Hospitals are anchor institutions in Washington State communities 24 hours a day, 7 days a week, 365 days a year. Hospitals have been crucial for Washingtonians during the COVID-19 pandemic, providing lifesaving inpatient and outpatient treatments and also vaccinations and testing. The Washington State Hospital Association (WSHA) strives to ensure that all our state’s diverse communities and patients have access to high-quality and equitable health care. Last year, Washington’s hospitals:
- Provided more than $330 million in charity care to patients and absorbed $1 billion in unpaid Medicare costs and $1.2 billion in unpaid Medicaid costs.
- Invested more than $285 million in community-building activities.
- Employed more than 119,000 people.
WSHA’s legislative priorities are grounded in the following key principles:
- Ensure patients have health coverage and access throughout the care continuum before, during and after hospitalization.
- Ensure hospitals are stable institutions serving their communities, long into the future.
- Maintain flexibility for hospital operations while mitigating new burdensome and costly regulations.
- Increase state funding for nurse education slots. Hospitals and other care settings are experiencing a critical shortage of nurses. Partnering with our state’s nursing unions, and other key stakeholders, WSHA strongly supports investments to expand the number of new nurse graduates and to help create a sustainable workforce of future nurses. Hospitals also support efforts to strengthen and improve the career ladder into the nursing profession.
- Increase state funding for long-term care for patients who are ready to be discharged and need post-acute care. No one should live in a hospital, but some patients are not able to be discharged to more appropriate post-acute care settings (such as a skilled nursing facility, adult family home or nursing home). The COVID-19 pandemic has exacerbated this situation. WSHA supports funding for DSHS assessors to ensure patients qualify for timely long-term care, providing increased dollars for low-income patients who need a legal guardian, and increasing Medicaid rates to support patients who need post-acute care.
- Make strategic investments in comprehensive behavioral health programs to ensure everyone in Washington has access to services in the most appropriate setting. Access to behavioral health services is lacking across the continuum of care. We need legislative investments in the behavioral health system of care, including behavioral health workforce development, expanded coverage of services, such as partial hospitalization and intensive outpatient treatment, and additional step-down options to ensure access to services before people are in crisis and after hospitalization.
- Maintain hospital stability. The pandemic continues to disrupt care delivery for hospitals and patients, which also impacts financial viability. Reductions in payment rates or new taxes could jeopardize hospitals’ long-term financial stability. The recent COVID surge has resulted in continued cancellation of non-urgent procedures and will have consequences on hospital revenues. In the short-term, we urge the legislature to be flexible in the potential need to support hospitals during this time and to adequately fund the Washington Medical Coordinating Center to ensure hospital resources are deployed appropriately across the state during times of increased need for hospital services. In the long term, WSHA supports a conversation about increasing the state’s low hospital Medicaid payment rates.
- Preserve flexibility in workforce and staffing. As the health care system confronts these extremely challenging times, the entire health care community must do our absolute best to ensure access to care for all patients. Hospitals across the country are facing critical staffing shortages, most acutely felt with a severe national shortage of nurses. Hospitals must be able to staff for patients during the pandemic and would oppose new mandates that impact workforce and staffing laws. WSHA would like the legislature to prioritize and invest in increasing the health care workforce.
- Allow recognized surrogate decision makers to consent to long-term care placement and services. A recent change in DSHS interpretation of federal and state law has led to a significant increase in patients in hospitals who must have a guardian appointed by a court to move out of the hospitals and into long-term care placement. We need to clarify state law to return to the previous framework that allowed close family and friends (listed in the state surrogate decision maker law) to consent to long-term care for their loved one.
- Allow hospitals to continue to merge, affiliate and engage in business transactions. The ability for hospitals to enter into appropriate mergers and affiliations should be maintained. Health care mergers in our state have led to continued access to health care services for patients across the state and in local communities. In other recent cases where hospitals did not merge and hospital closure occurred, services have been disrupted for patients.
- Seek clarification that the state’s use of force law (HB 1310) does not preclude law enforcement officers from carrying out their community caretaking role. Interpretation of changes in the use of force law have impacted the safety of hospital patients and staff and access to care for our community members in need of behavioral health services.
- Ensure increasing charity care requirements reflect differences in communities. WSHA strongly supports access to necessary hospital care for all Washingtonians, regardless of income. Income and family size vary significantly throughout our state. We need to ensure legislative changes in discount levels balance these differences. The best way to ensure access to health care is to support all patients enrolling and accessing comprehensive health care coverage.
- Oppose private “bounty hunter” type enforcement of employment laws (qui tam). WSHA opposes allowing individuals to sue employers for violating employment laws in exchange for a portion of the monetary proceeds. Washington State has an array of employment laws related to wages, safety, overtime and leave. California is the only state in the nation to have this type of law and it has proven to generate frivolous lawsuits.
- Ensure hospitals are not disadvantaged in contracting with health insurers. WSHA opposes the Legislature changing the dynamic of the contracting between hospitals and health insurers. Hospitals need to be able to ensure continuity of care, financial viability and access to services for their local communities. Involvement in private party negotiations may lead to unintended consequences.
- Allow nurses to distribute an opioid reversal medication in hospital emergency departments. Last year, the Legislature enacted a bill requiring hospitals to provide opioid reversal medication to certain patients at risk of an overdose. Unfortunately, the new law is too narrow in application and requires a prescriber to distribute the medication to patients in the ER setting. WSHA supports a fix to recognize current practice in hospitals.
- Ensure state business laws recognize unique hospital considerations. WSHA supports ensuring that new business laws recognize and appropriately address the unique differences between hospitals and other types of businesses. Any changes to our state’s business or environmental laws must account for the critical contributions our industry makes for patients and the economy.
- Modernize the hospital MRSA law. Update the existing state methicillin-resistant Staphylococcus aureus (MRSA) law with a proposal that recognizes modern infection control policies and approaches for multidrug-resistant organisms. The current MRSA law is out of date and inconsistent with scientific evidence, and it has been waived since the beginning of the pandemic.
- Maintain recognition of health privacy laws in consumer data privacy. WSHA supports efforts to enhance consumers’ access and control of their personal data. However, general consumer privacy laws must not disrupt the existing privacy and security standards of health information already regulated under state and federal laws, including federal Health Information Portability and Accountability Act (HIPAA).
- Increase and preserve access to behavioral health care. In coalition with behavioral health advocates and providers, WSHA supports comprehensive efforts to strengthen the behavioral health system of care across the continuum for all patients and acuity levels. We also support appropriate changes and advancements to “988” and related programs to increase and strengthen crisis services. WSHA would be concerned with proposals that fail to recognize that hospitals vary in the ability to care for certain complex populations. WSHA welcomes longer-term conversations about how to fill these gaps.
- Support thoughtful scope-of-practice expansions as a creative way to extend health care workforce capacity. With critical health care workforce shortages, WSHA supports deliberative and safe scope of practice legislation enabling providers to practice at the top of their licenses.
- Support in-person care provision for telemedicine. WSHA supports the telemedicine law to require an in-person visit for reimbursement for audio-only services with an exception for behavioral health.
Other Initiatives WSHA Supports
In addition to WSHA’s top priority issues for hospitals, we support two Medicaid funding proposals that will strengthen the underlying health care system upon which patients rely.
Long-term care. WSHA supports broad Medicaid rate enhancement for long-term care providers, whether this comes in the form of an extension of pandemic-related rate enhancements beyond the public health emergency or another formulation. The long-term care system needs to be supported for patients discharging from acute care hospitals, and everyone deserves access to quality long-term care.
Community behavioral health. Multiple legislative workgroups are advocating for a 7-percent Medicaid rate increase for community behavioral health providers. WSHA supports this effort to bolster the behavioral health system of care across the continuum and ensure people with behavioral health conditions have access to the right level of care when and where they need it.
-Chelene Whiteaker, SVP Government Affairs