Legislature(2003 - 2004)

04/30/2004 01:35 PM HES

Audio Topic
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
   HB 500(title am)-DEFINITION OF MEDICAL REVIEW ORGANIZATION                                                               
                                                                                                                                
CHAIR  DYSON  announced the  next  order  of  business to  be  HB
500(title am).                                                                                                                  
                                                                                                                                
SARA NIELSON,  staff to  Representative Ralph  Samuels, described                                                               
HB  500  as a  simple  bill.  She  paraphrased from  the  sponsor                                                               
statement as follows:                                                                                                           
                                                                                                                                
     House  Bill 500  simply  adds the  Joint Commission  on                                                                    
     Accreditation of  Health Care Organizations  (JCAHO) to                                                                    
     the narrow definition of a "review organization."                                                                          
                                                                                                                                
     The Joint  Commission on  Accreditation of  Health Care                                                                    
     Organizations    is     the    principle    independent                                                                    
     organization that  performs accreditation  of hospitals                                                                    
     throughout the  United States, including  Alaska. JCAHO                                                                    
     recently implemented a  new program requiring hospitals                                                                    
     to  undergo  a  Periodic Performance  Review  (PPR)  to                                                                    
     achieve  continuous  standards  compliance,  and  thus,                                                                    
     continuous  provision  of   safe,  high-quality  health                                                                    
     care.                                                                                                                      
                                                                                                                                
     The  current statute  defines  a "review  organization"                                                                    
     expressly and  narrowly and is  silent as to  the major                                                                    
     organization conducting  hospital accreditation  in our                                                                    
     state,  [which is]  JCAHO. Without  the change  in this                                                                    
     legislation,  a party  in  an  unrelated civil  action,                                                                    
     could argue vigorously that JCAHO  is well known within                                                                    
     the health care community  as the primary accreditation                                                                    
     instrument  for hospitals  in  the  United States,  and                                                                    
     that  it would  have been  a very  easy matter  for the                                                                    
     legislation to have included it  in the definition of a                                                                    
     "review organization."  It could  be asserted  that the                                                                    
     courts have no business  re-writing statutes to include                                                                    
     provisions that  it thinks  the legislature  would have                                                                    
     included  if it  had thought  of  it at  the time  that                                                                    
     provision  was  enacted. Thus,  there  is  a very  real                                                                    
     danger that  information provided  to JCOHO as  part of                                                                    
     this process would not be treated as confidential.                                                                         
                                                                                                                                
     This legislation  is necessary  so that  hospitals will                                                                    
     feel free to fully  report all the information required                                                                    
     by JCAHO in  an open manner and  promote quality health                                                                    
     care in Alaska.                                                                                                            
                                                                                                                                
CHAIR DYSON asked whether the administration supported the bill.                                                                
                                                                                                                                
MS.  NIELSON said  she didn't  believe they  had a  position, but                                                               
Janet Clarke could respond.                                                                                                     
                                                                                                                                
JANET   CLARKE,   Department   of  Health   &   Social   Services                                                               
representative,  said  they  support   quality  health  care  and                                                               
quality  assurance  for  health  care  facilities,  but  she  was                                                               
unaware  of any  public position  paper on  the legislation.  She                                                               
continued  to say,  "We run  a hospital  that is  covered by  the                                                               
Joint  Commission  Review.  We have  hospital  certification  and                                                               
licensing  and   anything  that  could  promote   that  we  would                                                               
support."                                                                                                                       
                                                                                                                                
CHAIR DYSON asked if the organization is credible.                                                                              
                                                                                                                                
MS. CLARKE replied they are extremely credible.                                                                                 
                                                                                                                                
CHAIR DYSON asked what the  legislation would allow that can't be                                                               
done now.                                                                                                                       
                                                                                                                                
MS. CLARKE  didn't know of  anything, but  right now it  could be                                                               
argued that  confidentiality is in  question because  JCAHO isn't                                                               
mentioned as a review organization.                                                                                             
                                                                                                                                
CHAIR DYSON asked Laurie Herman to comment.                                                                                     
                                                                                                                                
LAURIE  HERMAN,  Regional  Director  of  Government  Affairs  for                                                               
Providence    Health   System    in    Alaska,   testified    via                                                               
teleconference. To demonstrate why  they believe this legislation                                                               
is necessary she explained:                                                                                                     
                                                                                                                                
     Recently  JCAHO redesigned  their  survey process  from                                                                    
     being  a  once-every-three-year   survey  to  one  that                                                                    
     requires hospitals and  other health care organizations                                                                    
     to complete a mid-cycle  performance review the purpose                                                                    
     of  which is  to review  and make  certain that  we are                                                                    
     achieving  continuous   standards  of   compliance  and                                                                    
     continuous  provision  of  safe,  high  quality  health                                                                    
     care.                                                                                                                      
                                                                                                                                
     In  addition to  the requirement  of self-reporting  of                                                                    
     deficiencies, this performance  review process requires                                                                    
     that a  hospital or  health care  organization complete                                                                    
     an in-depth  survey of  their policies  and procedures.                                                                    
     If the hospital  is found to be out  of compliance with                                                                    
     accepted standards in any  area, an attended corrective                                                                    
     plan has  to be submitted  to JCAHO. And  JCAHO prefers                                                                    
     implementation  of  both  the   review  and  the  self-                                                                    
     reporting  deficiency to  be  in  an electronic  online                                                                    
     communication.                                                                                                             
                                                                                                                                
     To the  extent that anyone would  have deficiencies, as                                                                    
     part of  this process  they must  prepare and  post the                                                                    
     corrective action  plans. Because  of the  concern that                                                                    
     state statutes  do not specifically include  JCAHO as a                                                                    
     quality  review   organization,  which   would  thereby                                                                    
     protect   the   reporting   information   from   public                                                                    
     accessibility, they  may go to a  less preferred option                                                                    
     that would  allow such organizations to  simply certify                                                                    
     that  they  made  corrections   on  their  own  without                                                                    
     providing  any information  to JCAHO.  We believe  that                                                                    
     the  quality of  health  care would  improve if  health                                                                    
     care organizations  feel free  to fully report  all the                                                                    
     information required by JCAHO in an open manner.                                                                           
                                                                                                                                
CHAIR DYSON asked if she had any idea why JHACO wasn't included                                                                 
in the statutory language.                                                                                                      
                                                                                                                                
MS. HERMAN said there aren't any specific organizations that are                                                                
mentioned in current statute. The language is quite vague, which                                                                
makes  it arguable  that  since they  aren't  mentioned then  the                                                               
information  should  be  accessible  to the  public.  That  could                                                               
certainly deter reporting and/or lead to self-analysis.                                                                         
                                                                                                                                
There was no further testimony, questions or comments.                                                                          
                                                                                                                                
CHAIR DYSON asked for a motion.                                                                                                 
                                                                                                                                
SENATOR GREEN motioned to report  HB 500(title am) from committee                                                               
with  individual recommendations  and accompanying  fiscal notes.                                                               
There being no objection, it was so ordered.                                                                                    

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