August 9, 2006
The Honorable Judy Chu, Chair
Assembly Appropriations Committee
Sacramento, CA. 95814
RE: SB 739 (Speier), as amended August 8, 2008: OPPOSE
Hearing: Assembly Appropriations Committee, August 16
Dear Assembly Member Chu:
Consumers Union, nonprofit publisher of Consumer Reports, writes in opposition to
SB 739 (Speier) as proposed to be amended. SB 739 will do nothing to protect consumers from the danger of hospital-acquired infections. Consumers Union previously supported SB 1487 (Speier) from the 2004 session¬¬—a strong bill that required public reporting of hospital infection rates. That bill was sent to Gov. Schwarzenegger by the Legislature; regrettably, the governor vetoed it. The current bill, SB 739, however, does nothing to advance the issue and instead is far weaker than bills adopted in 15 other states. Enacting this bill will merely give the appearance of reform without any substance.
Hospital-acquired infections kill 90,000 Americans every year; two million patients – one in 20 – will get an infection in the hospital, according to the CDC. These infections cost the state hundreds of millions of dollars each year in Medi-Cal and other state funding for healthcare programs. Most of these infections are preventable.
Consumers Union launched a multi-state campaign for public disclosure of hospital-acquired infection rates in 2003. Since then, 15 have passed laws to provide consumers with this important patient safety information. Public disclosure provides a strong incentive for hospitals to act against this largely preventable problem. Specific data on which hospitals have low infection rates and which have high ones is the best way to ensure improvements in quality. Consumers, payers of healthcare (such as employers), health insurers, researchers and the media can all use this information. As long as hospitals can keep infection rate data secret, they have no incentive to improve.
SB 739 merely requires hospitals to have policies in place to prevent infections—so-called “process” measures. Process measures are things like: raising the head of the bed for ventilator patients; giving surgical patients the most effective antibiotic for their specific procedure 60 minutes prior to the operation and discontinuing them after 24 hours. While these actions are important, without any data on infection rates, we simply do not know if these measures actually work to lower the rate of infections in a hospital. To use a simple analogy: examples of process measures for a football team would be: how many team members show up for practice? How many hours do coaches spend preparing for the next game? While these measures are undoubtedly important for a team’s success, following them religiously does not necessarily translate into wins. Without keeping score, process measures tell us nothing about the outcomes and the actual performance—which is the bottom line for a sports team and for healthcare quality.
SB 739 adds nothing to current practice as all hospitals in the state probably already have policies for preventing infections. The problem is: they do not consistently follow them—and this is what reporting of actual infection rates would show. For example, policies for doctors and nurses to clean their hands between patients is at the core of every hospital infection prevention policy today, yet research has repeatedly shown that appropriate hand cleansing occurs only about 50% of the time. SB 739 fails to give us results-oriented accountability and it establishes no firm groundwork for “outcome” measures, such as hospital infection rates, in the future.
SB 739 selectively requires public reporting on only a portion of the measures listed in the CDC Guidance to Public Reporting issued in February, 2005, and developed by leading infection control experts to help legislators considering bills such as this one. Specifically, SB 739 completely disregards the two outcome measures that CDC includes in this guidance: rates of central-line-associated blood stream infections in the ICU that are confirmed by lab tests and rates of surgical site infections following selected operations. Even the limited public reporting of this bill is to be done at some unspecified time, on or AFTER Jan. 1, 2008.
The proponents of SB 739 claim that the Department of Health Services will check to see that the hospital policies are being followed. However, the department is limited to doing so during its routine surveys, which occur only once every three years. Further, this authority will not begin until Jan. 1, 2009.
All the public will be told as a result of SB 739 is whether or not their hospital has infection control policies in place¬–we will not know whether they actually follow these practices, but more importantly, we will not know whether their policies are resulting in a real reduction in the rate of infection at their facility. SB 739 requires that some information about preventing infections will become public–but it comes very late, sometime after Jan 1, 2008, a full year after we expect to see much of this information on the CMS federal “Hospital Compare” website. In 2007, we expect Medicare to begin attaching enhanced payment for hospitals reporting the rate at which they conduct surgical infection prevention practices.
Finally, SB 739 refers to the voluntary “CHART” project. CHART is a voluntary hospital report card supported by the California Healthcare Foundation. Hospitals can choose to stop participating in CHART at any time. CHART includes some limited hospital infection rate data information, but only on a trial basis and only for intensive care units. In any event, SB 739’s reference to a voluntary process demonstrates clearly the bill’s ineffectiveness.
If you have any questions, please contact Lisa McGiffert, Consumers Union’s “Stop Hospital Infections” Project Director, at 512-415-5405.
Lisa McGiffert, Project Director
A Project of Consumers Union
Earl Lui, Senior Attorney
West Coast Office
Consumers Union of U.S., Inc.
cc: Assembly Appropriations Committee Members and staff
Senate Jackie Speier