Legislation Seeks Additional Information, Transparency From Washington Hospitals

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Dr. Kay Funk, a retired physician and Yakima City councilwoman, mentioned Astria Health in expressing support for a bill in the Washington Legislature that would require additional information from hospitals.

"Improved transparency and accountability might have prevented the closure of a needed hospital in our city," Funk said Friday during a hearing of the Senate Health & Long Term Care Committee, referencing the closure of Astria Regional Medical Center in January 2020.

Funk and others who support House Bill 1272 say it will force hospitals to be more transparent about their finances and allow stakeholders to hold them accountable for failing to meet the state's health care needs.

Under the bill, hospitals across the state would be required to provide the state Department of Health with more financial and patient data. That includes additional revenue and expense figures in financial reports already submitted to the Department of Health, patient demographics in hospital discharge reports and additional information in hospitals' community health needs assessment. Hospitals would also have to disclose any funds received from local, state and federal governments in response to a national or state-declared emergency.

The bill is also seeking a report from the state Department of Health, in collaboration with a research entity, that would look at the impact of staffing on patient outcomes and mortality.

The bill has an effective date of July 1, 2022.

State Rep. Nicole Macri, a Seattle Democrat and the bill's sponsor, said during Friday's hearing that the COVID-19 pandemic has exposed the health care system's stresses and disparities.

"I would also say some of the policies in the bill are urgent because of the COVID-19 pandemic," she said.

The bill passed the House on a 58-40 vote. All of the House representatives in the 13th, 14th or 15th districts, all Republican, voted against the bill. The Senate must pass the bill by April 11 to be eligible to be signed into law this year.

Seeking accountability

Unions representing health care workers in the Yakima Valley say there needs to be more disclosure of how hospitals are spending their money and how their finances influence their decisions.

Jayson Dick, associate director of labor advocacy for the Washington State Nurses Association, used Astria Health as an example. Had the Sunnyside nonprofit system been required to disclose more financial information, the organization's financial issues might have come to light much sooner. That could have prevented some of the organization's actions, such as limiting supplies or closing Astria Regional.

Astria Health filed for bankruptcy protection in May 2019. The organization is now operating under a reorganization plan as of January, but ended up closing several operations, including the Yakima hospital and several clinics, during the bankruptcy process.

"Those financial impacts do trickle down to nurses not having supplies, not hiring enough staff to cover patient loads, which all impact patient care," he said. "(Hospitals') liability is a public health concern. There got to be transparency. There got to be accountability."



Last year, two nurses with Yakima Valley Memorial filed a complaint with the state Department of Health stating that the hospital's actions, including failure to provide sufficient masks and gowns, put staff at risk during the pandemic.

A Department of Health spokeswoman said Friday that the complaint was investigated and closed in late February with a "Statement of Deficiencies and an approved Plan of Correction." Additional details were not immediately available Friday.

Where is the money going?

During the hearing Friday, nearly all those who spoke expressed support for the bill.

Justin Gill, who spoke on behalf of the Washington State Nurses Association, noted hospitals were getting COVID-19 relief funds. At the same time, staff, including nurses represented by the union still dealt with everything from furloughs to supply and PPE issues.

"The day-to-day reality didn't change for health care workers," he said.

Candace Jackson of the African American Health Board and Community Health Board Coalition said that hospitals are receiving money to improve care for various communities, but it isn't clear how hospitals are using that money to improve outcomes.

Jackson said her organization has tried to find out how health care systems are using that money.

"Every time we have those conversations, we leave pretty unclear where the money is going or what exactly the impact is," she said. "In order for us to be good partners to health care systems we need to know what is happening and understand where the impact is being made."

Execution

The Washington State Hospital Association said during the hearing it has been working with the bill's sponsor on different aspects of the bill.

Chelene Whiteaker, WSHA's senior vice president of government affairs, said the main issue still to address is whether there could be accommodations for rural and small hospitals that may have challenges getting additional patient information. Two possibilities mentioned were time-limited exceptions for rural hospitals unable to update their electronic health records and a grant program to help critical access and sole community hospitals to fund the necessary changes to electronic health record systems.

Kristin Reichl, interim legislative affairs manager for the state Department of Health, also spoke during Friday's hearing. She said the department appreciates the bill's intent to promote "health equity through greater health system transparency," but was concerned with some deadlines in the bill. For example, the hospital staffing impact study is due by September 2022, just three months after the planned effective date.

Reichl said the department would submit full written testimony that would include changes that would help the department better respond to the bill's timelines.