Californians thwart problematic legislation … again

Healthcare Financial Management, April, 1994 by Bill Siwicki

In the February 1994 issue of HEALTHCARE FINANCIAL MANAGEMENT, this column focused on the efforts of HFMA Southern California Chapter members to rectify problems with California Senate Bill 664 (SB664). This bill progressed through the California legislature virtually unnoticed by healthcare professionals and was passed into law. Had it been left unchallenged, it would have required lengthy documentation of outside clinical laboratory services be included with initial bills sent to patients and third parties--a requirement that, for a variety of reasons (such as insufficient space on government required forms), was often impossible to obey. However, California HFMA members and other healthcare professionals were able to assist in passing another bill that amended SB664 to everyone's satisfaction.

The moral of the story, as stated by an individual involved with the SB664 debate: "Legislators and professional associations that sponsor healthcare-related legislation should seek a healthcare financial management perspective during the bill reading process."

And they all lived happily ever after. Not.

California State Assembly Bill 1301 (AB1301) was introduced March 3, 1993, by Assemblyman Dominic Cortese. The bill, based on a request by a surgeon in Assemblyman Cortese's district, would require hospitals to send copies of patient bills to all attending healthcare practitioners. Critics of AB1301 contended that compliance would require production of expensive, hard-copy bills; necessitate dispatch of myriad copies of bills, jeopardizing patient confidentiality; and require healthcare financial managers to assume responsibility for interpreting the definition of the term "healthcare practitioner," as used nebulously in the bill. All of this, critics furthered, to create a paper quagmire of dramatic proportions at a time of industry-wide transition to electronic billing.

AB1301 was passed by the assembly June 1, 1993, and was on its way to the senate when Brad King--associate administrator of managed care and chief information officer at Saint Joseph Medical Center in Burbank, California, HFMA Region 11 chapter liaison representative, and HFMA Southern California Chapter Legislative Affairs Task Force cochairman--discovered the bill's downside and felt AB1301 should not be passed into law without being amended.

"Other California HFMA members and I identified AB1301 as an issue that could affect our hospitals substantially," comments King. "We decided to invest the necessary time to challenge it."

King started by calling Assemblyman Pat Nolan, who represents King's district, and asked how best to oppose AB1301 before it became law. Assemblyman Nolan informed King that he should contact the bill's author and have it amended prior to final consideration in the senate. Acting on Nolan's advice, King contacted Cortese and began examining the origins and goals of AB1301. Then, King researched how AB1301 could be improved to provide the best bill for hospitals with the least resistance from its supporters.

King's research identified the common ground between AB1301's author and the state's hospitals--rising costs. In an effort to change AB1301 without adding additional regulations, King--with assistance from colleagues at the medical center--provided amended language for Cortese. The amended AB1301 requires that hard copies of patient bills be provided to healthcare practitioners only when specific written requests for such copies are made of healthcare providers. Additionally, hospitals are allowed to charge healthcare practitioners for copies of patient bills.

King, along with officials from the Hospital Council of Southern California, followed up on behalf of the amended AB1301 by making calls and sending letters to elected state officials. The amended AB1301 was passed into law October 10, 1993.

David L. Cohan, MBA, MHA--senior consultant at Blumberg Ribner, Inc., in Beverly Hills, California, and a member of HFMA's Northern California Chapter--is a colleague of King's and became involved in King's quest in an observer capacity, recording the events for HFMA's California chapters.

"I look at the whole AB1301 experience as a positive thing, a wake-up call for healthcare financial managers," remarks Cohan. "Healthcare administrators need to take a more active role in deciding the direction that healthcare policy takes. We cannot allow decisions about the politics of health care to be made solely by the politicians. As professionals, we have to become more actively involved in the legislative process. I applaud those in the forefront, like King.

"We should not bury our heads in the sand and let healthcare reform hit us. Lobbying on behalf of our hospitals and clients is not a bad thing. We are major players in the healthcare debate. We should feel comfortable speaking up for ourselves.

"As healthcare financial managers, we are the experts," concludes Cohan. "All this debate about whether or not the United States can afford healthcare reform is being bandied about by politicians and economists and people who are not in the trenches. Their opinions are valuable, but we have an important role to play in the debate, as well. It is important for us to set some time aside--like we do for budgeting and committee meetings--for civics, staying current in current events. Being knowledgeable about local, state, and Federal issues is essential if we really do want to have a say in the direction that healthcare changes take."