Update - The Patient Protection and Affordable Care Act

Entering into its fourth month, the Patient Protection and Affordable Care Act (Health Care Reform) is starting to take some shape, even if only aemoeba-esque. Under the direction of the President, the federal Health and Human Services (HHS), Labor and Treasury departments must create new regulations defining patients' rights as they relate to health insurance. Perhaps one of the more widely publicized right under Health Care Reform prohibits health plans from denying coverage to individuals due to preexisting conditions. Set to take effect no later than September 23, 2010, many health plans have already adopted this directive.

Under Health Care Reform, patients should also anticipate to benefit from additional rights by the end of September. These rights may include:

• A prohibition against health plans from rescinding coverage due to unintentional mistakes on applications.
• A 30-day notice period to individuals before a health plan can rescind coverage.
• For plans that provide obstetrical and/or gynecological care, health plans can no longer require women to get prior authorization or a referral when they see an in-network doctor.
• The end of lifetime limits on health plans.
• The phasing out of annual limits on benefits by 2014. Depending on issuance or renewal dates, health care plans cannot set limitations below $2 million for 2012, $1.25 million as of September 2011, and $750,000 as of September 23, 2010.

New High Risk Insurance Exchanges

Last week the Federal Government announced the anticipated establishment of a new, "Pre-existing Condition Insurance Plan" (PCIP) designed to offer health care coverage to "high risk" individuals who remain uninsured. Administered by the Federal government for 21 states and directly by the remaining 28 states (including California and the District of Columbia), this new plan will offer insurance to qualifying individuals with the requisite pre-existing health condition, have been uninsured for at least six months, and are legal citizens or residents. Backed by $5 billion in federal funding, the PCIP is the first health plan to be established under the new health care reform legislation. The 21 states under Federal control opened this new plan to applicants last week, and the state-run exchanges should follow shortly.

Retrofitting Hospitals in California

With health care reform and electronic health records stealing the spotlight in hospitals across the nation, there is no better time than now to revisit the retrofitting requirements in California. Estimated to cost hospitals in California about $120 billion, California Senate Bill 1953 (SB 1953) was signed into law on September 21, 1994 (the same year as the Northridge Earthquake). This bill requires that all Hospital buildings designed prior to the 1973 building code, which have been identified as Structural Performance Category 1 (SPC-1) buildings, must either be demonstrated to meet higher seismic safety standards defined as Structural Performance Category 2 (SPC-2) by a Structural Engineer or be replaced or retrofitted to this higher seismic safety standard by 2013. Otherwise, the State may force these hospitals to close.

An SPC-2 Building can remain as an acute care facility until 2030 at which time it would have to remove its acute care services or be replaced or retrofitted to the seismic safety standards required by the current code. Newly designed buildings will have be determined to have higher Structural Performance Categories (SPC-3, 4 or 5) and are allowed to remain as acute care facilities to 2030 and beyond.

Coast Plaza has been working with the Structural Engineering firm John A. Martin & Associates and the Office of Statewide Health Planning and Development (OSHPD) in order to meet the numerous submittal requirements and corresponding deadlines outlined in the SB 1953 regulations. John A. Martin & Associates has successfully established with OSHPD that three out of the five acute care hospital buildings on Coast Plaza's campus subject to SB 1953 regulations have a Structural Performance Category 4 (SPC-4) and can remain as acute care facilities to 2030 and beyond. One out of the five hospital buildings on our campus will not require retrofit, but can remain as an acute care facility until 2030. Plans to finish the remaining building, a small structure that does not house hospital patients, are already under way, and the Hospital anticipates meeting the 2013 deadline.

The Vigilant Battle to Prevent Health Care Associated Infections

Nosocomial infections are infections that result from treatment in any health care facility (sometimes a couple of days after admission, and sometimes in the first month after discharge). Another name for this type of infection is "hospital-acquired infection", or "health-care associated infection".

Like most hospitals, Coast Plaza is committed to the prevention of health care associated infections (HAI). Coast Plaza has strict sanitation protocols regarding uniforms, equipment sterilization, washing, and other preventative measures. Indeed, thorough hand washing and/or use of alcohol rubs by all medical personnel before and after each patient contact is one of the most effective ways to combat nosocomial infections.

Washing hands as promptly and thoroughly as possible between patient contacts and after contact with blood, body fluids, secretions, excretions, and equipment or articles contaminated by them is a critical component of Coast Plaza's infection control and isolation precautions policies. It is also just as important that visitors follow these same procedures as Hospital staff to control the spread of infections. As an added measure, dispensers with sterilizing agents are located throughout the entire Hospital, available at all times for Hospital physicians, Hospital employees, and Hospital visitors.

Fortunately, this is one battle California hospitals do not need to face alone. Recently, the California Department of Public Health (CDPH) has received funding from the American Recovery and Reinvestment Act, allowing for an opportunity to accelerate this state-wide effort. Nine experienced infection preventionists (IPs) are now strategically located throughout different regions in the state to provide onsite and/or phone consultation to California's acute-care hospitals in support of the efforts related to HAI prevention, surveillance and reporting. These IPs are already working in collaboration with California Hospital Association (CHA) and the regional entities to support these efforts. As Coast Plaza continues to do its part in this battle, we are grateful for CDPH's support.

Coast Plaza is fortunate and grateful to work with Milad R. Shokair, M.S.P.H. in its battle against not just nosocomial infections but epidemiology and infection control hospital-wide. Overseeing Coast Plaza's program as well as programs in numerous other hospitals in Southern California, Milad's work includes: (a) surveying admissions, surgeries and laboratory reports in gathering information on infectious cases and nosocomial infections; (b) maintaining critical statistical data about these infections; (c) conducting timely education programs for hospital staff; (d) developing and reviewing infection control standards and practices for hospital departments; and (e) developing infection control programs and studies geared toward quality improvement and risk management.

With both a Bachelor of Science degree in biology and a Masters of Science degree in public health from the University of California, Los Angeles, Milad brings to Coast Plaza more than 30 years of experience in his field. Milad is a critical part of the Coast Plaza team.

Many thanks to Jackie Vinkler and Theodore Kirton of John A. Martin & Associates for helping with the overview on retrofitting in California.

Welcome Alice Louise, born July 5, 2010. No relation to the Alice quoted above.