State changes policy on regulating HMOs |

State changes policy on regulating HMOs

The California State Legislature has passed legislation to change how HMOs will be regulated. A total of 21 bills were enacted in the 1999 session, all of which aim to increase the quality of patient health care.

Legislators have decided to give the state Department of Managed Care more authority to regulate managed care and two laws in particular are likely to affect medical service providers and the consumers who subscribe to them.

Assembly Bill 394, sponsored by Sheila James Kuehl, D-Santa Monica, requires the Department of Health Services to look into nurse-to-patient ratios in critical care facilities and rate them according to the type of facility. The law became effective Jan. 1, 2000, but is not operable until July 1, 2000 or as ordered by the governor.

“This bill is a key element in the great reform of California’s health care system that we accomplished this year,” Kuehl said of her bill.

Asked if the nursing staff at Barton Memorial Hospital met current DHS standards for providing patients with appropriately staffed medical care, Director of Nursing, Kathy Cocking replied, “Yes.”

She believes DHS has a long and difficult task ahead of it, but when it does reveal its findings on nurse staffing standards next year, Barton Memorial will be one step ahead. Cocking said DHS is responsible for mandating state nursing classification systems within acute care facilities, but at Barton, “We’ve done that for years.”

The hospital conducted a “job work redesign” in March 1998 that resulted in a team approach to patient care.

“Our change in job duties and skill mix did not adversely affect patients,” Cocking said. “The way we have patients assigned now won’t be affected by DHS’s decision.”

Barton’s Chief Executive Officer, Bill Gordon, said, “You need a nice mixture of employees. That is what works.”

Research conducted by Boston College School of Nursing Associate Professor, Judith Shindul-Rothchild, regarding unlicensed nursing personnel performing registered nurse duties resulted in the publication of a national study.

She discovered 60 percent of the nurses studied observed a reduction in the number of RNs giving direct care and 40 percent reported unlicensed staff substituted for registered nurses. The survey indicated the decrease in RN care resulted in a higher number of complications, medication errors, and patient deaths.

Cocking said RNs are responsible for planning and coordinating patient care. They are assisted by licensed vocational nurses and unlicensed personnel, but with “a nursing shortage,” Cocking sees no reason why scrub technicians, for instance, should not be allowed to check vital signs.

“They are extremely helpful,” she said.

AB 78, sponsored by Assembly Member Martin Gallegos, D-Los Angeles, will transfer regulation of managed care programs to a new Department of Managed Care within the Business, Transportation, and Housing Agency.

An advisory committee will be created within the department to advise the director and will be responsible for expanding the existing ombudsman program by implementing an Office of Patient Advocate.

The office will do its best to serve patient interests and is required to:

nDevelop educational and informational information;

nCompile an annual quality-of-care report card;

nProvide advice and assistance to enrollees regarding health plan and department grievance systems;

nMake referrals within the department regarding necessary investigations and audits;

nCoordinate and work with other patient-assistance programs;

nIssue an annual report on the activities of the office.

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