Campaign for a Healthy California Launches our 2015-16 Patient’s Bill of Rights!

We are excited to announce that the Campaign for a Healthy California has finalized our Patient Bill of Rights for the 2015-2016 legislative session! This legislative package features bills that protect patients, improve care, hold insurers and hospitals accountable, and expand access to healthcare. For more information, click here .

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A $10,169 blood test is everything wrong with American health care

A lipid panel is one of the most basic blood tests in modern medicine. Doctors use it to measure cholesterol levels in their patients, probably millions of times each year.

This is not a procedure where some hospitals are really great at lipid panels and some are terrible. There’s just not space for quality variation: you are running blood through a machine and pressing buttons. That’s it.

And that all makes it a bit baffling why, in California, a lipid panel can cost anywhere between $10 and $10,000. In either case, it is the exact same test.

“What we were trying to see is, when we get down the simplest, most basic form of medicine, how much variation is there in price?” says Renee Hsia, an associate professor at University of California, San Francisco who published the price data in a recent study.

“It shows how big the variation really is. We’re not talking twofold or threefold differences, it’s a completely different level of magnitude.”

More than 100 hospitals — with more than 100 different prices

For this research, published in August in the British Medical Journal, Hsia and her colleagues compiled reams of data about how much more than 100 hospitals charged for basic blood work. The prices these facilities charged consumers were all over the map.


The charge for a lipid panel ranged from $10 to $10,169. Hospital prices for a basic metabolic panel (which doctors use to measure the body’s metabolism) were $35 at one facility — and $7,303 at another.

For every blood test that the researchers looked at, they found pretty giant variation:

This huge variation in the price of a really simple, incredibly basic blood test tells us a few things about the American health care system.

Blood tests aren’t the only place with this variation

Hsia’s previous research looked at the cost of an appendectomy in California and found similarly gigantic variation. For an appendectomy with no complications, she found that hospitals in the state would charge anywhere between $1,529 and $186,955.

One the issues with that study, she says, is that different hospitals might treat patients differently. “Some hospital might use more IV bags than others or one doctor could be ordering a lot of blood tests,” she says.

The point of comparing an incredibly basic blood test, and its prices, was to distill down to a very basic test that offers no space for variation — but still has a huge range in how much hospitals will charge.

Not every patient pays the full charge rate: insurance companies, for example, typically negotiate a lower rate with the hospital. Medicare, which covers seniors, has a set fee schedule it uses. But these are the prices that an uninsured patient — who doesn’t have a health plan bargaining on her behalf — could face.

“If I’m hospitalized, don’t have insurance and my doctor orders three days worth of blood tests, this is what I’m getting billed for,” Hsia says.

What this tells us about American health care

For one, there’s not much price transparency: it’s really hard to know whether one hospital is charging $10 or $10,169 because prices are rarely listed. For this particular study, Hsia literally had to hire a software engineer to collect the data and line up all the different hospitals against each other.

The $10,169 blood test tells us we’re suckers: we’ve developed a health care system where its hospitals have pretty full authority to name their price with little protest from consumers.

For people with health insurance, really big price variation often isn’t a concern. If their plan covers the bill, it doesn’t matter to them, personally, whether they get the $10 test or the $10,000 one.

For those without coverage (or those whose coverage only covers a certain percent of the bill), price variation matters a lot. Getting a $10,000 blood test can put a patient into bankruptcy. But right now, our health care system doesn’t have the mechanisms to limit those high charges — nor would the patient likely have the tools to know the cost of his or her blood test to begin with.

“There’s no other industry where you see this kind of extreme variation,” Hsia says. “And nobody has ever really challenged it. It shows an extreme inefficiency, and something we really need to change.”

Source: Sarah Kliff

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Majority Still Supports Single-payer Option, Poll Finds

4833652311_5a580ba672_nThe single-payer option – also known as Medicare for all – would create a new, government-run insurance program to replace private coverage. The system, once backed by President Obama, became one of the biggest casualties of the divisive healthcare debates of 2009.

The idea remains extremely popular among Democrats, with nearly 80 percent in support, according to the poll, which was shared first with The Hill by the Progressive Change Institute.

“There is a hunger in America for big progressive ideas,” spokesperson TJ Helmstetter wrote in a statement. “The state of our union is progressive, and the president would be smart to give America the big, popular, progressive economic ideas that people have been crying out for.”

Another proposed idea under ObamaCare – the public option – also retains wide approval.

Only 13 percent of people said they opposed the public option, which would give individuals the choice of buying healthcare through Medicare or private insurers.

The Progressive Change Institute, which is a sister organization of the million-member Progressive Change Campaign Committee, has long supported the public option, which Helmstetter said would “level the playing field for consumers and dilute the power of insurance companies.”

The approach was also an initial part of Obama’s reform plan, though it was attacked by both parties on the Hill and was ultimately rejected in favor of a new, government-funded healthcare system based on subsidies.

At the time, Democrats leading the negotiations were accused of caving into corporate interests, while Obama was accused of “selling out.”

As recently as 2009, Obama has also said he is a proponent of the single-payer system, which remains far more controversial among policy experts.

The poll was comprised of 1,500 likely voters and was conducted this month by the firm GBA Strategies.

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Hospitals’ sale: Prime is the only buyer who can keep facilities open

By: Sharon Erlich and Donna Fischer, San Jose Mercury News

oconn-wpFor decades, registered nurses at Daughters of Charity Health System have outlasted wars, pestilence and even earthquakes to fulfill their mission of serving the indigent and the poor in the Bay Area and Southern California. No one alive can recall a time care was not available at the local hospitals.

At Seton Medical Center in Daly City, four generations of Nikki Santiago’s family have benefited from our care, culminating in the birth nearly four years ago of her baby daughter.

Ten years prior, Santiago had miscarried, and when she fell pregnant this time around, the doctors warned her that she was at risk of miscarrying again. A hotel clerk, she was uninsured at the time; after enrolling in the state’s public insurance program, Medi-Cal, she began visiting the Seton clinic regularly.

“That was really important because the doctors at Seton told me I needed bed rest,” she recalled recently. “I relied on public transportation so it would take me at least an hour one way to go to the next closest hospital in San Mateo County or San Francisco. I can see Seton from my house.”

The verdict? Santiago delivered a healthy, bouncing 7-pound, 6 ounce baby girl.

But now care for families like Nikki’s are at risk. Daughters of Charity hospitals face the threat of bankruptcy and possible closure as soon as June unless California Attorney General Kamala Harris approves a sale to the leading bidder, Prime Healthcare.

“How can we close O’Connor Hospital,” said Maria Canonizado, an RN at O’Connor, “where one quarter on the babies in the San Jose area were born, there were almost 5,000 emergency room visits in the last year, is a stroke center and accepts many of the community’s most acutely ill patients?”

Or risk the loss of St. Louise Regional Hospital, the only hospital serving Gilroy whose closure would force the nearly 24,000 patients who went to its ER last year to travel 25 miles to get to the next nearest hospital.

That’s why the California Nurses Association and its 1,800 members who work in Daughters of Charity hospitals are working so hard to support the proposed sale to Prime, the only bidder which has pledged, and signed an agreement, to keep all six hospitals open and preserve their vital health services for at least five years. Prime has also agreed to pay off nearly $750 million in tax-exempt bonds, pension and other debts, and commit an additional $150 million to hospital improvements.

Nurses are not standing alone in this fight. We’re joined by the Sierra Club, Food and Water Watch, Consumer Watchdog, the National Organization for Women, NAACP and countless patients and community residents who know how vital it is to retain out community hospitals.

Those who oppose the sale can point to only one other bidder, Blue Wolf Capital, a Wall Street turnaround firm that specializes in “restructuring” troubled businesses and cutting core services for a quick resale and hefty profit. It has no experience in the health care industry, unless you count their 2008 investment in a Chicago laundry that cleans linens for area hospitals. Unlike Prime, Blue Wolf has made no commitment to keep open our community hospitals.

The time to speak out is now. Join with us to avert a public health crisis and urge Harris to approve the sale.

Sharon Erlich has been a registered nurse in the Emergency Department at O’Connor Hospital for 17 years. Donna Fischer, an RN for 38 years, has worked for the past 32 in the ICU at St. Louise Regional Hospital. They wrote this for this newspaper.

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Nurses Issue Impact Report, Urge State Officials to
 Act in Public Interest and Save Daughters of Charity Hospitals

DaugOfCharRegistered nurses who work in five Daughters of Charity hospitals across California held a Sacramento press conference Wednesday urging Attorney General Kamala Harris to approve the sale of the hospitals to a buyer that has pledged to stop the threatened closure of the hospitals and preserve critical healthcare services.

The RNs, members of the California Nurses Association/National Nurses United, represent 1,800 RNs who work at the hospitals in the San Jose and Los Angeles regions.

The California Nurses Association recently issued an impact report on the essential health services that will be lost if the hospitals are allowed to go under. The Attorney General must act in the public interest, nurses say, and allow Prime Healthcare to move forward with its offer to purchase the Daughters of Charity Hospitals which include: O’Connor Hospital in San Jose, Saint Louise Regional Hospital in Gilroy, Seton Medical Center in Daly City, and St. Vincent Medical Center in Los Angeles.

“Prime Healthcare signed an agreement that guarantees that these hospitals will continue to provide vital health services to the communities surrounding them, while no other buyer has stepped forward and offered any commitments whatsoever” said Maribel Licardo, RN, O’Connor Hospital in San Jose.

“Those who oppose the sale are playing a dangerous game with our patients and our communities that could be steering the hospitals towards bankruptcy and closure. As nurses we will do whatever we can to prevent this from happening, in order to protect public access to healthcare and emergency services” said CNA Co-President Zenei Cortez, RN.

In October, the California Nurses Association/National Nurses United reached an agreement with Prime that includes a pledge to keep all of the hospitals open for at least five years. Under the agreement, Prime also promised it has no intention of reducing patient services or taking actions that would put the services at risk, as well as respecting collective bargaining rights, jobs, pension rights and existing labor standards at the hospitals covered by the pact.

Another potential buyer, Blue Wolf Capital, a Wall Street private equity firm, has refused to commit to keeping the hospitals open, protecting patient services, or honoring employee contracts or existing labor standards.

CNA members have held rallies with local community leaders and patients demanding that the hospitals be maintained and kept open for their patients.

“We call on the Attorney General and elected officials to support the sale of Daughters of Charity Hospitals to Prime Healthcare” said Cortez, RN. “Their support will pave the way to a smooth transition and the survival of the hospitals”

Daughters of Charity Hospitals are operated as non-profit entities, and their purchase by a new operator requires the Attorney General’s approval. In the new year, from Jan. 5-9, the Attorney General will hold five public hearings in each of the communities served by one of the Daughters of Charity Hospitals. Nurses will testify and share findings from the impact report that will be released on Wednesday at the hearings located in Los Angeles, Lynwood, San Jose, Gilroy, Moss Beach, and Daly City, Ca. We are urging all community members, patient advocates, and allies to attend these hearings and speak out on behalf of keeping these hospitals open at existing capacity via sale to Prime Healthcare:

  1. Saint Francis Medical Center on January 5, 2015, beginning at 10:00 a.m., at Bateman Hall Auditorium, 11331 Ernestine Ave., Lynwood, CA 90262.
  2. Saint Vincent Medical Center on January 6, 2015, beginning at 10:00 a.m., at Seton Hall Auditorium, 262 South Lake Street, Los Angeles, CA 90057.
  3. O’Connor Hospital on January 7, 2014, beginning at 10:00 a.m., at O’Connor Hospital Medical Office Building, 2101 Forest Ave., San Jose, CA 95128.
  4. Saint Louise Regional Hospital on January 8, 2015, beginning at 10:00 a.m., at Gilroy City Hall, Council Chambers, 7351 Rosanna St., Gilroy, CA 95020.
  5. Seton Medical Center Coastside on January 9, 2015, beginning at 9:00 a.m., at Seton Medical Center-Coastside, 600 Marine Blvd., Moss Beach, CA 94038

Read the Impact Report detailing how closure of daughters of charity hospitals 
would dramatically reduce patient access to essential healthcare services

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Integrated Single-Payer Health Care System is best approach to dealing with Ebola and future Pandemics

California Nurses Association Testifies at State Capitol on need for Single Payer

This is a proud moment for California Nurses Association/National Nurses United, whose members have taken the lead in blowing the whistle for Ebola preparedness. From a die-in on the Las Vegas Strip in September to the 50,000 strong national day of action on November 12th, the nurses of CNA/NNU have made history.
Contrary to what their hospital administrators have said about their adherence to the CDC guidelines—nurses reported quite the opposite in a survey of over 3500 nurses from every state in the US. So this new guidance in California creates a real level of security for nurses, and we thank Governor Brown and Director Baker, and the staff who worked so diligently to set this new national standard.
But what about the patients in a fragmented, under resourced “non-system” who are at the mercy of their insurance company’s high-deductible, minimal benefit, narrow network, sparse drug formulary health plan? And those on Medi-Cal who can’t find a doctor to accept them, or those undocumented workers and others who must rely solely on ER visits and a decimated public health system.

Funding for public health preparedness and response activities in the US was $1billion less in 2013, than in 2002, according to a CDC report from earlier this year.

According to CMS data collected in 2013, patients in California Emergency Departments faced waits that are 23 minutes longer than the national average. Specifically, California patients waited on average more than two-and-a-half hours in the ED.
Further, if a patient is admitted to the hospital, the average wait increased to:

  • About five hours and 18 minutes from arrival to the time a patient is admitted; and
  • Nearly an additional two hours before a patient is moved to a bed.

At least 5% of patients at 20 of the state’s EDs left before being treated because of the long waits, according to Center for Health Reporting/Daily News.

Let’s make a distinction between an integrated, well-resourced system that guarantees a single standard of care for all with a dedicated funding source and real public accountability – known as single-payer – verses the existing fragmented approach that seeks to regulate behavior sometimes with the force of law as in the case of this new guidance, and mostly as monetary incentives and voluntary guidance. Now, the treatment response to Ebola, for example, as other in other pandemics is largely governed by private healthcare corporations who are only accountable to their shareholders or board of directors, not the public.

Understaffing, access to treatment based on ability to pay, technology replacing hands-on care, difficulty gaining admission: it could and does happen everyday in our fragmented corporate health care system. All this happened to Ebola patient Thomas Eric Duncan in a Dallas hospital, and in his case, it was fatal and two nurses infected.
We know what works, Canada has done it: A province-based single-payer system and federal agency that has the responsibility and authority to ensure local, state and national coordination to detect, respond and treat outbreaks.
The Ebola epidemic reveals the fissures and fatal inadequacies of our healthcare “non-system.” Only greater integration, planned and directed resources, and authority to a public health system can protect people in California from the dangers of pandemics like Ebola.
This new guidance issued by Cal/OSHA stands out as a clear mandate for precaution and protection establishing a national standard. Let us a create system where that is the rule, rather than the exception.

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Huge victory for California RNs, Caregivers, and Patients!

Follows Global Day of Action With 100,000 RNs Demanding Highest Safeguards, Contrast to Hospital Industry’s Failure to Act

Following a worldwide day of actions of 100,000 registered nurses and health workers demanding substantial improvements in safeguards for the deadly Ebola virus, California officials have announced landmark mandatory Ebola guidelines that should be a model for federal and state action for all U.S. hospitals, National Nurses United said today.

NNU, which has sponsored two months of actions to upgrade Ebola protections, and its California affiliate, California Nurses Association, praised the new standards released today by the California Occupational Safety and Health Administration (Cal-OSHA) under the leadership of Gov. Jerry Brown.

“These rules are a testament to the outspoken efforts of nurses who have repeatedly pressed for the highest level of mandatory safety precautions to protect nurses, patients, and the public. Nurses have raised their voices, and California has now listened, acted, and once again set a benchmark for the nation,” said NNU and CNA Executive Director RoseAnn DeMoro.

The new California standards, an elaboration of existing Cal OSHA regulations on Aerosol Transmissible Disease and other existing regulations, go well beyond the faulty procedures and protective gear employed by hospitals across the U.S., and the current, unenforceable recommendations of the federal Centers for Disease Control and Prevention.

By contrast, California regulations are mandatory. The guidance under existing standards, which are effective immediately, stipulate the optimal level of personal protective equipment, rigorous training and drills, and break additional ground in identifying modes of possible transmission of the virus and when safety precautions must be engaged for nurses and other front line health workers who encounter patients with the deadly Ebola virus.

“With the hospital industry dismissing the concerns of the nurses, and the federal government failing to order the hospitals to implement the optimal level of Ebola protection, California, under the stewardship of Gov. Brown, has heard the voices of nurses, and established a model that all should follow,” said CNA Co-President Zenei Cortez, RN.

Not only are the new guidelines a substantial step beyond existing federal standards, the California rules are mandatory, with civil penalties for hospitals that fail to comply.

“The nurses are fighting for the public. They went to the governor demanding action.  He departed from the paralysis of government and corporate inaction. He listened intently and heard the nurses reports of how deeply unprepared and resistant hospitals were and he moved to protect the public, the nurses, and other health care workers,” DeMoro said, adding, “That’s how government should work, Gov. Brown has delivered an example for the nation.”

In addition to Gov. Brown’s leadership, the nurses also praised the diligent work of Cal OSHA in developing guidance on the standards.

The California regulations embody the precautionary principle NNU has advocated in response to Ebola, that absent scientific consensus that a particular risk is not harmful, especially one that can have catastrophic consequences, the highest level of safeguards must be adopted, and a sharp contrast to the profit principle that has guided the response of most hospitals, DeMoro noted.

Further, the Ebola standards set a new benchmark for strong infection control protections for other epidemics which are expected to accelerate in the coming years.

NNU will press for legislation and regulation in other states, and continue to demand the federal government enact mandatory guidelines all hospitals must follow for Ebola and other epidemics modeled on the California standards.

In California, CNA will closely monitor hospital compliance with the guidelines, and work closely with Cal-OSHA on enforcement.

The California regulations, says NNU, exceed existing federal guidelines, close the biggest loopholes in CDC regulations, and replicate the demands NNU has made across the nation for two months.

Among highlights, under the new standards:

  • California hospitals are now required to have full-body protective suits, that meet the American Society for Testing and Materials F1670 standard for blood penetration, F1671 standard for viral penetration, that leave no skin exposed or unprotected, and that are available for all hospital staff providing care for a suspected or confirmed Ebola patient, employees cleaning contaminated areas, and staff assisting other employees with the removal of contaminated protective gear.
  • Hospitals must provide air-purifying respirators (PAPRs) with a full cowl or hood for optimal protection for the head, face and neck of any RN or other staff who provide care for a suspected or confirmed Ebola patient. Like the suits, this requirement extends to cleaning contaminated areas or assisting staff in removal of protective gear. Both these respirators and the suits have been a key NNU demand.
  • Infection by the Ebola virus can occur not just through direct contact with droplets of bodily fluids, but even through aerosol transmission of fluids from coughing or other aerosol exposure with a symptomatic Ebola patient.
  • Regular training is required for any staff who are at risk of exposure, including hands on practice in teams with the ability to interact and ask questions. Computer based training does not meet the requirement.
  • Employees who report hospitals that violate the regulations are protected from retaliation by their employers with whistleblower protection.
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