Legislature(2007 - 2008)SENATE FINANCE 532
04/03/2007 09:00 AM Senate FINANCE
| Audio | Topic |
|---|---|
| Start | |
| SB62 | |
| SB4 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| + | SB 62 | TELECONFERENCED | |
| + | TELECONFERENCED | ||
| = | SB 4 | ||
MINUTES
SENATE FINANCE COMMITTEE
April 3, 2007
9:02 a.m.
CALL TO ORDER
Co-Chair Bert Stedman convened the meeting at approximately
9:02:51 AM.
PRESENT
Senator Lyman Hoffman, Co-Chair
Senator Bert Stedman, Co-Chair
Senator Charlie Huggins, Vice Chair
Senator Joe Thomas
Senator Fred Dyson
Senator Donny Olson
Senator Kim Elton
Also Attending: DOUL LETCH, Staff to Senator Gary Stevens; JAY
BUTLER, MD, Director, Division of Public Health, Department of
Health and Social Services; GINNY AUSTERMAN, Staff to Senator
Olson; JANET CLARKE, Assistant Commissioner, Finance and
Management Services, Department of Health and Social Services;
ELLIE FITZJARRALD, Director, Division of Public Assistance,
Department of Health and Social Services
Attending via Teleconference: From Anchorage: PAT LUBY, Advocacy
Director, AARP; From an offnet location: SANDRA STARK, Member,
Task Force to Assess Public Reporting of Health Care Associated
Infections
SUMMARY INFORMATION
SB 62-TASK FORCE ON HEALTH CARE INFECTIONS
The Committee heard from the sponsor, the Department of Health
and Social Services, and took public testimony. The bill was
held in Committee.
SB 4-SENIOR CARE PROGRAM
The Committee heard from the sponsor and the Department of
Health and Social Services. The bill reported from Committee.
9:03:40 AM
SENATE BILL NO. 62
"An Act establishing the Advisory Committee on Public
Reporting of Health Care Associated Infections; relating to
reporting and dissemination of data concerning health care
associated infections; and providing for an effective
date."
This was the first hearing for this bill in the Senate Finance
Committee.
Co-Chair Stedman communicated that the intent today would be to
hear an explanation of the bill and then hold it in Committee
for further consideration.
9:04:12 AM
DOUG LETCH, Staff to Senator Gary Stevens, the bill's sponsor,
read the sponsor statement as follows.
SB 62 is legislation recommended by the Task Force to
Assess Public Reporting of Health Care Associated
Infections, which met during the 2006 Legislative Interim
to study the unique challenges facing Alaska with regard to
tracking and reporting health care acquired infections.
This bill creates the Advisory Committee on Public
Reporting of Health Care Associated Infections under the
Department of Health and Social Services.
Mr. Letch communicated that the Task Force consisted of Senator
Gary Stevens, Senator Bettye Davis, Representative Carl Gatto,
Representative Peggy Wilson, six health care representatives
including Dr. Jay Butler, Director, Division of Public Health in
the Department of Health and Social Services who, at the time,
was the State Epidemiologist, and two consumer representatives.
Mr. Letch reviewed the make-up of the 11-member Advisory
Committee that would be established by this legislation. In
addition to one member being the State official in charge of
epidemiology, one member would be a Senator appointed by the
Senate President, and another would be a Representative
appointed by the Speaker of the House of Representatives. The
remaining members would be appointed by the Governor. They would
include two physicians with significant experience in the area
of infectious diseases and one representative of each of the
following: the Alaska Native Tribal Health Consortium; the
Alaska Chapter of the Association of Professionals in Infection
Control and Epidemiology; the Alaska State Hospital and Nursing
Home Association; a health care consumer in urban Alaska; a
health care consumer in rural Alaska, and a statistician.
Mr. Letch again read from the sponsor's statement.
In the coming years, the Advisory Committee's role will be
to develop recommendations for collecting, analyzing and
distributing information related to health care associated
infections. By January, 2009, the Advisory Committee will
provide recommendations to the Department for establishing
a pilot program for public reporting of health care
associated infections. By January, 2011, the Advisory
Committee will provide to the Legislature a report
addressing the unique challenges in the state, as well as
recommendations for ongoing reporting.
Some 2 million infections a year are acquired in hospitals
and an estimated 90,000 people die as a result of these
infections, making it the sixth-leading cause of death in
the country. The cost to the consumers is between $4.5 and
$11 billion a year. Given these alarming statistics, it is
vital for consumers to have full knowledge
Mr. Letch stated that, in addition to his Task Force experience,
another situation prompted Senator Stevens to further this bill.
That being that a close friend of his had nearly died after
acquiring a staff infection in a hospital where he had been
admitted to for treatment.
Mr. Letch announced that the goal of this legislation was
twofold: to promote public awareness of the issue and to
encourage those in the health care industry "to take steps to
reduce the risk of infections". It was not intended to target
any particular hospital or to assign blame.
Mr. Letch noted that Dr. Butler with the Department of Health
and Social Services (DHSS) was available to answer technical
questions. Dr. Butler's assistance in developing the language in
the bill was appreciated.
Mr. Letch considered the direction of the bill to be "a good
approach to the issue; its does not force anything down anyone's
throats" and it provides the industry a chance to assist in
addressing "a serious problem".
9:09:04 AM
Senator Olson asked for clarification as to whether 90,000
people die each year as a result of hospital acquired infections
or as a result of infections in general.
Mr. Letch stated that research indicates that 90,000 people die
each year from infections acquired in a health care facility
including hospitals and clinics.
Co-Chair Stedman asked whether the number of Alaskans who have
died from a health care facility acquired infection was known.
Mr. Letch deferred to Dr. Butler who was more familiar with the
issue, not only in Alaska but in other states as well.
9:10:04 AM
Senator Elton deduced that the underlying intent of the bill was
to alert consumers to the issue. This would allow them to make
choices when considering health care facilities. However, most
communities in the State do not have many alternatives.
Senator Elton also concluded that even though many Alaskans
travel out of state for medical procedures, the State could not
require those hospitals, such as Virginia Mason in Seattle
Washington, to reveal what their "incidence of infections are".
9:11:05 AM
Mr. Letch acknowledged that one of the issues discussed by the
Task Force was that many communities "have only one choice of
health care" facilities. The determination was to task the
Advisory Committee with developing "workable recommendations" to
address this and other public reporting issues including
confidentiality.
Senator Elton asked the definition of a health care facility;
specifically whether community health clinics and surgical
outpatient facilities would be required to report.
9:13:15 AM
Mr. Letch stated that the definition of a health care facility
is addressed in Sec. 3 subsection (3) of Sec. 44.29.599.
Definitions. on page 4 line 16 of the bill. That language
identifies a health care facility as having "the meaning given
in AS 18.15.372". Thus a health care facility would include out-
patient clinics and small clinics. Further clarification of the
facilities affected by this legislation would be conducted.
9:14:22 AM
Senator Olson asked whether the reporting requirements that
might be enacted could negatively affect certifications held by
health care facilities such as the Joint Commission on
Accreditation of Healthcare Organizations (JCAHO) certificate.
9:14:42 AM
JAY BUTLER, MD, Director, Division of Public Health, Department
of Health and Social Services, stated that the reporting should
not affect facility certifications. That is not the intent of
the legislation. One of the issues addressed by the Task Force
was "how to achieve the goal of doing good infection control
practices and encouraging that within hospitals without being
repetitive in terms of the administrative burden it places upon
the hospitals … The goals of any kind of public reporting system
would be to be coordinated with" those required by JCAHO, for
example.
Senator Olson agreed to the importance of reviewing hospital
acquired infections; particularly in consideration of the
existence of drug-resistance and aggressive bacteria. He also
asked whether such things as the avian influenza, commonly
referred to as the bird flu, would be addressed.
9:15:32 AM
Dr. Butler responded that the legislation could "potentially"
address two issues. "One is the overall high rate of hospital or
health care associated infections". Recent national Centers for
Disease Control and Prevention (CDC) data supports that
approximately 1.7 million of these types of infections occur in
the nation each year. 98,000 of these infections result in a
death.
Dr. Butler noted that even though Alaska does not track this
sort of data, national statistics were extrapolated to indicate
that 150 to 200 infection related deaths occur annually in
Alaska. While not all of these deaths could be prevented by
addressing hospital acquired infections, "it does suggest that
we can do better to protect patients in the health care
environment".
Dr. Butler identified another concern this legislation would
address. That being that "health care settings have become the
breeding ground for some of our more difficult to treat
bacterial infections".
9:18:07 AM
Dr. Butler contended that drug resistance infections and health
care associated infections could be preventable though basic
infection control techniques, appropriate use of antibiotics
before and after surgery procedures and through simple
administrative measures such as facilities making sure that
their workers are vaccinated against influenza each year.
9:18:34 AM
Senator Thomas agreed that the State's statistics would mirror
the nationwide experience. He also shared his surprise at
learning that health care associated infections ranked so high
as a cause of death in the nation. Continuing, he asked about
current reporting requirements as he would have thought that
standards to address this issue would have been in place by now.
Dr. Butler deemed this a complex question. "The market-based
approach or the best practices approach" has not "fully
addressed the challenge of health care associated infections".
This is partly because infections are difficult to diagnose and
it is often difficult to identify where an infection was
acquired. To that point, however, he advised that current
epidemiology testing capabilities have improved in this regard.
Dr. Butler cited another factor as being the amount of funding
"a hospital is willing to invest in infection control not only
in implementing infection control measures but in conducting
surveillance to be able to detect the problems that occur".
Dr. Butler communicated that the changing health care
environment presents another challenge. For instance, an
increasing number of people are being treated outside of a
hospital.
Dr. Butler concluded that due to these and other factors, it has
been difficult "for the infection control community to get a
handle on" the issue.
9:21:05 AM
Senator Thomas asked whether, in addition to the efforts of the
Advisory Committee, the State would make recommendations on this
issue since it reimburses and makes payments to medical
facilities for services relating to the Medicaid and Medicare
programs.
Dr. Butler clarified that the State would "not be directly
involved in" this regard as the federal Center for Medicaid and
Medicare Services has regulations in place regarding infection
control practices in health care facilities receiving Medicaid
and reimbursements and payments. The State's involvement would
relate to processing the data provided by hospitals and
producing that information "in a form that's interpretable to
the public".
Dr. Butler advised that even though there is no scientific
evidence that the reporting of health care associated infections
would reduce the rate of hospital acquired infections, the
consumer group driving this nationwide reporting effort believes
that consumers have the right to know what the risk of infection
is when they go into a health care environment.
9:22:36 AM
Dr. Butler informed the Committee that 14 states have passed 14
"very different" forms of public disclosure legislation in terms
of the information that must be disclosed. Of those, two states
require confidential reporting to state public health officials.
Dr. Butler noted that the Task Force also considered CDC
recommendations; specifically the one supporting traditional
public health reporting techniques such as having the hospital
provide information to a state's public health agency as opposed
to allowing a hospital to independently publicize "whatever data
they collect and would like to disclose…" The traditional public
health reporting would assist in providing "a level playing
level amongst hospitals…"
9:23:32 AM
Senator Elton observed that the bill would require a health care
facility to report. He asked whether audits would be conducted
or whether a penalty would be imposed for non-reporting or
inaccurate reporting.
Dr. Butler responded that this is a challenge in any public
health reporting situation as there are "no public health
police". A trust relationship between the State and the hospital
must be developed.
Senator Elton pointed out that if the effort is "to induce
better behavior" by having informed consumers, inducements
should be provided to encourage accurate reporting, however, the
negative aspect of that is the possible loss of patients to
another health care facility.
Dr. Butler agreed. The accuracy of the reporting would be based
"on a trust relationship and the good will" of a hospital to the
welfare of its patients.
Dr. Butler avowed that the Task Force had considered the
downside of public disclosure. Hospitals with good surveillance
in place and who "identified and reported infections could
potentially appear to have a higher rate of infections. That is
certainly not the intent of this effort".
Senator Thomas asked for information regarding the timelines for
action as specified in Sec. 5 page 4 line 23 through page 5 line
3. To that point, he observed that Members' packets included an
article [copy on file] published in the Boston [Massachusetts]
Herald newspaper on February 21, 2007 which stated that the
president of the "Beth Israel Deaconess Medical Center, created
a big stir recently when he posted the hospital's infection
rates on his blog and encouraged other hospitals to follow suit
without a complicated state mandate".
Continuing, Senator Thomas opined that allowing the health care
industry to independently report might be preferred to enacting
legislation.
9:27:09 AM
Dr. Butler stated that this had been discussed by the Task
Force. The issue is that hospitals have no uniform standard for
collecting data. This would be detrimental to the effort to
provide "useful" information to both the hospitals and the
public.
Dr. Butler also noted that Alaska has "some peculiar
challenges"; one of those being the limited number of health
care facilities in the State and the fact that only six
hospitals have more than 50 beds.
9:28:10 AM
PAT LUBY, Advocacy Director, AARP Alaska, testified via
teleconference from Anchorage in support of the bill. While the
reporting requirements might not be as useful to the citizens of
Alaska as they might be in an area with more hospital choices,
they would assist in promoting "error reductions". Studies
conducted by The Institute of Medicine indicate that, by
"admitting to each other what problems" have been experienced
hospitals and health professionals can reduce errors.
Mr. Luby declared that this was not "a gotcha bill" in the sense
of "trying to catch hospitals … or health professionals who may
have made an error". Instead the intent of the reporting would
be to address an error, "find out how it happened and let's find
out how we can prevent any further errors from happening. Our
health professionals are very good about tracking problems, but
they need to know the number and the scope of those problems."
Mr. Luby considered this legislation to be "a good first step
toward reducing" medical errors.
9:29:32 AM
SANDRA STARK, Member, Task Force to Assess Public Reporting of
Health Care Associated Infections, testified via teleconference
from an offnet location in support of the bill. Requiring
individual hospitals to report infections would encourage them
to improve their procedures and thereby reduce health care
related infections.
Ms. Stark communicated that the effort to control infections is
compounded by many things. People do not stay in hospitals as
long as they used to and people are more transient. Thus, in
addition to improving hospitals' approach to containing
infections, an effort must be made to improve health care
throughout the State. The size of a facility should not be a
consideration.
Ms. Stark relayed that because some infections have a long
incubation period, symptoms might not present until long after a
person concluded their hospital stay. Thus knowledge of the
problem is often not immediately known. It is also possible that
the institution might never be informed. Even thought hospitals
and their staff have improved their approach to infection
control, "the lack of information exchange" between entities is
an obstacle. This bill would address that situation.
Ms. Stark applauded the dialogue that has occurred. It has
improved the bill to a point where it would be in "the best
interest and not a threat to health care facilities".
9:32:42 AM
Co-Chair Stedman questioned the expense of supporting the
Advisory Committee, as depicted in the DHSS fiscal note #1. In
addition to the effort to control the State's operating budget,
the Legislature is attempting to control the expenses of the
"litany" of State supported boards and commissions.
Mr. Letch deferred the fiscal note question to the DHSS.
9:33:27 AM
Dr. Butler explained that the fiscal note would provide for
travel and other Advisory Committee expenses. It would also
provide for Department staff support for the Advisory Committee
and funding to the Department for managing the data that would
be collected. Even though managing the data would be a
complicated process, an effort was taken to develop an efficient
fiscal note.
Dr. Butler disclosed that historically, the Division of Public
Health "has not interacted in the health care world much". This
is unfortunate as the health care world has experienced dramatic
changes, and the "clear cut line between the community and the
health care environment" has dissipated. Therefore this would
expand the type of work the Division had previously conducted.
Absorbing this additional work should not be done at the
detriment of existing Division responsibilities.
9:35:01 AM
Co-Chair Stedman followed up on Senator Thomas' earlier question
by asking whether the Department had considered developing an
internal data collection method which would allow them "to
organize it, consolidate it, and then maybe make recommendations
without creation of another board".
Dr. Butler expressed that even though "it would be desirable to
use that approach", the Task Force concluded, as it conducted
its proceedings, that it would be unable to "tackle" the
entirety of complicated and technical issues involved in this
effort in its allotted time-span.
9:36:03 AM
Senator Olson asked to the type of interaction that occurs
between the CDC and the State's epidemiologic section in this
regard. Furthermore, he inquired whether establishing this
program might negatively affect the funding of the epidemiologic
section.
Dr. Butler informed that currently no federal funds are provided
to support State health care related issues; however 75 percent
of the funding received by the State's epidemiologic section is
federal funds. The balance is State general funding. In
addition, no federal funds have been identified to support this
issue. To date, the CDC has acted as a technical consultant and
adviser in addition to ensuring that the State's data and
information is shared with other states.
9:37:32 AM
Senator Elton observed that the Department's fiscal note #1
indicates that program costs would be incurred through FY 2013,
even though the Advisory Committee would terminate in FY 2012.
9:38:01 AM
Dr. Butler communicated that, due to the numerous unknowns, the
decision was to specify a termination date for the Advisory
Committee. That decision could be revisited if, once in
operation, the Advisory Committee advised otherwise. The bill's
sponsor might be able to provide specific information to the
dates specified in the fiscal note.
Co-Chair Stedman, noting that the bill would be held in
Committee, stated that the discussion on the fiscal note would
continue during the next hearing on the bill. Other fiscal note
concerns include whether the overhead costs specified for the
program include the entirety of board operating costs and
whether there has been consideration that health care
facilities, rather than the State, might absorb the program
expenses.
9:39:37 AM
Senator Elton, noting this would be a voluntary reporting
program, asked whether the State might "accept liability … if a
hospital doesn't report correctly" and a consumer made a health
care choice based on information provided by the Department.
Dr. Butler stated that this issue would be researched.
Co-Chair Stedman ordered the bill HELD in Committee.
9:40:35 AM
SENATE BILL NO. 4
"An Act extending the cash assistance benefit program for
seniors under the senior care program and increasing the
benefit amount; and providing for an effective date."
This was the second hearing for this bill in the Senate Finance
Committee.
Co-Chair Stedman communicated that the intent today would be to
move this bill from Committee. A new fiscal note, dated April 3,
2007, relative to the Version 25-LS0056\C committee substitute
adopted during the bill's first hearing, had been distributed.
9:41:17 AM
Senator Olson, the bill's sponsor, informed the Committee he had
worked with both the House of Representatives and the Department
of Health and Social Services to perfect the language in this
bill. SB 4 would extend the Senior Care cash assistance program
to 2011. In addition, it would eliminate the under-utilized
prescription drug benefit component of the current program.
Senator Olson explained that the bill would provide monthly cash
assistance payments to eligible individuals as follows: $175 to
those whose household income did not exceed 100 percent of the
federal poverty guidelines for Alaska; $150 to those whose
household income did not exceed 135 percent but was above 100
percent of the federal poverty guidelines for Alaska; or $100 if
the household income did not exceed 150 percent of the federal
poverty guidelines for Alaska.
Senator Olson specified that the bill would not require
individuals meeting the household income test to provide
information on their asset holdings.
Senator Olson noted that provisions in the bill would prohibit
an individual from being eligible for both this program and the
Longevity Bonus Program were it re-authorized.
Senator Olson communicated that the new fiscal note estimated FY
2008 expenses to be $17.4 million. That amount was based on the
Department's estimation that 7,800 seniors would qualify for the
program.
9:43:11 AM
GINNY AUSTERMAN, Staff to Senator Olson, affirmed that the new
fiscal note had been distributed.
9:43:36 AM
Co-Chair Stedman observed that the fiscal note accompanying this
legislation would be the largest one advanced by the Committee
to date this session. While assistance to the State's seniors
and the needy is important, this legislation in essence "is
going counter" to the Legislature's effort to control the growth
of the operating budget this year.
JANET CLARKE, Assistant Commissioner, Finance and Management
Services, Department of Health and Social Services, explained
that the $17.4 million fiscal note "is a comprehensive fiscal
note for the cost of Senior Care program" in that it includes
administrative costs in addition to the benefits paid to
recipients. The annual costs associated with the existing Senior
Care Program, which has existed for approximately three years,
has been approximately 12 million dollars.
Ms. Clarke reviewed the Analysis information on page 3 of the
fiscal note. It depicted the monetary benefits estimated to be
paid at each of the three different income levels. These
payments which are estimated to amount to $16.6 million, would
account for the "bulk" of the program expenses. The balance
would address the cost of administering the program. Additional
staff would be required to administer this program since it is
more complex than the previous Senior Care program. The previous
Senior Care program allotted single cash payments of $120 per
month to program recipients as opposed to the three tiered
payment approach proposed in this bill.
9:47:28 AM
Co-Chair Stedman asked whether, instead of increasing staffing
levels, computer programs could be enhanced to address this
effort.
9:47:46 AM
Ms. Clarke explained that staffing was based on caseload levels.
The number of people who would be eligible for this assistance
is anticipated to increase.
Co-Chair Stedman asked the Department to testify to the accuracy
of its calculations.
9:48:29 AM
ELLIE FITZJARRALD, Director, Division of Public Assistance,
Department of Health and Social Services, stated that
approximately 7,000 seniors are currently enrolled in the Senior
Care program. "This bill would increase that number to 8,800".
Two additional staffers would be required to manage the
additional caseloads as each application must be reviewed to
determine eligibility and the information on each eligible
individual must be entered into the Department's computer
system. In addition, the Department's computer system must be
upgraded to ensure that payments are made in a timely matter.
Ms. Clarke pointed out that one time costs, such as the computer
upgrades, have been identified and could be eliminated from the
program expenses, once completed.
Co-Chair Stedman advised that it is much easier to control
expenses when things such as one-time expenses are identified
early on in the budget process. Otherwise the tendency is to
expand the program to absorb that funding.
Co-Chair Stedman also thought that the FY 2012 expenses depicted
in the fiscal note were an underestimation in light of the fact
that the number of program recipients might increase as the
State's population ages. To that point, he asked whether the
Department had studied the State's "aging trends" and the affect
of that beyond the timeframe specified in this bill.
Ms. Clarke affirmed that aging trends were analyzed. The
determination was that the State's senior population growth rate
would be "fairly flat" for the next eight to ten years and then
would experience a significant level of growth. That information
was utilized in developing the new fiscal note.
Ms. Clarke explained that the new fiscal note depicts a zero
expense for FY 2012 as the program is proposed to terminate in
2011.
9:51:18 AM
In response to a question from Senator Thomas, Ms. Fitzgarrald
expressed that the Department had conducted a survey of program
recipients to determine why the prescription drug component had
been under-utilized. The determination was that the program "was
not what they needed" as other prescription drug programs were
available to them through other insurance programs, pension
benefits, or the new Medicare Part "D" program.
Senator Thomas asked what consideration had been given to those
who had utilized the program.
Ms. Fitzgarrald specified that approximately 140 seniors were
currently utilizing the drug benefit. Senator Olson had
addressed this issue in this bill by revising the income test
levels and increasing the benefit levels.
9:53:24 AM
Senator Elton agreed with Co-Chair Stedman's remarks that once a
program is established, it is often difficult to curtail or
disband. To that point, he asked the Department to provide an
estimate of the program expenses were it continued to the year
2020, particularly as the senior population "bubble" was yet to
come. In addition, he asked whether the fiscal note was
developed in consideration of future changes in the federal
poverty level.
Ms. Fitzgarrald affirmed that the fiscal note did reflect the
fact that federal poverty guideline levels would increase each
year.
9:54:55 AM
Co-Chair Stedman asked for further clarification about the
staffing levels required to support the program.
Ms. Clarke specified that four staffers currently manage the
Senior Care program. Two additional staff would be required to
support the program proposed in this bill.
Co-Chair Stedman understood therefore that the program would be
supported by a total of six staffers.
Senator Olson moved to report Version "C" from Committee with
individual recommendations and new Department of Health and
Social Services fiscal note.
There being no objection, CSSB 4(FIN) was REPORTED from
Committee with the new $17,398,900 fiscal note, dated April 3,
2007 from the Department of Health and Social Services.
ADJOURNMENT
Co-Chair Bert Stedman adjourned the meeting at 9:56:51 AM.
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