Hospital Report Card Act
Summary:
The Hospital Report Card Act allows Illinois consumers
access to information about hospital staffing and patient
outcomes. The
measure provides that some staffing and training
information will be disclosed by hospitals upon request,
while additional nursing and nosocomial infection data will
be reported to the Illinois Department of Public Health (IDPH),
which will release the information to the public. Under the Act, the reported data is subject to the
administrative rule-making process. Therefore, hospitals should be prepared to comply
with certain provisions of the new law and plan for future
compliance activity once the IDPH rules are finalized.
The following highlights key provisions and
outlines hospitals’ responsibilities under the Act.
Background
The Hospital
Report Card Act (SB 59) was introduced as a bipartisan
measure, cosponsored by Sens. Barack Obama (D-Chicago),
Christine Radogno (R-LaGrange), and Rep. Mary Flowers
(D-Chicago). The legislation had the backing of organized
labor, consumer and business groups. It is intended to
empower consumers by making quality information about
hospitals available to the public.
The bill, as originally proposed, would impose costly and
confusing tracking and administrative burdens on hospitals,
publish invalid mortality and morbidity data, allow
employees to make false accusations against hospitals with
impunity, and yield very little meaningful consumer
information. Although IHA supported the goal of helping
consumers make better health care choices, the Association
strongly opposed the original version of SB 59.
Given the strong bipartisan political support behind SB 59
simply opposing the bill was not realistic. Instead, IHA
alerted members to the bill’s implications, discussed it
with the IHA Board, and developed
alternative language that addressed concerns expressed by
members and membership groups, including the Board,
Executive Committee, Policy Council, and Patient Safety
Steering Committee.
Following numerous meetings with the sponsors and
supporters of the bill, IHA successfully negotiated an
agreement that satisfies most interested parties. The
following summarizes what new information Illinois
consumers will have access to under the Hospital Report
Card Act:
-
Unit
staffing schedules;
-
Nurse-patient
assignment rosters;
-
Hospital-specific
methodologies to determine and adjust nurse staffing
levels;
Records of
staff training;
-
Nursing
coverage, reported in standardized units;
-
Select
hospital-borne infections based on CDC definitions and
associated with burdensome consequences for the patient, as
well as high treatment costs;
-
Mortality
data that hospitals have been submitting for years to the
State that will be appropriately risk-adjusted, so that any
comparisons will be valid; and
-
An annual
progress report on the Act's prescribed activities to the
General Assembly
The Hospital Report Card Act is not only a landmark change
for consumers in Illinois, but for hospitals, their medical
staff, the professionals hospitals employ, and the Illinois
Department of Public Health. It requires key stakeholders
to work together via a data validity and data accuracy
protocol so that hospitals’ compliance efforts result in
more than just another data repository activity.
Consequently, Illinois consumers will have access to useful
information that reflects patient outcomes within the
context of nursing coverage.
The bill passed both Houses. A summary of the bill is
attached (click
here). The actual measure may be found at:
http://www.ilga.gov
by entering SB 59.
Discussion of
Key Provisions
A. Staffing
Levels (Section 15) Compliance
Date: 1/1/04
Because Illinois law
and hospital practice already followed stringent hospital
staffing mandates prior to this specific bill proposal, IHA
was able to successfully argue that additional staff
planning provisions and numerical ratios were unnecessary.
The statutory language for the new Hospital Report Card
incorporates existing Illinois Hospital Licensing
regulations governing nurse staffing for patient care
units. This means that hospitals should experience minimal,
if any, change to their current staff planning process.
While hospitals may continue their current staffing
processes, they are obligated as of January 1, 2004 under
this new Act to share their current unit schedules,
nurse-patient assignment rosters, and the methodologies to
determine and adjust staffing levels with the public upon
request. Each prospective schedule must reflect the
assigned nursing personnel for each day in light of the
unit's historical average daily census. The actual nurse
staffing assignment roster needs to be available at the
patient care unit for the effective date of the
nurse-patient assignment. Hospitals must keep all pertinent
nurse staffing records for five years.
B. Orientation and Training (Section 20) Compliance
Date: 1/1/04
The Act mandates
that a hospital’s orientation process provide not only
initial job training and information, but includes an
assessment of the direct care nurse’s ability to fulfill
specified responsibilities. Direct supervision of personnel
is required for those assessed not to be competent for a
given unit until such time that they have been evaluated as
appropriately trained. As of January 1, 2004 and upon
request, a hospital must provide consumers access to staff
training information that is free of any identifiable
patient, employee or licensed professional data.
C. Hospital Reports (Section 25) Compliance
Date: Await IDPH Rules
This section
requires that hospitals report specific nursing information
and nosocomial infection rates to IDPH for public
disclosure. In addition to annual vacancy and turnover
rates, the nursing data includes quarterly reporting of
nursing hours per patient day, average daily census and
average hours worked. The nosocomial infection rates
required to be reported quarterly will be developed by rule
and are to address the following named categories: Class I
surgical site infections, ventilator-associated pneumonia
and central line-related bloodstream infections.
The mandate also imposes a detailed data validity and
accuracy protocol that must be adhered to by the Department
prior to any public release of hospital information.
Therefore, hospitals should expect that the actual
implementation of this section is likely to be delayed
beyond January 2004 and until such time as the Department
organizes an advisory group, provides reporting formats,
and completes the rule-making process. IHA will be working
closely with IDPH on our members’ behalf during this
development phase and will keep our membership duly
informed.
D. Whistleblower Protections (Section 35) Compliance
Date: 1/1/04
Whistleblower provisions provide immunity from employer
actions for hospital employees who, in good faith, disclose
activities that they believe may pose a risk to the health,
safety, or welfare of hospital patients or the public. In
order to qualify for immunity under the Act, employees must
provide their managers a written notice of the problem and
a reasonable period to address the concern. In turn, the
manager is obligated to respond in writing within seven
days, acknowledging that notice was received.
IHA negotiated successfully to eliminate blanket protection
for employees who may make false or misleading claims.
Furthermore, hospitals are allowed to take corrective
measures to improve the performance of employees who report
they are unable or unwilling to perform an assigned task.
Conclusion
The Hospital
Report Card Act joins a growing national movement that
promotes sharing hospital performance and quality
information with the public. The issue no longer is whether
quality data are to be made public. For hospitals, the
challenge is finding a way to work in a leadership position
with other key stakeholders to realize meaningful
collection, submission and release of accurate information
that will help to improve the quality of patient care and
better inform the public. IHA is committed to working on
our members’ behalf in this regard.
Staff Contact:
Cathy Grossi: (630) 276-5706
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