Hospitals are anchor institutions in Washington State communities, operating 24 hours a day, 7 days a week, 365 days a year to provide lifesaving inpatient and outpatient care. Washington hospitals are the only care facilities that care for all patients, regardless of their ability to pay and are the safety net providers for their communities. 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.
In 2022, Washington’s hospitals employed more than 121,000 people. In 2022, hospitals provided more than $483 million in charity care. In 2020, hospitals invested more than $285 million in community-building activities. Hospitals also absorbed $2.4 billion in unpaid costs from government payers – $1.4 billion from Medicaid and $1 billion from Medicare.
WSHA’s 2024 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 financially stable institutions serving their communities, long into the future.
- Maintain flexibility for hospital operations while mitigating new regulations that often add costs and complexity to the care hospitals deliver.
Budget Priorities
- Complex discharge patients: Increase post-acute care capacity for patients who are ready to be discharged. No one should live in a hospital. The Legislature can improve patients’ ability to be discharged to more appropriate community settings, such as a skilled nursing facility, adult family home or residential setting. WSHA supports:
- Increasing slots for undocumented residents who would otherwise qualify for long-term care services.
- Expanding community settings and/or providers with expertise to care for children with developmental disabilities, who currently remain stuck in hospitals due to lack of capacity.
- Complex discharge patients: Improve timeliness of guardianship proceedings and availability of guardians for hospitalized patients. Patients in hospitals who cannot make their own decisions and need a court-appointed guardian typically are stuck in the hospital for four-to-six months solely because of the lengthy court process. These long lengths of stay further exacerbate hospital capacity and staffing challenges. WSHA strongly supports 1) funding to the Office of Public Guardianship to hire more public guardians for hospitalized patients who do not have a family member or friend able to serve as a guardian; and 2) funding for the courts to help people navigate the guardianship process.
- Provide state financial support for low-volume hospital labor and delivery (L&D) unit sustainability. It is increasingly challenging to keep low-volume hospital L&D units open in Washington State and across the nation. Hospitals must maintain L&D unit facilities, staff, and providers 24/7 to be ready in a moment’s notice to deliver babies, care for patients if something goes wrong and provide after-birth care. L&D providers include obstetricians, pediatricians, anesthesiologists and surgeons. A low volume of births requires hospitals to significantly subsidize payments for professional services to make sure L&D providers are always available. Low-volume birthing hospitals do not have the resources to subsidize these professional services. WSHA proposes a low-volume Medicaid add-on or supplemental payment for the professional fees for labor and delivery to sustain L&D services in low-volume hospitals. Additionally, some low-volume birthing hospitals do not provide enough Medicaid births for a Medicaid add-on payment to be effective. For hospitals with 200 or fewer Medicaid births each year, WSHA supports a $350,000 annual hospital L&D sustainability grant.
- Provide support for small public hospitals with labor and delivery units in meeting the requirements of the Reproductive Privacy Act. WSHA supports creative financing options to promote access in rural areas.
- Expand Medicaid access for adults to partial hospitalization and intensive outpatient mental health services. WSHA strongly supported the expansion of Medicaid coverage for these services to children and we continue to support expansion to adults. These programs provide important outpatient care to prevent hospitalization or critical follow up care after a crisis.
- Support a Medicaid increase to Medicare levels for professional services. WSHA strongly supports WSMA’s proposal to increase payments for professional services delivered to Medicaid patients by physicians, physician assistants and ARNPs. Financing for this increase would be through an assessment on state-regulated and Medicaid health insurers (covered lives). This is an important step to maintain access to primary and specialty services in our state.
Policy Priorities
- Ensure access to care is not threatened by reductions in payments to hospitals or policy changes that impact hospitals’ ability to deliver timely access to a range of services. Hospital leaders have already eliminated administrative positions, and in some cases reduced available services to control the massive losses from 2022. Hospitals across the state are still experiencing significant losses from operations (caring for patients). Operating losses in the first six months of 2023 were nearly $750 million. While the Safety Net Assessment Program will increase Medicaid payments, these payments will not cover all of the ongoing operating losses.
- Allow hospitals and providers to continue to merge, affiliate and engage in business transactions. Health care transactions in Washington State have maintained access to health care and hospital services for patients in local communities across the state that would otherwise have been lost. In recent cases where hospitals or clinics could not find a partner, they closed and significantly disrupted services for patients. WSHA supports maintaining access to services in the event of a health care transaction. We have strong reservations about the legislative approaches that have been advanced and the unintended consequences of negatively impacting the current not-for-profit hospitals in our state and advantaging out-of-state actors and private equity in health care transactions.
- Work force innovation
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- Support continuation of hospital at home services to Washington patients. WSHA supports legislation to provide a framework for the state Department of Health to regulate hospital at home services. Hospital at home services have been offered in the United States for more than 20 years. There was a significant increase in adoption after Centers for Medicare and Medicaid Services (CMS) launched the Acute Hospital Care at Home waiver program in response to the COVID pandemic. Hospital at home services allow appropriately selected patients to receive in-patient level care for certain conditions within their home. Studies show that patients experience improved outcomes and increased levels of satisfaction. Many states have continued their hospital at home programs; DOH needs a legislative solution to allow hospitals to continue offering services.
- Allow EMS personnel to work in hospitals with a new credential. Many hospitals, particularly those in rural areas, would benefit from the ability to use EMS personnel as bedside staff within the hospital. In some cases, this may mean allowing EMTs to stay with a critical patient at drop-off as long as they do not have another call. In other cases, rural EMS teams are operated on a volunteer basis and a hospital offer of paid employment would allow the EMS volunteers to remain in the area. WSHA supports this added flexibility in law for hospitals and EMTs, which has already been adopted by multiple other states, thanks to the benefits to patients it would provide.
- Protect hospitals’ ability to negotiate sustainable contracts. Hospitals must be able to negotiate with payors in a manner that provides sustainable payment and preserves continuity of care and patient access to local services. Efforts to increase carrier leverage in contract negotiations will result in fragmentation of care, loss of access for patients and increased out of network services.
- Health Care Cost Transparency Board (HCCTB) operations and governance. The HCCTB has established a health care cost growth benchmark for hospitals and other health care providers, but that benchmark must be realistic and methodologically sound. WSHA supports legislation to improve the HCCTB’s governance process and determine the health care cost growth benchmark methodology and process by rule. WSHA remains opposed to the enforcement measures and data reporting requirements proposed by HB 1508.
- Support the in-person care provision for audio-only telemedicine. WSHA supports maintaining the “established relationship” definition enacted via HB 1821 (2022) that requires an in-person visit every two years for audio-only telemedicine providers to receive reimbursement at parity for physical health services beginning July 1, 2024. This provision had been waived during the pandemic.
- Support a regulatory structure for pharmacy benefit managers. WSHA supports the creation of a regulatory structure for Pharmacy Benefit Managers (PBMs), including PBMs that control pharmacy benefits of insurers and groups not currently regulated by the state.
- Maintain recognition of health privacy laws in consumer data privacy and access to advances in health care technology. 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 the federal Health Information Portability and Accountability Act (HIPAA). It also must not disrupt important safety efforts, such as tracking opioid prescriptions. While WSHA supports responsible use of artificial intelligence (AI), regulations to ensure consumer privacy should not interfere with patient access to promising advances in health care technology and safety.
- Support modernization of state medical record retention law. WSHA supports a simplified record retention law requiring records to be kept for a defined period of 26 years. The Washington State medical record retention law for hospitals has not been updated since 1985, and it is based on when the patient was last seen or discharged. This language makes it difficult to manage and dispose of older medical records due to the complexities of tying those records to recent patient visits.
- 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.
