staff on the new process to expedite treatment to minor patients in the appropriate setting.
• Developed a pilot project utilizing ReddiNet to track 5150 involuntary holds in Santa Barbara County EDs. The project will track length of stay, patients on 5150 hold awaiting transfer to a psychiatric facility and patients on holds without placement. In addition to data collection, it may also assist county EMS ambulance providers to better anticipate and accommodate 5150 patient inter-facility transfers.

Health Information Exchange

Gained consensus from hospitals in Ventura and Santa Barbara counties to use technology that allows hospitals to share patient images like MRIs, CT scans and X-rays, thereby avoiding the cost and potential harm of duplicative testing. The next step is to explore the possible sharing of patient data between local hospitals, health plans and clinics.

Recuperative Care

Secured approval to establish a recuperative care program for homeless patients discharged from local hospitals. While startup funds were provided by the local Medi-Cal managed care plan and a location for the program’s operations has been secured, the project is awaiting full funding from the County of Ventura. All general acute care hospitals are also providing financial support to fund the pilot.

Membership

• HASC’s 175 hospital members represent a 95 percent market share in the acute care sector.
• 38 freestanding members and 136 hospital members are in systems of two or more hospitals.
• 65 are investor-owned; 79 are not-for-profit; and 31 are state university, federal, county and district hospitals.

Education

• Hosted 48 education programs that drew 4,060 attendees, including:
• Patient Safety First/Patient Safety Collaborative – 1,540 attendees
• HASC Annual Meeting – 536 attendees
• LEAD Academy® – 440 attendees
• Hospital Disaster Management Training – 120 attendees
• Charge Nurse Development Programs – 110 attendees
• Health Care Provider Wellness Conference – 90 attendees

Quality and Patient Safety

Southern California Patient Safety First (PSF) Collaborative

• Since inception, over 6,000 lives have been saved and $114 million in costs were avoided.
• More than 370 individuals from 78 hospitals participated in three in-person collaborative events and 13 webinars.
• Hospitals demonstrated improvement in sepsis mortality and continued to tackle reduction of C-section rates and C. difficile infection:
  • Sepsis Mortality, goal: 13.9%, result: 13.9%, Goal met.
  • NTSV C-Section Rates, goal: 3.0%, result: 3.3%, Goal nearly met.
  • C. Difficile Events, goal: 7.7 per 10k pt. days, result: 8.5 per 10k pt. days, Goal nearly met.

Most Appropriate Care

Thirty hospitals participated in the nine-month initiative based on Choosing Wisely recommendations to address areas of potential overuse.

Person-Centered Care (PCC)

Secured funding from The SCAN Foundation to test models that improve continuum care for frail older adults. Community Memorial Hospital, Eisenhower Medical Center and Encino Hospital Medical Center/Sherman Oaks Hospital were selected to lead collaborative partnerships with post-acute providers and community-based organizations.

TeamSTEPPS Training

Five hospitals participated in the Inland Empire TeamSTEPPS Collaborative designed to help hospitals improve their patient safety culture to systematically and reliably prevent medical errors.

Safe Opioid Prescribing

HASC staff worked with the RVPs and hospitals to implement guidelines for safe ED prescribing of opioids.

The Hospital Quality Institute (HQI)

• CalHEN 2.0 hospitals prevented 1,618 incidents of harm and saved $9.2 million.
• HQI was awarded the Hospital Improvement and Innovation Network contract beginning October 2016 through 2019.
• The HQI Conference drew more than 400 attendees and provided executives and clinicians with innovative strategies to increase quality and reliability.
• CHPSO reached a milestone of over 1 million event/near miss reports, which are used for analysis and trending to help California hospitals avoid errors and adverse events.

Human Resource Services

• Allied for Health Compensation Report included data from more than 300 hospitals in California.
• Workforce – Launched the Specialty RN Shortage Project, an 18-24 month initiative designed to address the growing demand for experienced nurses in specialty areas.
• Human Resource Services hosted 26 educational programs that drew over 600 attendees.
• The Wellness Certification Program trained and certified 10 wellness professionals.
• The Union Penetration Report captured data from union and non-union hospitals in California. The report provides key labor union information for insight on labor union trends.
• The Allied for Health Compensation Report was expanded to include pre- and post-acute care positions. The survey includes data from more than 300 hospitals and over 300,000 employees in California.

Patient Access Services

Eligibility on Site (EOS)

Eligibility workers out-stationed at hospitals in Los Angeles and Orange counties took 10,822 Medi-Cal applications for uninsured patients. A total of 8,278 applications were approved, allowing hospitals to bill over $200 million to Medi-Cal. The average cost per EOS referral is $40.12.

California Children’s Services (CCS)

CCS eligibility workers out-stationed at two hospitals enrolled 411 CCS-eligible patients.

Conservatorship Access Network (CAN)

Twenty-two hospitals made 102 referrals that resulted in a 40 percent reduction in the days it took to secure probate conservatorship. Hospitals saved an estimated $681,000 by using CAN instead of a private probate conservator. The CAN referral volume increased by 20 percent from 2015.

Orange County Bridges Maternal Child Health Network

Screened 8,211 at-risk mothers and distributed 16,204 kits for new parents.

Secured funding to purchase computer tablets for staff to conduct bedside screenings at the 10 network hospitals.

Orange County Mental Health Hospital Triage Services

• Secured $3.4 million from the SB 82 grant to fund 17 employees at nine hospital EDs to provide mental health triage services. The program provides timely behavioral health assessments and crisis intervention with a referral to outpatient treatment when appropriate.
• Since its August launch, 427 patients utilized the program; 239 (56 percent) of these patients were discharged with referrals to outpatient services.

Insurance Services and Risk Prevention

• CyberEdge® Cyber Liability Insurance Program — The HASC-sponsored insurance policy is available to all hospitals and health care organizations in California, Colorado and Washington State. Ten hospitals have purchased coverage.
• Health Benefits and Wellness Program (HBWP) — HASC provides administrative support to HBWP, LLC, which HASC created for self-insured hospitals. HBWP is a group purchasing program designed to provide the insurance vehicle, provider network and care management/wellness tools that help hospitals significantly reduce the cost of employee health benefits. There are 33 Southern California HBWP hospitals representing over 20,000 hospital employees. One new hospital joined in 2016, and three hospitals will join in 2017, adding 3,700 employees.

ReddiNet

ReddiNet® now serves 14 counties in California with a total population of 24 million lives, or 63 percent of Californians.

Contra Costa and Solano counties have licensed ReddiNet’s Family Reunification Center (FRC), which facilitates the process of locating and reuniting injured and unaccompanied minors with those searching for them. ReddiNet is developing an interface with Facebook Find U, and Red Cross Safe and Well. These applications assist in tracking and reuniting patients and reported missing persons with family members.

Bed capacity has been added to the mobile app (Apple and Android) allowing users to view or update HAvBED and patient census on their mobile devices.

ReddiNet developed a new feature to track 5150 patients on holds in emergency departments in Santa Barbara County. This new feature could be used by other counties as well.

National Health Foundation (NHF) Affiliation

NHF conducted an environmental scan and community-driven health action plan for South Central Los Angeles that seeks to improve the experience of obesity, diabetes and cardiovascular disease through a focus on upstream social, economic and environmental factors. Funded by the Robert Wood Johnson Foundation, partners include California Hospital Medical Center and the Los Angeles Department of Public Health.

NHF launched a new component to its Pathway Recuperative Care program: Bridge Housing. NHF received a total of $450,000 from various grantors to support the Bridge Housing project, which provides temporary housing for Recuperative Care clients who need a place to stay until NHF staff can finalize a housing placement and/or the client’s identified housing is ready for move-in.

NHF was awarded a three-year (2016-19) grant from the Los Angeles County Department of Public Health’s Champions for Change – Healthy Communities initiative.