Legislature(2003 - 2004)

03/25/2004 03:04 PM HES

Audio Topic
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
HB 500-MEDICAL REVIEW ORGANIZATION                                                                                            
                                                                                                                                
Number 0050                                                                                                                     
                                                                                                                                
CHAIR WILSON announced that the  first order of business would be                                                               
HOUSE  BILL  NO.   500,  "An  Act  relating   to  medical  review                                                               
organizations; and providing for an effective date."                                                                            
                                                                                                                                
Number 0102                                                                                                                     
                                                                                                                                
SARA  NIELSEN,  Staff  to Representative  Ralph  Samuels,  Alaska                                                               
State   Legislature,  testified   on  behalf   of  Representative                                                               
Samuels, sponsor of HB 500.   She told the members that this bill                                                               
adds  the  Joint  Commission  on  Accreditation  of  Health  Care                                                               
Organizations  (JCAHO)  to  the  narrow definition  of  a  review                                                               
organization.     She  explained   that  the  commission   is  an                                                               
independent  not-for-profit  organization that  evaluates  16,000                                                               
health care  organizations within the  United States.   The board                                                               
is  comprised of  physicians, nurses,  and consumers,  she added.                                                               
Ms. Nielsen  said that JCAHO  is the nation's oldest  and largest                                                               
standards setting and accrediting body  in the health care field,                                                               
having operated for  more than four decades.   She emphasized the                                                               
importance  of   including  JCAHO  in  the   review  organization                                                               
definition   because   health   care  facilities   that   provide                                                               
information  to  the  commission  will have  the  assurance  that                                                               
information will  be treated  as confidential.   Its  addition to                                                               
the  statute  will  ultimately promote  quality  health  care  in                                                               
Alaska, she summarized.                                                                                                         
                                                                                                                                
Number 0213                                                                                                                     
                                                                                                                                
SANDY   SEVERSON,   Administrative  Director,   Quality   Support                                                               
Services, Providence  Health System,  testified in support  of HB
500.  She told the members  that she believes this legislation is                                                               
necessary   because   JCAHO    is   the   principal   independent                                                               
organization that  performs accreditation of hospitals  and other                                                               
health   care  organizations   throughout   the  United   States.                                                               
Recently JCAHO  redesigned its survey  process from  a tri-annual                                                               
survey to a  policy of requiring hospitals and  other health care                                                               
organizations  to  complete   a  mid-cycle  periodic  performance                                                               
review.  The periodic performance  review is a self-assessment of                                                               
compliance with  all applicable  standards, she  said.   If there                                                               
are areas that  are found to be in  non-compliance, the hospitals                                                               
and  health  care facilities  are  charged  to develop  plans  of                                                               
action along  with measures  of success  to demonstrate  that the                                                               
identified problem  areas have been  resolved when JCAHO  does an                                                               
on-site visit every three years, Ms. Severson explained.                                                                        
                                                                                                                                
Number 0322                                                                                                                     
                                                                                                                                
MS. SEVERSON  told the members  that it  was the intent  of JCAHO                                                               
that  all information  developed  through this  process would  be                                                               
shared directly  with them.   The American  Hospital Association,                                                               
the American Society of Health  Care Risk Management, and several                                                               
state hospital associations  immediately identified this approach                                                               
as  a  significant  risk  management   concern  for  health  care                                                               
organizations,  she explained.    Ms. Severson  pointed out  that                                                               
depending on  each state's statutes regarding  confidentiality of                                                               
quality  information, and  what specifically  entailed a  quality                                                               
review organization,  the information shared directly  with JCAHO                                                               
could be  deemed discoverable  and used  against the  health care                                                               
facilities by any individual or  entity requesting those results,                                                               
she  said.     This  would   waive  health   care  organizations'                                                               
protection of  the quality  control data if  the statutes  do not                                                               
recognize JCAHO as a quality review organization.                                                                               
                                                                                                                                
Number 0441                                                                                                                     
                                                                                                                                
MS.  SEVERSON told  the  members that  JCAHO  met with  concerned                                                               
health  care organizations,  the  American Hospital  Association,                                                               
and  the American  Society  of Health  Care  Risk Management  and                                                               
offered  the health  care organizations  two additional  options.                                                               
The  first option  suggested doing  the self-assessment,  but not                                                               
submitting  it to  JCAHO.    The drawback  of  this  is that  the                                                               
organization  would loose  the ability  to  actively discuss  the                                                               
details  of the  action plan  with  JCAHO and  get feedback  from                                                               
them.   She explained  that JCAHO  takes data  from participating                                                               
hospitals and publishes  trends in patient safety  and quality of                                                               
care so health care organizations can  learn from each other.  In                                                               
order for this  to work effectively it is important  that all the                                                               
health care organizations submit its data to them, she said.                                                                    
                                                                                                                                
MS. SEVERSON said  that the second option is to  choose to not do                                                               
the periodic performance  review and instead do  an on-site JCAHO                                                               
survey.   The  cost  of  additional surveys  are  charged to  the                                                               
hospitals and will further inflate  health care costs.  She added                                                               
that surveys  also take staff time  away from patient care.   Ms.                                                               
Severson  told the  members that  Providence Health  Systems does                                                               
not believe  this option is the  solution.  She said  that it has                                                               
completed  the self-assessment  process and  has found  it to  be                                                               
very meaningful and  educational for staff.   Ms. Severson shared                                                               
that  Providence Health  Systems sought  legal counsel  to review                                                               
the  Alaska statute  as it  pertains to  public accessibility  to                                                               
information  reported  through  this   process.    She  said  its                                                               
attorneys reported  that under current  Alaska statutes  JCAHO is                                                               
not  considered a  quality  review  organization; therefore,  the                                                               
self-assessment  information  could  be vulnerable  to  discovery                                                               
once it  is submitted to  JCAHO.  She summarized  that Providence                                                               
Health  Systems  is committed  to  evaluating  and improving  the                                                               
quality of  health care  in Alaska.   It  is important  that this                                                               
legislation   be   enacted   to  protect   the   quality   review                                                               
information, Ms. Severson stated.                                                                                               
                                                                                                                                
Number 0566                                                                                                                     
                                                                                                                                
REPRESENTATIVE COGHILL commented that  he understands the benefit                                                               
of JCAHO.  He said  he believes current statute already addresses                                                               
this   issue  and   asked  for   clarification  that   additional                                                               
protections are needed.                                                                                                         
                                                                                                                                
Number 0615                                                                                                                     
                                                                                                                                
MS. NIELSEN  replied that it  is important to add  the commission                                                               
to  the statute  to  eliminate  any uncertainty  that  it is  not                                                               
included.                                                                                                                       
                                                                                                                                
REPRESENTATIVE COGHILL asked if there  are any other review teams                                                               
that should be included.                                                                                                        
                                                                                                                                
MS. NIELSEN responded that she is  not aware of any; however, she                                                               
told  the  members that  the  sponsor  would  not be  opposed  to                                                               
including others who would want to be included in this bill.                                                                    
                                                                                                                                
Number 0722                                                                                                                     
                                                                                                                                
REPRESENTATIVE SEATON moved  to report HB 500, Version  A, out of                                                               
committee  with individual  recommendations and  the accompanying                                                               
fiscal notes.  There being no  objection, HB 500 was reported out                                                               
of  the  House Health,  Education  and  Social Services  Standing                                                               
Committee.                                                                                                                      
                                                                                                                                

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