GOOD AFTERNOON WILL GO AHEAD AND
GET STARTED WITH THEIR HEARING
NOW WE WILL BE EXPECTING SOME
OTHER MEMBERS TO JOIN US BUT TO
THANK YOU FOR BEING HERE.
THIS IS A JOINT HEARING A SET
OF THE ASSEMBLY SENATE AND
HEALTH.
ON ON TWO INITIATIVES TODAY.
STATE LAW REQUIRES THAT WANTS
PROPONENTS OF A PROPOSED
INITIATIVE WHO GATHER TWENTY
FIVE PERCENT OF THE NUMBER OF
SIGNATURES REQUIRED. THEY
CERTIFY THAT THEY HAVE DONE SO
TO THE SECRETARY OF STATE.
THE SECRETARY OF STATE THEN
PROVIDES COPIES OF THE PROPOSED
INITIATIVE TO THE LEGISLATURE.
EACH HOUSE ASSIGNS THE PROPOSED
INITIATIVE MEASURE TO THE
APPROPRIATE COMMITTEES AND HOLDS
JOINT PUBLIC HEARINGS. AT LEAST
ONE HUNDRED THIRTY ONE DAYS
BEFORE UP BEFORE THE DATE OF THE
ELECTION AT WHICH THE MEASURES
TO BE VOTED ON IN THIS CASE JUNE
TWENTY EIGHTH.
HOWEVER THE LEGISLATURE CANNOT
AMEND THE PROPOSED INITIATIVE
MEASURE ARE PREVENTED FROM
APPEARING ON THE BALLOT.
SO HERE WE ARE.
I'D LIKE TO WELCOME YOU THANK
OUR SPEAKERS OF THE PROPONENTS
OF THE OPPONENTS FOR THEIR
PRESENTATIONS TODAY. THE GOAL OF
THIS HEARING IS TO HAVE A FAIR
IMPARTIAL PRESENTATION OF THE
RELEVANT FACTS ABOUT THIS
INITIATIVE TO THE ELECTORATE.
INTO A THE ELECTRIC EXCUSE ME
IN REACHING AN INFORMED JUDGMENT
REGARDING THIS MEASURE.
SO LET'S GET STARTED AFTERNOONS
WHICH I'D SAY OKAY.
BUT THAT'S WILL GO AND GET
STARTED WILL ASK OUR.
.
OUR FIRST.
.
PALESTINIAN UP AND BE RYAN WILL
SEE GOING TO BE SPEAKING TO US A
SENIOR BALL OF FISCAL POLICY
ANALYST FROM THE LA SHOW.
AND FRIEND.
MARK.
WE NEED CAN PROCEED WHENEVER
WHENEVER YOU'RE READY.
THANK YOU AND GOOD AFTERNOON HAD
CHAIRS MEMBERS OF THE
COMMITTEES.
AND THIS AFTERNOON WE'VE BEEN
ASKED TO PROVIDE AN OVERVIEW.
OF THE INITIATIVE I'LL BE
SPEAKING FROM A HAND OUT.
AND THAT YOU SHOULD HAVE
RECEIVED.
WRITTEN.
AND ALL BEGIN ON. PAGE ONE OF
THE HAND OUT JUST BY BRIEFLY
DESCRIBING THE ROLE OF THE
LEGISLATIVE ANALYST'S OFFICE.
IN THE INITIATIVE PROCESS.
.
BEFORE AN INITIATIVE GOES OUT TO
COLLECT SIGNATURES STATE LAW
REQUIRES OUR OFFICE ALONGSIDE
THE DEPARTMENT OF FINANCE TO
PREPARE. AN IMPARTIAL FISCAL
ANALYSIS
AND OF EACH INITIATIVE. AND THIS
AND ALICE THIS IS INTENDED TO
PROVIDE AN ESTIMATE OF THE
MEASURES FISCAL IMPACT ON STATE
AND LOCAL GOVERNMENTS AND A
SUMMARY OF THIS FISCAL IMPACT IS
INCLUDED. WITH THE CIRCULATING
PETITION.
ONCE A MEASURE HAS RECEIVED
SUFFICIENT SIGNATURES TO QUALIFY
FOR THE BALLOT STATE LAW ALSO
REQUIRES OUR OFFICE TO PROVIDE.
IMPARTIAL ANALYSIS AND THAT GOES
IN THE STATEWIDE VOTER
INFORMATION GUIDE.
AND THIS ANALYSIS SIMILARLY
INCLUDES A DESCRIPTION. OF THE
MEASURE AND IT'S PAST FISCAL
AFFECTS
AND WE ARE CURRENTLY IN THE
PROCESS OF PREPARING THESE
MATERIALS FOR INITIATIVES THAT
HAVE QUALIFIED OR WHICH. HAVE A
REASONABLE LIKELIHOOD OF
QUALIFYING FOR THE NOVEMBER
TWENTY EIGHTEEN BALLOT.
SO WITH THAT BACKGROUND.
.
ACTUALLY FIRST THOUGHT IS
VERIFIED ARE WE WERE SPEAKING
FIRST OF THE CHILDREN'S HOSPITAL
INITIATIVE NOW DALLAS OKAY.
MY APOLOGIES.
AND WITH THAT BACKGROUND.
PAPARAZZI BACKGROUND ON THE
INITIATIVE.
.
IN STAGE RENAL DISEASE ESRD IS
THE FINAL STAGE OF CHRONIC
KIDNEY KIDNEY FAILURE.
.
PATIENTS SUFFERING WITH THE SRT
MUST HAVE REGULAR KIDNEY
DIALYSIS OR TRANSPLANT IN ORDER
TO SURVIVE. AND KIDNEY DIALYSIS
ALLOWS.
AND FOR PATIENTS TO CONTINUE BY
NOT MAKING WHAT HEALTHY KIDNEYS
DO WHICH IS THE FILTER. WASTE
AND TOXINS FROM THE BLOOD
SUPPLY.
MANY HAVE PATIENCE WITH THE
AUTHORITY RECEIVED ALICE'S
TREATMENT IN CHRONIC DIALYSIS
CLINICS
WHICH ARE LICENSED BY THE
DEPARTMENT OF PUBLIC HEALTH TO
PROVIDE LESS THAN TWENTY FOUR
HOUR CARE. FOR THE TREATMENT OF
THE SRT PATIENTS.
AND THE DEPARTMENT PUBLIC HEALTH
WEBSITE CURRENTLY LISTS ABOUT
FIVE HUNDRED AND EIGHTY
LICENSED.
CHRONIC DIALYSIS CLIP CLINICS
IN THE STATE.
AND WE ESTIMATE THE TOTAL RENTAL
REVENUES TO THESE CLINICS TOTAL.
AROUND THREE BILLION DOLLARS
ANNUALLY.
I AM.
WE ALSO KNOW THAT THE MAJORITY
OF CHRONIC DIALYSIS CLINICS IN
THE STATE OUR OWN AND OPERATED
BY ONE OF TO.
FOR PROFIT PARENT COMPANIES.
DEFEAT A HEALTH CARE PARTNERS
AND FOR SENIORS MEDICAL CARE.
I'M ON PAGE TWO WE.
DESCRIBE HOW DIALYSIS TREATMENT
IS TYPICALLY PAID FOR.
PAYMENT COMES FROM A FEW
SOURCES TYPICALLY THE FIRST AND
MOST IMPORTANT AS MEDICARE.
THIS IS THE FEDERALLY FUNDED
HEALTH CARE PROGRAM FOR.
INDIVIDUALS AGE SIXTY FIVE AND
OLDER AND ALSO SOME INDIVIDUALS
WITH A CERTAIN DISABILITIES.
AND MEDICARE PROVIDES COVERAGE
TO ALL INDIVIDUALS WITH YES RD
PROVIDED THAT THEY MEET CERTAIN
WORK REQUIREMENTS.
AND.
AS A RESULT MEDICARE IS THE
PRIMARY PAIR FOR THE MAJORITY.
OF PATIENTS RECEIVING AND ALSACE
TREATMENT ACRON DOUBTS CLINICS.
UPON ANOTHER SIGNIFICANT PAYER
FOR DIALYSIS TREATMENT IS MEDI
CAL IN CALIFORNIA THIS IS.
OUR VERSION OF THE MEDICAID
PROGRAM AS YOU KNOW. AND THE
COSTS OF THIS PROGRAM ARE SHARED
BETWEEN THE FEDERAL AND STATE
GOVERNMENT. AND IN MANY CASES
INDIVIDUALS ARE ELIGIBLE FOR
BOTH MEDICARE AND MEDICAID HOW.
IN THOSE CASES MEDI CAL PICKS UP
A TWENTY PERCENT SHARE OF
TREATMENT COSTS.
THAT OTHERWISE WOULD BE BORNE BY
THE PATIENT BECAUSE THERE AND
MEDI CAL MEDICARE PICKS THAT UP.
IF AN INDIVIDUAL IS ELIGIBLE FOR
MEDI CAL ONLY THE MEDICARE
PROGRAM PAYS THE FULL COST OF
DOWNSTREAM.
FINALLY.
SOME.
ESRD PATIENTS HAVE PRIVATE
HEALTH INSURANCE COVERAGE THIS
COULD BE THROUGH AN EMPLOYER
SPONSORED PLAN OR THROUGH AN
INDIVIDUAL.
PLANETS PURCHASE FOR EXAMPLE ON
ON THE STATE'S ON HEALTH BENEFIT
EXCHANGE.
THESE INSURERS RECEIVE PREMIUM
PAYMENTS FROM EMPLOYERS AND AND
INDIVIDUALS AND THEN COVER AN
AGREED SET UPON A AGREED UPON
SET OF SERVICES AND DIALYSIS IS
A COMMON.
A COMMON BENEFIT IN IS IS IN
FACT AN ESSENTIAL HEALTH BENEFIT
UNDER UNDERSTATE STATE LAW.
I'M ONE.
.
NEW ONES THAT WILL BECOME MORE
IMPORTANT LATER ON IS THAT IN
SOME CASES HAVE GOVERNMENT.
PROGRAMS AND GOVERNMENT AGENCIES
CONTRACT WITH PRIVATE.
INSURANCE COMPANIES TO PROVIDE
HEALTH BENEFITS SO AN EXAMPLE OF
THIS WOULD BE. AND STATE
AGENCIES THAT PROVIDE HEALTH
COVERAGE FOR THEIR EMPLOYEES.
I'M THROUGH CALPERS FOR EXAMPLE
WILL CONTRACT WITH PRIVATE
INSURERS TO PROVIDE THOSE
BENEFITS FOR. AND PRIVATE
INSURERS IN SOME CASES CONTRACT
WITH AND THE MEDICARE PROGRAM TO
PROVIDE COVERAGE.
IT'S ON THOSE CASES IT'S A
PRIVATE ENTITY ACTING ON BEHALF
OF HE GOVERNMENT. AN AGENCY OR
PROGRAM.
NEXT WE'LL TALK A LITTLE BIT
ABOUT THE DIFFERENCES IN RATES
THAT ARE PAID FOR DIALYSIS
TREATMENT.
.
GOVERNMENT PROGRAMS LIKE
MEDICARE.
.
IN MOST CASES PAY A FIXED RATE
THAT'S ESTABLISHED THROUGH.
.
REGULATION AND IN THE CASE OF
MEDICARE RATES HARM ON AVERAGE
ONLY SLIGHTLY EXCEED THE AVERAGE
COST OF TREATMENT.
MEDICARE RATES ARE DIFFICULT TO
DIRECTLY COMPARE WITH MEDICARE
RATES BUT OUR UNDERSTANDING IS
THAT THEY. TYPICALLY ARE ARE
LOWER.
PRIVATE INSURERS AND SPEAKING
AGAIN ABOUT EMPLOYER SPONSORED
PLANS OR OR INDIVIDUAL MARKET
COVERAGE.
AND THEY NEGOTIATE WITH PAYERS
TO.
ARRIVE AT A RATE THAT THEY'LL
PAY AND THESE RATES ARE
ESSENTIALLY DETERMINED BY THE
RELATIVE BARGAINING. POSITION OF
THE INSURERS AND THE PROVIDERS.
AND ON AVERAGE INSURERS AND PAY
MULTIPLE TIMES WHAT GOVERNMENT
PROGRAMS PAY. FOR OUT PATIENT
DATA SERVICES.
NOW DESCRIBED THE MAIN
PROVISIONS OF THE INITIATIVE
BEGINNING ON PAGE FIVE.
THE. MAIN PROVISION REQUIRES
CHRONIC DIALYSIS CLINICS TO PAY
REBATES TO CERTAIN PAYERS.
WHEN THE CLINICS REVENUES EXCEED
A CAP THAT'S EQUAL TO A HUNDRED
AND FIFTEEN PERCENT.
CERTAIN SPECIFIED COSTS.
THOSE COSTS INCLUDE AND DIRECT
PATIENT CARE SERVICES COST AND
QUALITY IMPROVEMENT COSTS.
SO AS AN EXAMPLE.
.
A CLINIC WOULD BRING IN A
CERTAIN AMOUNT OF REVENUE IN A
CLINIC WITH SPEND A CERTAIN
AMOUNT ON CALL ON ON TREATMENT
AND OTHER EXPENSES IN THE
DIFFERENCE BETWEEN THOSE TWO.
WOULD BE THE PROFIT TO THE
CLINIC
AND TWO IT'S.
COMPANY THAT IT BELONGS TO IF
IT IF IT DOESN'T WANT TO HAVE. A
LARGER CHAIN OF OF CLINICS.
AND THIS MEASURE WOULD MEASURE
THAT WOULD IDENTIFY CERTAIN
COSTS AND CAP REVENUES THAT
HUNDRED FIFTEEN PERCENT OF THOSE
COSTS.
AND IF THE TOTAL REVENUES TO A
CLINIC EXCEED THAT REBATES MUST
BE PAID.
THE MEASURE REQUIRES THAT THESE
REBATE SPEAK CALCULATED AT THE.
WHAT IS WAS REFERRED TO AS A
GOVERNING AND ANY LEVEL?
WHICH REFERS TO THE ENTITY THAT
OWNS OR OPERATES THE CLINIC SO
IT WOULD NOT BE A CLINIC BY
CLINIC CALCULATION IT WOULD BE
AT A HIGHER.
SORT OF CORPORATE LEVEL.
AND AND THE MEASURE PROVIDES
THAT THE REBATES WOULD ONLY BE
PAID TO. NON GOVERNMENT PAYERS.
ANOTHER SIGNIFICANT PROVISION OF
THE INITIATIVE IS THAT.
.
THE MEASURE ENVISIONS THAT A CDC
OR A GOVERNING AND IN THE MIGHT
AT SOME POINT CHALLENGE THE
MEASURE ON THE GROUNDS THAT IT
UNCONSTITUTIONALLY.
IS IT IS THE TAKING OF PRIVATE
PROPERTY WITHOUT DUE PROCESS.
OR JUST COMPENSATION.
THE MEASURE REQUIRES THAT IF
SUCH A CHALLENGE IS SUCCESSFUL
AT THE CLINIC CAN DEMONSTRATE
THAT IT'S AN UNCONSTITUTIONAL
TAKING.
THAT THE REVENUE CAPS STILL
APPLIES EXCEPT THAT THE NUMBER
ONE HUNDRED AND FIFTEEN IS
REPLACED WITH A HIGHER NUMBER.
WHICH WOULD ALLOW A GREATER
AMOUNT OF REVENUES TO BE CAPPED.
.
SO THAT IT IS NO LONGER ON AN
UNCONSTITUTIONAL TAKING AND THE
BURDEN IS ON THE CLINIC.
TO SUPPLY THAT. THAT ALTERNATIVE
NUMBER THAT WOULD BE JUST ENOUGH
TO ALLOW IT TO NOT BE AN
UNCONSTITUTIONAL TAKING.
FINALLY THE MEASURE.
REQUIRES GOVERNING ENTITIES TO
SUBMIT VARIOUS INFORMATION TO
THE DEPARTMENT OF PUBLIC HEALTH
EACH YEAR.
RELATED TO THE REBATE
REQUIREMENTS THINGS LIKE THE
NUMBER OF TREATMENTS PROVIDED
THE AMOUNT OF REVENUES THAT ARE
BROUGHT AND THE AMOUNT OF COSTS.
AND THAT.
.
I COUNTED TOWARDS DETERMINING
THE CAP AND THE AMOUNT OF
REBATES THAT ARE PAID.
THOSE ARE THE MAIN COMPONENTS OF
THE INITIATIVE ON NOW TALK A
LITTLE BIT ABOUT. THE MEASURES
POTENTIAL IMPACTS ON CLINICS AND
ON STATE AND LOCAL GOVERNMENT
FINANCES.
.
LOOKING AT PAGE SEVEN.
WE BELIEVE THAT.
CHRONIC DIALYSIS CLINIC REVENUES
AND IN MOST CASES EXCEED THE CAP
THAT WOULD BE PUT IN PLACE BY
THIS MEASURE.
AND THAT IF CLINICS DID NOT
CHANGE THEIR BEHAVIOR IN ANYWAY
AND CONTINUED OPERATING AS THEY
DO NOW.
REBATES WOULD BE REQUIRED.
LIKELY IN IN THE HUNDREDS OF
MILLIONS OF DOLLARS.
I AM HOWEVER THE PRECISE AMOUNT
OF THE REBATES AND THE IMPACT ON
CLINICS IS UNCERTAIN FOR A FEW.
A FEW REASONS AM. THE AMOUNT OF
THE REBATES IS SIGNIFICANT FOR
CLINICS BECAUSE A LARGE AMOUNT
OF REBATES COULD POTENTIALLY
RESULT IN THE CLINIC.
HAVING NO PROFITS HAVING LOSSES.
WHERE IS A SMALLER AMOUNT OF
REBATES AND MAY NOT?
?
THE AMOUNT OF REBATES IS UNCLEAR
FOR TWO MAIN REASONS NUMBER ONE
THERE SEVERAL INSTANCES WHERE.
IT'S I'M UNCLEAR HOW THE MEASURE
WILL BE IMPLEMENTED IN PRACTICE.
AND WHAT ONCE AND YOU ASSUME A
CERTAIN IMPLEMENTATION OF THE
MEASURE IT'S UNCLEAR HOW
EXACTLY.
THE CHRONIC DIALYSIS CLINICS AND
THEIR GOVERNING ENTITIES WILL
RESPOND.
SO A LOT THROUGH SOME OF THOSE
UNCERTAINTIES AND TALK ABOUT A
RANGE OF POTENTIAL THINGS THAT
COULD HAPPEN.
ON PAGE EIGHT.
THE FIRST SOURCE OF UNCERTAINTY
ABOUT HOW THE MEASURE WOULD BE
IMPLEMENTED RELATES TO WHICH
COSTS.
WOULD BE INCLUDED WHEN
DETERMINING THE REVENUE CAP.
.
INCLUDING MORE COSTS RESULTS IN
HIGHER CAP.
SMALLER REBATES
AND RELATIVELY LESS IMPACT ON A
CLINICS BOTTOM LINE.
INCLUDING HAVE FEWER COSTS
RESULTS IN A LOWER CAP HIGHER
REBATES AND.
POTENTIALLY MORE NEGATIVE IMPACT
OF THE CLINIC'S OPERATIONS.
AS AN EXAMPLE. THAT WHEN
DEFINING DIRECT PATIENT CARE
COSTS ONE OF THE MAIN CATEGORIES
OF ALLOWABLE COSTS IN THE
MEASURE.
THE LANGUAGE AT IT
SCOOTS COSTS THAT ARE RELATED
TO.
.
BECAUSE CAN ONLY BE INCLUDED IF
THEY'RE FOR NON MANAGERIAL
STAFF.
.
HOWEVER THERE ARE A FEW
POSITIONS THAT THE FEDERAL
GOVERNMENT REQUIRES CLINICS TO
MAINTAIN. IN ORDER TO GET
MEDICARE REIMBURSEMENT
THAT.
IT'S NOT ENTIRELY CLEAR WHETHER
THEY WOULD BE CONSIDERED
MANAGERIAL OR NOT AND THESE ARE
THE MEDICAL DIRECTOR AND THE
NURSE MANAGER.
THEY'RE INVOLVED IN PROVIDING
DIRECT PATIENT CARE SO. ONE
MIGHT THINK THAT THEY COULD BE
INCLUDED AS A DIRECT PATIENT
CARE COST BUT ON THE OTHER HAND
THEY HAVE.
AND RESPONSIBILITIES THAT THAT
ARE MANAGERIAL. AND THE
PROPONENTS IN THE OPPONENTS OF
THE MEASURE DISAGREE. ABOUT
WHETHER THE COST OF THESE
PARTICULAR MANDATORY POSITIONS
THAT MEDICAL DIRECTOR AND THE
NURSE MANAGER.
WOULD BE INCLUDED. WHEN
DETERMINING THE REVENUE CAPS.
A SECOND SOURCE OF UNCERTAINTY
IS HOW PRIVATE INSURERS THE
CONTRACT WITH GOVERNMENT
AGENCIES AND GOVERNMENT PROGRAMS
WOULD BE TREATED.
AS WE NOTED PREVIOUSLY.
REBATES CAN ONLY BE PAID TO NON
GOVERNMENT PAIRS BUT.
.
PRIVATE INSURERS THAT ARE
RESPONSIBLE FOR PROVIDING CARE
FOR AN INADVERTENT OF VISUAL
PATIENT ON BEHALF OF A
GOVERNMENT AGENCY.
SUCH AS CALPERS.
OR ON BEHALF OF THE MEDICARE
PROGRAM.
AND MAY NOT BE CONSIDERED A A
GOVERNMENT PAYER.
.
A FINAL
POINT OF UNCERTAINTY IS HOW THE
LEGAL PROCESS THAT WOULD ALLOW
THE CAP TO BE RAISED HOW THAT
WOULD WORK IN PRACTICE.
OTHER STATE POLICIES THAT
REGULATE PRICES THAT CAN BE
CHARGED FOR GOODS AND SERVICES
HAVE ADMINISTRATIVE PROCESSES
WHERE THE REGULATED ENTITY CAN
DEMONSTRATE AND JUSTIFY THEIR
COSTS.
IN THIS CASE THE MEASURE
DEFINES ITS REVENUE CAP BY
FORMULA AND ALLOWS ADJUSTMENTS
ONLY THROUGH A COURT CHALLENGE.
AND WE'RE NOT AWARE OF.
A SIMILAR REGULATORY SYSTEM
THAT EXISTS TODAY AND AS A
RESULT IT'S UNCERTAIN HOW THE
PROCESS WOULD WORK IN PRACTICE
AND WHAT. LEVEL OF.
REBATES A COURT MIGHT CONSIDER
TO BE I'M CREATING AN
UNCONSTITUTIONAL TAKING.
I'M IN THE CASE OF ANY
PARTICULAR CLINIC OR GOVERNING
ENTITY.
ON PAGE TEN WE WALK THROUGH SOME
OF THE POTENTIAL CLINIC
RESPONSES.
GIVEN ANY AND INTERPRETATION OF
OF HOW THE MEASURE WOULD BE
IMPLEMENTED.
AND CLINICS WILL OF COURSE AND
LIKELY TAKE ACTION TO MINIMIZE
THE AMOUNT OF REBATES THAT THEY
WOULD HAVE TO PAY SO'S TO.
CONTINUE THEIR OPERATIONS.
.
THERE A FEW POSSIBLE RESPONSES
THAT COULD COME ABOUT TO ACHIEVE
THIS NUMBER ONE THE CLINICS
COULD MODIFY THEIR COST
STRUCTURES.
AND.
IF A CLINIC.
REDUCES COSTS THAT ARE NOT
COUNTED TOWARDS REVENUE CAP THEY
CAN KEEP THE SAME AMOUNT OF
REVENUE.
BUT THOSE REVENUES ARE NOTED
AGAINST A SMALLER AMOUNT OF
COSTS RESULTING IN.
MORE MORE PROFIT.
ALTERNATIVELY A CLINIC MAY HAVE
LESS INCENTIVE TO.
LIMIT COSTS THAT DO COUNT
TOWARDS THE CAP SINCE.
HAVING ADDITIONAL COSTS AND
ALLOWS REVENUES TO RISE.
AND ORDINARILY I HAVE A COMPANY
WOULD TRY AND LIMIT ITS COSTS.
GIVEN THE AMOUNT OF REVENUES BUT
IN THIS CASE INCREASING YOUR
COSTS ALLOWS YOU TO HAVE GREATER
REVENUES THAN YOU WOULD HAVE
OTHERWISE.
IN SOME CASES HAVE CLINICS MAY
CHOOSE TO LOWER THE RATES THAT
THEY CHARGE.
TO PAYERS IN PARTICULAR.
PRIVATE INSURANCE
SO AS TO AVOID HAVING TO PAY
REBATES.
AND IF.
A CLINIC. OR ITS GOVERNING AND
HE BELIEVES THAT IT CANNOT
ACHIEVE A REASONABLE RETURN
AFTER MAKING THOSE KINDS OF
ADJUSTMENTS THAT MIGHT SEEK
RELIEF.
THROUGH THE LEGAL PROCESS AND.
IF THESE CHALLENGES PROCEED IS
THE MEASURE OUTLINES THEY COULD
RECEIVE A HIGHER CAPITAL WHILE
THEM TO.
TO CONTINUE OPERATING THAT WAY.
AND FINALLY.
IN SOME CASES THAT REDUCED
REVENUES UNDER THE REBATE
PROVISIONS.
COULD RESULT IN.
CLINICS CLOSING GOVERNING
ENTITIES CHOOSING NOT TO OPEN AS
MANY CLINICS.
IF IF THEY DON'T HAVE ENOUGH.
RETURNED TO JUSTIFY THEIR
CONTINUING IN THE MARKET.
WHICH BEHAVIOR RESPONSE CLINICS
CHOOSE TO TAKE HOW WILL DEPEND
IN PART ON HOW IT'S IMPLEMENTED
HOW THE MEASURES IMPLEMENTED IF
THE MEASURE IS IMPLEMENTED IN. A
BROADER WAY THAT.
ALLOWS OF A WIDER RANGE OF
COSTS ACCOUNT IN DETERMINING
THAT REVENUE CAP.
THE MEASURE IS LESS LIKELY TO
NEGATIVELY IMPACT.
CLINICS VIABILITY AND CLINICS
ARE MORE LIKELY TO TAKE THE
FIRST TWO BEHAVIORAL RESPONSES
WHERE THEY WILL ADJUST THEIR
OPERATIONS TO MITIGATE THE
EFFECT.
OF OF THE REBATES.
ON THE OTHER HAND IF THE MEASURE
IS IMPLEMENTED WITH A MORE
NARROW DEFINITION OF COSTS.
AND REVENUE CAPS ARE LOWER
REBATES ARE MORE SIGNIFICANT.
IT'S MORE LIKELY THAT.
.
CLINICS ONGOING OPERATIONS WILL
BE WILL BE NEGATIVELY IMPACTED
AND THEY MAY BE MORE LIKELY TO
SEEK ADJUSTMENTS TO THE REVENUE
CAP.
OR TO SCALE BACK THEIR
OPERATIONS.
TO WRAP THIS ALL UP ON PAGE
TWELVE WE TALK ABOUT.
AND THE POTENTIAL FISCAL EFFECTS
ON STATE AND LOCAL GOVERNMENTS
FROM THIS MEASURE.
I GIVEN THE UNCERTAINTY THAT
WE'VE DESCRIBED THERE IS A RANGE
OF POSSIBLE OUTCOMES.
AND AGAIN GOING BACK TO A BROAD
INTERPRETATION OF THE MEASURE IF
THE REVENUE CAPS ARE RELATIVELY
HIGHER BECAUSE MORE COSTS ARE
COUNTED.
AND AND IF CLINICS ARE ABLE TO
MAKE ADJUSTMENTS IN THEIR
OPERATIONS TO.
GIVE THEM A SUFFICIENT RETURN
TO WANT TO CONTINUE OPERATING.
OR THEY'RE ABLE TO ACHIEVE
HIGHER REVENUE CAP THROUGH THE
COURT PROCESS.
AND IT'S POSSIBLE THAT CLINICS
WILL CONTINUE AS THEY DO TODAY.
BUT THERE WILL BE LOWER I
POTENTIALLY LOWER PRICES AND
PAID BY PRIVATE INSURERS.
IF THAT SCENARIO PLAYS OUT THESE
INSURERS MAY PASS ON.
A PORTION OF THIS POUND. THAT
THEY RECEIVE.
AND PAYING LOWER RATES TO STATE
AND LOCAL GOVERNMENT AGENCIES.
AND THE FORMER REDUCE PREMIUMS.
THE AMOUNT OF THESE POTENTIAL
SAVINGS IS IS UNCERTAIN.
BUT COULD BE AS MUCH AS THE ONE
MILLIONS OF DOLLARS ANNUALLY.
ON THE OTHER HAND IF THERE IS A
MORE NARROW INTERPRETATION OF
WHAT COSTS ARE DETERMINED TO BE
ALLOWABLE.
AND CLINICS. HAVE.
ARE NEGATIVELY IMPACTED IN AND
HAVE.
.
IF THE MEASURE NEGATIVELY
IMPACTS THE ONGOING VIABILITY OF
THE CLINICS.
THERE COULD BE FEWER NEW
CLINICS OPENING OR SOME CLINICS
CLOSING.
WHICH COULD RESULT IN SOME ESRD
PATIENTS RECEIVING DIALYSIS IN
NON CLINIC SETTING SUCH AS
HOSPITALS.
WHICH.
ARE GOING TO BE MORE EXPENSIVE
THIS WOULD RESIST RESULT IN
STATE COSTS IN MEDICARE HOW.
AND.
.
ALSO COSTS FOR STATE LOCAL
GOVERNMENTS.
THAT PROVIDE HEALTH BENEFITS TO
THEIR EMPLOYEES.
AND THE AMOUNT OF THESE
POTENTIAL COSTS IS UNCERTAIN BUT
THEY COULD BE SIGNIFICANT.
THAT WOULD BE MORE SHORT RUN
ROTH SHORT RUN EFFECT IN THE
LONGER RUN TIME WE EXPECT THE
BROADER ADJUSTMENTS IN THE
DIALYSIS INDUSTRY.
AND POTENTIALLY CHANGES TO HOW
THE MEASURE'S PROVISIONS ARE
IMPLEMENTED SUCH AS THROUGH
REGULATORY CHANGES.
JUDICIAL ACTION OR LEGISLATIVE
ACTION
AND WHICH IS ALLOWED TO FOR THE
PURPOSES OF THE MEASURE.
WOULD TEND TO REDUCE THE HIGHER
COSTS OVER TIME.
AND THAT WE DO NOT ALSO THAT.
THE DEPARTMENT OF PUBLIC HEALTH
WOULD HAVE INCREASED COSTS.
IN THE LOAN MILLIONS OF DOLLARS
ASSOCIATED WITH ADMINISTERING
THIS.
MEASURE THESE WOULD BE COVERED
BY INCREASED FEES PAID BY
CLINICS.
OVERALL BASED ON THE INFORMATION
THAT WE HAVE REVIEWED TO DATE.
AND IN LIGHT OF THE SIGNIFICANT
UNCERTAINTY ABOUT HOW VARIOUS
PROVISIONS OF THE MEASURE WOULD
BE IMPLEMENTED AND HOW CLINICS
WOULD RESPOND.
THE NET FISCAL IMPACT ON STATE
AND LOCAL GOVERNMENTS IS
UNCLEAR.
AND THAT CONCLUDES OUR OVERVIEW
AND WE WOULD BE HAPPY TO TAKE
ANY QUESTIONS YOU HAVE AT THIS
TIME.
QUESTIONS FROM THE DICE.
THEY HAVE BEEN QUESTIONS.
I DO I DO HAVE I DO HAVE ONE YOU
TALKED ABOUT TALK ABOUT A SORT
OF A GLOBAL.
PERCENTAGE.
OF.
AMOEBA NETWORK.
A PROFIT.
GLOBAL PROFIT SO IT IT WOULD NOT
BE AT NECESSARILY THAT IT'S NOT
NECESSARILY THE INDIVIDUAL
CLINIC LEVEL IT'S AT THE.
PARENT PART OF THE CORRECT IS A
DANGER OF THAT.
SO IT'S POSSIBLE INDIVIDUAL
CLINICS COULD OPERATE AT A LOSS.
SO THE IMPACT.
TO COMMUNITY COULD.
TO ME THAT'S HOW.
IF YOU GIVE ANY THOUGHT TO HOW
HOW THE INDUSTRY MIGHT RESPOND
AND THAT WE REQUEST ON HOW TO IS
HOW THE INDUSTRY RESPOND IF
SOMETHING'S INDIVIDUAL CLINICS
ACTUALLY DO OPERATE OUT A LOT.
BASED ON THIS NEW FORMULA THAT'S
CORRECT AND THE THE REBATES
WOULD BE CALCULATED AT THE
GOVERNING AND ANY LEVEL AND THAT
MEANS THAT WITHIN A GOVERNING
AND ANY THERE COULD BE SOME
CLINICS THAT DO BETTER THAN
OTHERS.
THE REBATES WOULD BE DETERMINED.
ON AGGREGATE AND IN FACT TODAY.
WITHIN GOVERNING ENTITIES
WITHIN THESE.
THESE GROUPS OF CLINICS ARE
CLINICS TO OPERATE AT A LOSS
NOW.
AND FOR VARIOUS REASONS IT COULD
BE BECAUSE THE CLINIC IS JUST
STARTING UP HAS RECEIVED A
CERTIFICATION TO GET MEDICARE.
REIMBURSEMENT AND THINGS LIKE
THAT AND THE CLINIC WILL
ESSENTIALLY SUBSIDIZE THAT THE
PARENT AND AND ANY WILL
SUBSIDIZE THE OPERATIONS OF THAT
CLINIC WITH.
WITH THE OTHER CLINICS
AND SO IN TERMS OF HOW THAT
COULD AFFECT.
GOVERNING ANY BEHAVIOR.
IT IS TRUE THAT IF YOU HAVE
FOUND.
CERTAIN CLINICS IN A GOVERNING
AND IF YOU WERE DOING WELL
ENOUGH TO SUBSIDIZE OTHERS THAT
COULD ALLOW. SOME CLINICS TO
CONTINUE OPERATIONS.
HOWEVER.
.
COMPANIES ARE LIKELY TO MAKE
CHOICES THAT WILL ALLOW THEM TO
MAXIMIZE.
THERE.
THEY'RE RETURNS AM GIVEN THE
THAT THE FRAMEWORK THAT THEY'RE
OPERATING IN AND WE STILL COULD
SEE SITUATIONS WHERE A GOVERNING
AND HE CHOOSES TO CLOSE. THE
LOWEST PERFORMING CLINICS TO.
ACHIEVE ON MARGINAL IMPROVEMENT
AND IN THEIR RETURNS.
ANY ANYONE ELSE HAVE ANY
QUESTIONS.
THANK YOU VERY MUCH APPRECIATE
THAT.
SEE NO LESS SUFFERS OUR FIRST
PANEL TO COME UP.
HAVE FOR.
THE PROPONENTS I'M SORRY IT
SHOULD QUESTIONS MADE THAT CLEAR
I'M SORRY
.
I KNOW THAT'S WHAT
OKAY LET'S GO AHEAD WHAT
DISTURBED WE HAVE ABOUT FIVE TO
SEVEN MINUTES REACH.
PERSONS PRESENT.
SO WHENEVER WHENEVER YOU'RE
READY PLEASE.
GREAT THAT.
THANK YOU FOR.
HEARING US OUT TODAY.
MY NAME IS MAGELLAN HANFORD.
I'M A DIALYSIS NURSE.
I'VE BEEN A DIALYSIS NURSE FOR
OVER SEVENTEEN YEARS.
AND I'VE SEEN THE INDUSTRY'S
PROBLEMS UP CLOSE.
I'VE SEEN PATIENTS BLEEDING OUT
IN THE PARKING LOT.
AND THE BATHROOMS.
AND AS A RETIRED LOS ANGELES
AREA POLICE OFFICER. THESE
SITUATIONS THAT REMIND ME OF
DIFFERENT CRIME SCENES.
NOW I'M HERE TESTIFYING TODAY
BECAUSE DIALYSIS PATIENT CARE IS
IN A CRISIS FOR THE SIXTY SIX
THOUSAND. BALLOTS IS PATIENTS
HERE IN CALIFORNIA.
WHOSE KIDNEYS HAVE A FAILED
THEM.
AND THEY RELY ON BALLOTS IS TO
STAY ALIVE.
NOW EVEN AS A AS A PATIENT CARE
SUFFERS.
PALACES CORPORATE PROFITS.
ARE OUT OF CONTROL.
AND THEY'RE OVERCHARGING DRIVES
UP HEALTHCARE COSTS FOR ALL OF
US.
PATIENTS HAVE REPORTED
BLOODSTAINS* ROACHES.
RATS AND CLINICS
STAFFING LEVELS FOR PATIENT CARE
TECHNICIAN'S ONE THE TWELFTH.
WANT ONE TECHNICIAN TO TWELVE
PATIENTS.
NURSES
TWENTY FOUR NURSES.
I'M A TWENTY ONE ONE NURSE FOR
TWENTY FOUR PATIENTS.
AND WHEN PATIENTS ON ABLE TO.
GET TO STAFF MEMBERS ATTENTION
THEIR LIVES COULD BE AT RISK.
SO WIERD ALICE'S CORPORATION
PUTTING PATIENTS LIVES IN
DANGER.
FOR ONE OF THE WORST.
AND MOST ON DEFENSIBLE REASONS
OF LAW.
SO THEY CAN MAKE BILLIONS IN
PROFITS HOW PEOPLE HAVE NO
CHOICE BUT TO GET THEIR
TREATMENT IN THEIR CLINICS.
NOW THE DIALYSIS INDUSTRY IN
CALIFORNIA IS DOMINATED BY TWO
COMPANIES.
THE VITA EFFORTS ENNIUS.
WHO OWN AND OPERATE SEVENTY TWO
PERCENT? OF THE CLINICS AND THIS
STATE.
THESE COMPANIES ARE MAKING A
MASSIVE PROFITS
THAT COULD OTHERWISE BE SPENT ON
THAT TREATING PATIENTS WITH THIS
DEADLY DISEASE.
THE PROFIT MARGIN OF THEIR
DIALYSIS CLINIC IS NEARLY FIVE
TIMES HIGHER THAN THE AVERAGE
HOSPITAL HERE IN CALIFORNIA.
THAT MEANS BIG MONEY.
PROFITS UP FROM THEIR U. S.
DIALYSIS OPERATIONS TOTALED
THREE POINT NINE BILLION DOLLARS
IN TWENTY SIXTEEN.
THAT'S BILLIONSAND THAT'S WHAT
THE BE.
NOW MOST CORPORATIONS WOULD
CONSIDER FIFTEEN PRINT PERCENT
PROFIT THAT WE TURN.
BUT THESE COMPANIES HAVE BEEN
SAYING AND I HAVE NO DOUBT THAT
THEY WILL SAY THIS HERE TODAY.
THATLIMITING THEM TO A FIFTEEN
PERCENT PROFIT MARGIN.
NOT THAT THREE HUNDRED AND FIFTY
PERCENT MARGIN THAT THEY OFTEN
GET FROM PRIVATE INSURANCE.
WILL CAUSE THEM TO CLOSE CLINICS
AND RESULT IN THE DEATH OF
PATIENTS.
NOW THE ONLY REASON THEY WERE
CLOSE CLINICS IS BECAUSE THESE
CORPORATIONS CHOOSE TO.
NOT BECAUSE THEY'RE FORCED TO.
TO ME AS A DIALYSIS NURSE FOR
OVER SEVENTEEN YEARS.
SUCH A HEARTLESS AND CALISTO AT
THE CLOSE CLINICS AND PUT LIVES
AT RISK.
S. POSES WHO THESE CORPORATIONS
REALLY ARE.
AND WHAT THEY REALLY CARE ABOUT.
AND LET'S BE CLEAR ITS PROFITS.
FOR MONTHS THEY HAVE REPEATED
OUT LOUD FOR THE WHOLE WORLD TO
HEAR.
THAT IF THEY CAN'T MAKE THESE UP
ST UP PROFITS.
BOB THIS TERRIBLE TERMINAL
ILLNESS.
THEY WILL CLOSE CLINICS
AND PEOPLE WILL DIE.
THIS INITIATIVE WILL BRING SOME
MUCH NEEDED SANITY IMBALANCE TO
THIS INDUSTRY.
WHICH DESPITE HUGE PROFITS
IT'S PUTTING PATIENTS THE REST
OF UNNECESSARY COMPLICATIONS AND
EVEN DEATHS.
ON A DAILY BASIS.
WE DESERVE BETTER.
CALIFORNIA'S DESERVE BETTER.
THE FAIR PRICING FOR DIALYSIS
ACT WILL BE ON THE BALLOT
NOVEMBER OF TWENTY EIGHTEEN.
AND IT WILL HELP IMPROVE PATIENT
LIVES.
AND LOWER HEALTHCARE COSTS FOR
ALL CALIFORNIANS.
BY LINKING REVENUE TO CARE THEN
ISSUE PROVIDES A STRONG
INCENTIVE FOR THE DALLAS IS
CORPORATIONS TO INVEST MORE AND
DIRECT PATIENT CARE.
SUCH AS STAFFING.
NEW EQUIPMENT.
AND IMPROVE FACILITIES.
THESE INVESTMENTS CAN RESTORE
SOME OF THE DIGNITY TO THE
PATIENT'S LIVES. AND REDUCE THE
RISK OF INFECTIONS WHICH WE WE
WE BELIEVE. WILL ALSO EXPAND
PATIENT LIVES.
BY STOPPING THESE COMPANIES FROM
OVERCHARGING WE ALSO WILL BRING
DOWN THE COST OF HEALTHCARE
INSURANCEPREMIUMS FOR ALL
CALIFORNIANS.
THE FAIR PRICING FOR DIALYSIS
ACT HAS BROAD PUBLIC SUPPORT.
WE'VE COLLECTED NEARLY SIX
HUNDRED THOUSANDS OF VOTER
SIGNATURES.
AND THAT'S MORE THAN ENOUGH TO
PLACE IT ON THE NOVEMBER TWENTY
EIGHTEEN BALLOT.
MANY STATE ORGANIZATIONS SUPPORT
THE MEASURE.
PATIENTS HEALTHCARE ADVOCATES
COMMUNITY GROUPS
CHARGERS.
AND LABOR UNIONS.
MORE THAN ONE HUNDRED
ORGANIZATIONS SO FOR HAVE JOINED
THE CAMPAIGN.
NOW COME NOVEMBER THE SIX
CALIFORNIAS WILL HAVE THE
OPPORTUNITY TO TAKE A STAND TO
IMPROVE THE QUALITY OF CARE AND
ALICE'S CLINICS.
AND LOWER HEALTHCARE COSTS FOR
ALL CALIFORNIANS.
NOW THE DIALYSIS NURSE.
I GOTTA TELL YA I CAN'T WAIT TO
VOTE FOR THIS.
THANK YOU.
YOU OPENLY WAS RELUCTANT LISTA.
I AM ALSO ADELE OF SPEAKING I
BEEN ANALYSIS BY LAST PAST EIGHT
YEARS.
PRETTY SOON UP BEYOND NINE YEARS
THIS COMING JANUARY THE TWENTY
FIFTH.
.
I EVER STATE MERE.
DID I ACTUALLY.
ON MY LIFE ABOUT BEING ON
DIALYSIS.
WHICH ARE CC HERE'S SKINNER READ
FOR ME BECAUSE MY. EYESIGHT IS
NOT TOO GOOD BECAUSE BLOOM FROM
ON. DIABETES AND ALICE'S.
HELLO GOOD AFTERNOON. MY NAME IS
ACTUALLY CECILIA GOMEZ GONZALEZ.
AND MIKE BOTH OF MY PARENTS WORD
DIALYSIS PATIENTS AS WELL.
BUT AS.
ON BEHALF OF ROBERT.
GOOD AFTERNOON MY NAME IS
ROBERTO ACOSTA.
I LIVE IN APPOINTED. A CITY IN
LOS ANGELES COUNTY AND I'VE BEEN
THE DALES PATIENT FOR EIGHT
YEARS.
BEFORE MY KIDNEYS FAILED I WAS A
TRUCK DRIVER FOR FORTY YEARS AND
LEVY AND LEFT GOLFING. HIKING
DIRT BIKE GRADING AND HUNTING.
BUT I CAN'T DO THOSE THINGS
ANYMORE.
INSTEAD EVERY MONDAY.
WEDNESDAY.
FRIDAY.
I'M IN TREATMENT AT THE DALLAS
CLINIC.
GRUELING. BUT IT'S WHAT I HAVE
TO DO TO SURVIVE.
I SPENT MUCH OF THE OTHER DAYS
RECOVERING.
DIALYSIS IS AN EXHAUSTING
PROCESS THAT REMOVES MY BLOOD.
CLEANS IT AND RETURNS IT TO MY
BODY.
EACH SESSION LASTS ABOUT THREE
TO FOUR HOURS.
I STARTED DIALYSIS IN TWENTY
TEN.
TWENTY TEN AT A CLINIC IN
IRWINDALE.
AND OVER THE NEXT SIX YEARS I
COMPLAIN MULTIPLE TIMES.
ABOUT POOR CONDITIONS BUT LITTLE
WAS DONE.
DURING FOUR SESSIONS IN TWENTY
FIFTEEN I SAW FLIES ENTERED THE
FACILITY THROUGH THE DOOR. THE
FLIES WOULD HOOK OVER AND LAND
ON PATIENTS INCLUDING ME.
DURING TREATMENT WE ARE
CONNECTED TO TO BEING WHICH MADE
IT DIFFICULT TO SHOO THE FLIES
AWAY.
I ALSO SAW COCKROACHES SCURRYING
ACROSS THE FLOOR. THAT CLINIC
AND.
HAD A.
HAD SPIDERS CRAWL UP MY ARMS.
CLINIC STAFF.
SAID THAT EXTERMINATOR SPRAYED
ONCE A MONTH BUT I KEPT SEEN
THEM AND I COULDN'T DO ANYTHING
BECAUSE. I WAS IN A VULNERABLE
POSITION HOOKED UP TO A DIALYSIS
MACHINE.
THE RUSSIANS AT THE CLINIC WORK
UNSANITARY.
THERE WAS OFTEN YEAR IN ON THE
TOILETS AND FLOOR.
WASTE BASKETS WERE OVERFLOWING
WITH PAPER TOWELS AND OTHER
TRASH.
I COMPLAINED AND WAS ASSURED
THAT MAINTENANCE CLEAN THE
RESTROOMS EVERYDAY BUT IT SURE
DIDN'T LOOK THAT WAY TO ME.
BEING TREATED IN THESE
CONDITIONS WAS FRIGHTENED
BECAUSE I CAN EASILY GET AN
INFECTION.
FROM WHERE THE TUBING IS
INSERTED IN MY BODY AND I END UP
IN THE HOSPITAL.
AFTER SIX YEARS I LEFT FOR A
DIFFERENT CLINIC.
I AM GRATEFUL TO BE GONE BUT I
KNOW THAT ORINDA CLINIC WAS NOT
AN EXCEPTION BASED ON WHAT OTHER
PATIENTS HAVE TOLD ME.
WE DESERVE BETTER AND THAT'S WHY
I'M SUPPORTING THE FAIR PRICING
FOR DIALYSIS ACT.
WE NEED TO IMPROVE PATIENT CARE
BY INVESTING MORE IN STAFF BEING
EQUIPMENT AND FACILITIES.
DIALYSIS IS NOT A CHOICE FOR ME.
THIS IS A LIFE OR DEATH
SITUATION.
AS MUCH AS MY BODY IS IN PAIN
FROM DIALYSIS.
I KEEP GOING BECAUSE MY CHILDREN
AND MY GRANDKIDS.
I LOVE SEEING THEM HAPPY AND
PLAYING TOGETHER AND I'M STAYING
ALIVE FOR THEM.
I DON'T BELIEVE THE CORPORATIONS
THAT OWN THESE CLINICS CARE
ABOUT MY LIFE. OR MY STRUGGLE TO
SURVIVE.
I DON'T BELIEVE THEY GIVE ME A
SECOND THOUGHT. TO THEM I AM
JUST A NUMBER ON A SPREADSHEET
AND THEY'RE TAKING ADVANTAGE OF
ME.
THIS BAD BALLOT MEASURE WILL
HELP REVERSE THAT.
IT MAY NOT MAKE THE PEOPLE WHO
PROFIT FROM MY ILLNESS SEEN ME
AS A REAL PERSON WITH FEELINGS
AND THE FAMILY.
BUT IT WILL FORCE THEM TO TREAT
ME AND MY FELLOW PATIENTS
BETTER.
AND FOR NOW THAT'S GOOD ENOUGH
FOR ME. THANK YOU.
BLOOM.
I'M PASSED AWAY EMPTY SMART
JUNIOR.
PRESIDENT AND CEO OF THE
SOUTHERN CHRISTIAN LEADERSHIP
CONFERENCE
OF SOUTHERN CALIFORNIA.
THE ORGANIZATION THAT DOCTOR
MARTIN LUTHER KING JUNIOR FOUND
IT AND IN FACT HE FOUND THAT THE
ONE. THAT I'M THE PRESIDENT OF
IN LOS ANGELES.
I'M HERE TODAY BECAUSE AS DOCTOR
KING OFTEN CAME TO SITUATIONS.
THERE'S AN INJUSTICE HERE.
IN FACT DR KING STATED ALL OF
ALL THE FORMS OF BEEN IN THE
QUALITY. INJUSTICE IN THE HEALTH
CARE. IS THE MOST SHOCKING IN
INHUMANE HE SAID THAT IN
NINETEEN SIXTY SIX.
AT THE MEDICAL COMMISSION FOR
HUMAN RIGHTS.
I'VE WATCHED AND I'VE LISTEN AND
I'VE VISITED I'VE SEEN IN MY
PAST STORY.
CAREER OF OVER FIFTY YEARS.
AND IRAQ'S I'M ONLY FIFTY EIGHT
SO I STARTED AT EIGHT YEARS OLD.
LOOKING AT JACK AND JUSTICE IN
FIGHTING FOR PEOPLE WHO COULDN'T
FIGHT FOR THEMSELVES.
YOU WERE HERE TODAY BECAUSE THEY
ARE PEOPLE WHO CAN'T FIGHT FOR
THEMSELVES.
EVEN THOUGH WE'VE HEARD THE
VOICES OF SOME OF THEM TODAY AND
THEY'VE GOT SO MANY SIGNATURES.
BUT THERE ARE GOING UP AGAINST A
GOOD LIE.
IN THE INDUSTRY THIS SEEMINGLY
DOESN'T CARE ABOUT THE COMMENT
BROTHER AND SISTER WHO STRUGGLES
EVERY DAY.
THIRTY SIX PERCENT OF.
THE DIALYSIS PATIENTS AND ARE
AFRICAN AMERICANS IN EVEN THOUGH
THEY ONLY MAKE UP TWELVE WE ONLY
MAKE UP TWELVE PERCENT OF THE
POPULATION.
THESE PATIENTS GOAL.
OF ALL COLORS IN ALL RACES GOAL
TO UNLOCK.
THE GOAL INTO THESE CLINICS.
PATIENTS ARE THERE BECAUSE
THEY'RE VERY SICK.
THEY NEEDS TO GET DIALYSIS THREE
AND FOUR TIMES A WEEK JUST TO
STAY ALIVE.
THEIR CONDITIONS
MAKES THEM PARTICULARLY
VULNERABLE SWIM FACTION IN OTHER
ILLNESSES.
THESE CLINICS OR SOME OF THE
NASTIEST AND DIRTIEST ONES IN
THE COUNTRY.
TOO MANY OF THEM FACE SUB
STANDARD CONDITIONS IN THESE
COME TO THESE CLINICS WHEN THEY
GO THERE FOR TREATMENT. AS
YOU'VE HEARD.
PATIENTS AND CAREGIVERS REPORT
INSTANCES ABOVE THE BLOODSTAINS
SO OFTEN THERE ARE NOT ENOUGH
STAFF.
TO PROPERLY CARE FOR THEM WHEN I
TOOK A MEMBER OF MY CHURCH TO A.
TO A HOSPITAL'S DIALYSIS THERE
WERE TWO PEOPLE WATCHING OVER
THEM CONTRA CONSTANTLY I'VE
HEARD REPORTS IN THESE THAT
SOMETIMES THERE'S ONE PERSON ONE
CAREGIVER RESPONSIBLE FOR THREE
OF FOUR PEOPLE. THAT'S AWFUL.
SO OFTEN THAT HAPPENS IMPATIENCE
ARE NOT TREATED FAIRLY.
SO WE'RE HERE BECAUSE AN
INJUSTICE IS HERE.
WE'RE HERE BECAUSE WE WANT TO
CHANGE THIS
AND WE'RE HOPING TO THE FAIR
PRICING FOR DIALYSIS IS THAT.
THAT THAT WOULD MAKE A CHANGE A
VERY IMPORTANT CHAINS
THE INDUSTRY HAD AN OPPORTUNITY
TO DO IT. BUT THEY DIDN'T DO IT
SO NOW WE THE PEOPLE HAVE SPOKEN
IN NOVEMBER SIX WE'RE GOING TO
PROVE SO THIS INDUSTRY HOW THEY
MISSED AN OPPORTUNITY TO WORK
TOGETHER WITH US.
WE'RE CONCERNED ABOUT THEM
BECAUSE THEY PUT MONEY BEFORE
MORALITY FINANCES BEFORE FAMILY
DARLA'S BEFORE DECENCY PROFIT
BEFORE PEOPLE EARNINGS BEFORE
ETHICS
INCOME BEFORE INDIVIDUALS SO
WHERE HERE THE DAY THE SAME. WE
ARE NOT GOING TO TAKE THIS
ANYMORE WHERE YOU BELIEVE IN
THESE PEOPLE AND ARE PEOPLE
GETTING A FAIR HEARING IN THE
FAIR OPPORTUNITY EVERY TIME THEY
WALK INTO.
THANK YOU.
JOHN ALLEN HERE TO ANSWER TO.
AFTER THAT I
OKAY.
IF YOU THINK YOU.
.
I DO HAVE A COUPLE.
QUESTIONS IN THEIR TECH.
GOING GOING TOWARD YOU JEFF.
.
THERE'S.
.
I THINK WAS BROUGHT UP IN THE
ALLEY OWES ANNOUNCES SOME
QUESTIONS ABOUT.
YOU KNOW DEFINITIONS AROUND NON
MANAGERIAL CHRONIC.
PRODUCT AYE CHRONIC DIALYSIS.
A CLINIC STAFF.
.
OUR MEDICAL CONSIDERED A MEDICAL
DIRECTORS CONSIDERED
ADMINISTRATORS.
AND DO THIS MEDICAL TRYING
UNDERSTAND WHAT THE INTENT IS SO
THE INTENT OF THE MEDICAL
DIRECTORS ARE INCLUDED IN THE
DEFINITION OF PATIENT CARE. AND
FOR US THAT WAS MADE INCREDIBLY
CLEAR. WHEN WE USE THE AMENDMENT
PROCESS.
OF THE INITIATIVE BECAUSE
INITIALLY WE HEADS EXPLICITLY
EXCLUDED MEDICAL DIRECTORS. BUT
BASED ON FEEDBACK DURING THE
AMENDMENT PROCESS WE STRUCK
THOSE.
OF STRUCK THAT MENTION OF
MEDICAL DIRECTORS BEING
EXCLUDED.
SO.
BOTH.
BY THE INTENT AND ALSO WE WOULD
SAY THAT BY THAT DEFINITION THE
MEDICAL DIRECTOR IS NOT AN
EMPLOYEE OF THE CLINIC.
OF. THEY ARE THEY'RE AN EXTERNAL
MEDICAL DIRECTOR. OF AND SO WE
ARE CONFIDENT THAT A READING OF
THE THE INTENT AND THE
INITIATIVE LANGUAGE WOULD
INCLUDE MEDICAL DIRECTORS
SO WITH THOSE SALARIES AND
INCLUDED IN THE GLOBAL CAPTAIN
YES.
OKAY.
AND TO YOU AND YOU KNOW HOW MUCH
ON AVERAGE.
PRIVATE INSURERS PAY FOR
DIALYSIS.
AND MEDI CAL. AND MEDICARE.
SO PRIVATE INSURANCE PAYS ME
SAKE APPROXIMATELY A THOUSAND
DOLLARS.
BASED ON THE DIFFERENT
CONTRACTS.
MEDICARE ROUGHLY TWO HUNDRED
AND FIFTY DOLLARS.
AND MEDI CAL SOMEWHAT LOWER.
SO THE DIFFERENCE BETWEEN THAT
COMMERCIAL AND THAT MEDICARE
RATE. IS SUBSTANTIALLY LARGER
THAN WE SEE IN MANY OTHER
COMMERCIAL HEALTH CARE FEELS.
FOR MEDI CAL IS LESS THAN TWO
HUNDRED FIFTY DOLLARS YEAH BUT
MEDICARE PAYS.
AND YOU HAPPEN TO KNOW HOW MANY
PATIENTS ARE PRIVATE PAY IN OF
THE SIXTY SIX THOUSAND PATIENTS
HOW MANY ARE PRIVATE PAPERS IS.
THOSE THAT ARE ON MEDI CAL AND
MEDICARE.
THE ROUGH BREAKDOWN IS THAT IT'S
APPROXIMATELY EIGHTY PERCENT
MEDICARE.
DIALYSIS IS A CARVE INTO
MEDICARE EVEN FOR PATIENTS WHO
ARE UNDER SIXTY FIVE NOT
DISABLED. SO THE VAST MAJORITY
PATIENTS ARE ELIGIBLE FOR
MEDICARE. THERE'S ROUGHLY.
TEN PERCENT.
MEDIC HAL.
AND THEN ROUGHLY TEN PERCENT
COMMERCIAL.
THOSE NUMBERS FLUCTUATE SOME
EACH YEAR.
AND THEN HOW HOW DID HOW DID YOU
COME UP WITH WHAT YOU CONSIDER
FAIR AND REASONABLE PAYMENT.
WE LOOKED TO THE ACA.
RATIO IN THE AFFORDABLE CARE
ACT.
THAT REGULATES WHAT IS
CONSIDERED A FAIR AND REASONABLE
ADMINISTRATIVE AND PROFIT.
FOR GROUP HEALTH PLANS.
THEN THE RATIO THERE IS CITED
EIGHTY FIVE PERCENT PATIENT CARE
AND FIFTEEN PERCENT
ADMINISTRATIVE AND PROFIT.
SO. WE BASED IT AROUND THAT ACA
FRAMEWORK FOR HEALTH PLANS.
SO YOU'VE YOU'VE ESSENTIALLY.
TREATED SO YOU'RE LOOKING AT AS
AS IF.
ONE OF THESE COMPANIES IS A
HEALTH PLAN.
IT WAS MORE THAT THAT THAT THAT
LANGUAGE THAT THAT RATIO AND
THAT FRAMEWORK HAD ALREADY BEEN.
INVESTIGATED ITEMS TESTED IN THE
ACA AND SO AS WE WERE LOOKING TO
WHAT IS THAT RIGHT NUMBER.
DO WE AND TWO WE GO WITH
SOMETHING LIKE A. OF PERCENTAGE
OF ABOVE MEDICARE OR PERCENTAGE
OF MEDI CAL. OR COST BASED
AND SEEING THE ACA'S FRAMEWORK
OF THAT COST BASED. OF.
AS.
OPERATING WELL IN THE CA.
AND REALLY SEEING THAT. A
SUCCESSFUL MODEL WE LOOKED TO
EXTENDED DOWN AND WHAT IS THIS
VERY UNIQUE INDUSTRY.
WITHIN HEALTH CARE FOR THERE IS
SUCH MARKET CONSOLIDATION SUCH
MONOPOLY.
TO TREATED A LITTLE DIFFERENTLY
THAN THE REST OF HEALTH CARE SO
HAS THAT BEEN EXPLORED ANYWHERE
ELSE OTHER MEANS OTHER THAN
THROUGH THIS INITIATIVE OR
THROUGH THIS.
THROUGH THIS APPROACH BECAUSE I
BUT NOT I'M GONNA MOMENT I'M
ASKING JUST CURIOUS BECAUSE I AM
NOT AWARE THAT.
THAT THIS.
HAS BEEN APPLIED TO OTHER AND IN
ANY OTHER STATE SO IS THIS IS
THIS UNIQUE IT'S FAIRLY NOVEL
APPROACH WITHIN.
WITH INTO ALICE'S IN PARTICULAR
BUT IT IS. IT DOES ALSO. MIRROR
TO SOME EXTENT THE WAY THAT WE
ADDRESS OTHER MONOPOLIES AND
OTHER HIGHLY CONCENTRATED
INDUSTRIES.
FOR EXAMPLE SOMETHING LIKE.
.
A PROFIT SETTING REGIME WITHIN A
UTILITY.
OR OTHER MONOPOLY ARE HIGHLY
CONCENTRATED MARKETS BUT WITHIN
A HEALTH CARE WITHIN A DIALYSIS.
INDUSTRY THIS IS FAIRLY UNIQUE
MODEL SO FAR.
WE'RE LOOKING FOR TO SPREAD TO
OTHER STATES.
AND.
OF.
MY MISTER MAKES PERSON.
IT DOESN'T THOSE NUMBERS WERE
INTERESTING ABOUT THAT RELEASE
ONLY TEN PERCENT PRIVATE PAYERS
SO IF EIGHTY PERCENT IS MEDICARE
TEN PERCENT IS MEDI CAL THE
OTHER TEN PERCENT SO.
HOW WILL LIMITING WHAT INSURANCE
COMPANIES PAY HOW IS THAT GOING
TO BOMB IMPROVE CARE FOR?
DIALYSIS PATIENTS.
SO. THE WAY THAT. THE WEIGHT THE
INITIATIVE IS SET UP.
IS THAT DIALYSIS.
COMPANIES APTLY AT THE CORPORATE
LEVEL. WOULD BE ABLE TO ADD
TOGETHER ALL OF THEIR PATIENT
CARE COST.
SO WHETHER THAT PATIENT CARE
EXPENSE WAS ON BEHALF OF A MEDI
CAL PATIENT OR ON BEHALF OF THE
COMMERCIAL PATIENT.
THOSE WOULD ALL GO INTO THE SAME
COOL OF PATIENT CARE COST.
AND THAT WOULD BE COMPARED TO A
POOL OF REVENUE.
AGAIN FROM COMMERCIAL PATIENTS
PAYERS AS WELL AS GOVERNMENT
PAYERS.
AND THEN IF THAT REVENUE EXCEEDS
THE PATIENT CARE COST BY MORE
THAN FIFTEEN PERCENT. THAT WOULD
TRIGGER THE REBATES SO WHAT IT
ACTUALLY DOES IS CREATE THE
INCENTIVE.
FOR DIALYSIS CLINICS TO
TREAT MEDI CAL AND MEDICARE
PATIENTS.
THE EXACT SAME WAY THAT THEY
TREAT COMMERCIAL PATIENTS BE
BECAUSE THEY'LL GET EVERY DOLLAR
THEY INVEST.
IN A PATIENT'S CARE.
WHETHER THAT PATIENTS MEDICAL OF
MEDICARE OR COMMERCIAL WILL GO
TO RAISE THEIR OVERALL CAP.
A.
STRIP STRUGGLING WITH ECONOMICS
THAT A LITTLE BIT DOWN.
SO WILL ONE OF THE STATED GOALS
OF THE INITIATIVES THE FORCED
ALICE'S CLINICS TO HIRE MORE
WORKERS.
SOMEHOW WILL CLINICS BE ABLE TO
DO THAT IF THEY'RE CAP ON COSTS.
NOTHING CREE IN INITIATIVE
CREATES A CAP ON COSTS.
A BONE. IF AS THE COSTS RISE AS
THEY HIRE ANOTHER NURSE AS THEY.
STAFF BETTER. BY YOU BY NEW
SUPPLIES EXPAND TO NEW CLINICS.
THAT WOULD MEAN THAT THERE THAT
THE REVENUE THAT THEY CAN KEEP
AT THE END OF THE YEAR WHAT RISE
THERE'S NO CAP ON COSTS.
YEAH I'M LIKE A KIND OF FOLLOW
UP ON THE COMMENT YOU MADE WITH
REGARD TO THE ABILITY TO TREAT
MEDI CAL MEDICARE PATIENTS
EQUALLY AS.
.
SAY PRIVATE BEER COMMERCIAL AND%
SELECTORS TO ISSUES AT HAND
NUMBER ONE IS THE TREATMENT OF
THE PATIENT WHICH I HAVE SOME
EVIDENCE HERE OF INDIVIDUALS ARE
SAYING THIS.
AND THEN THE EXTREME PROFITS
THAT YOU'RE NOT STATING THAT THE
DIALYSIS INDUSTRY WHICH IS.
BEING DOMINATED BY ESSENTIALLY
TWO ENTITIES IS MAKING.
WHAT EVIDENCE DO YOU SHOW OR DO
WE HAVE BECAUSE I HAVE A REAL
PROBLEM IF SOMEBODY ON MEDICAID
OR MEDICARE IS BEING TREATED
DIFFERENTLY THAN SOMEBODY IN
COMMERCIAL?
WHAT KIND OF ANECDOTAL EVIDENCE
DO WE HAVE?
BUT SENATOR YEAH I'D LIKE TO
SPEAK TO THAT.
.
AS A DIALYSIS NURSE WORKING FOR
TO BE TO ENFORCE ANY HAS I'VE
SEEN FIRSTHAND. WHERE THE
INDUSTRY HAS?
?
PRETTY MUCH.
TAKEN THE RELATIONSHIP THAT I
HAVE AS A NURSE.
BUT MY PATIENTS AND SOCIAL
WORKERS HAVE WITH THEIR
PATIENTS.
AND HAVE IN.
BECAUSE THIS TO ENGAGE PATIENTS
AND TO TRY TO CONVERT THEM FROM
THEIR MEDICARE HOW. AND THEIR
MEDICARE AND TO THESE PRIVATE
INSURANCE'S.
PURELY FOR PROFIT.
.
THEY DISGUISE IT.
BOB VERY WELL.
PATIENTS ARE REALLY NOT
INFORMED ABOUT WHAT THEY'RE
DOING AND WHAT THE.
THE CONSEQUENCE OF THAT IS.
FOR ITS AS IF THEY GET A
TRANSPLANT.
WHAT HAPPENS IS A PATIENT WILL
NO LONGER BE QUALIFIED TO
RECEIVE A THIRD PARTY PAYER FROM
THE A. K. HALF? AND THEY'LL END
UP.
HAPPEN TO CARRY THAT TWENTY
PERCENT.
PREMIUM THAT THEY WOULD HAVE TO
PAY. AND AS WE KNOW MOST
PATIENTS THEIR ON DIALYSIS ON
DISABILITY. THEY CAN'T AFFORD
THAT THEY CAN AFFORD THAT
THOUSANDS OF DOLLARS IS GOING TO
COST HIM FOR THE ANTI REJECTION
MEDICATIONS.
THEY CAN AFFORD IT AND SO.
THEY HAVE.
PUT PRESSURE ON SOCIAL WORKERS
AND.
NURSES TO SPEAK TO PATIENTS
ABOUT CONVERTING OVER TO THESE
DIFFERENT PLANTS.
AS.
PURE PROFIT HAS NOTHING TO DO
WITH THE PATIENT RELATIONSHIP
THANK YOU CARE LESS ABOUT WHAT'S
GOING ON WITH THE PATIENT. IT'S
ALL ABOUT MONEY LET'S BE CLEAR
HERE IT IT'S ALL ABOUT MONEY
SOCIALIST LET'S FOLLOW UP AND
TALK A LITTLE BIT ABOUT THAT.
MANAGE STANDING CREEK WHERE I'M
WRONG THAT IF YOU ARE GET TEN IN
STAGE RENAL DISEASE
AUTOMATICALLY QUALIFY FOR
MEDICARE AT THAT POINT. I DON'T
THINK YOU CAN TRANSFER OVER. TO
A.
COMMERCIAL PAY AND IT WAS MY
UNDERSTANDING THAT WHAT YOU'RE
TELLING ME IS THAT TEN PERCENT.
OF THE COMMERCIAL MARKET WHEN
YOU'RE COMPARING THE RATES OF A
THOUSAND TO FIFTY UNLESS FOR
MEDI CAL. SOME ASSUMING THAT
THERE'S A LOT OF COST SHIFTING
ON THE COMMERCIAL DOT ORG
CORRECT.
AND IF THAT'S THE CASE THEN IF
THERE IS A LOT OF COST SHIFTING
BEFORE THEY BECOME AND STAGE
RENAL IT SEEMED LIKE THAT WOULD
BE TOTALLY INAPPROPRIATE TO TRY
TO ENCOURAGE PATIENTS TO GO INTO
THE COMMERCIAL MARKET.
HERE'S A CONCERN I HAVE.
IF WE HAVE COST SHIFTING.
AND YOU HAVE AN INDUSTRY THAT'S
PROFITING IN EXCESS PROFITS
A COST SHIFTING IS GOING OF
COMMERCIAL GUESS WHO PAYS FOR
IT.
WAITED ALL OF US THAT'S RIGHT
THAT'S THE REAL REAL CONCERN AND
THAT I HAVE.
IT'S TO COST SHIFTING TO THE
HEALTH CARE INDUSTRY.
MAN YOU KNOW SO.
A QUESTION I HAVE IS.
WITH REGARD TO THE PROBABILITY
MAYBE YOU MIGHT BE ABLE ANSWER
THIS BECAUSE I HEARD AND MAYBE
AFTER GOD WHO WAS IT SAID THAT
THERE IS FIVE TIMES HIGHER AND
I'VE.
HEARD THAT YOU KNOW THAT THEIR
PROFIT MARGINS DIALYSIS CLINICS
HAVE INCREASED SIGNIFICANTLY
PAST SEVEN YEARS TEN YEARS TO
SEVENTY PERCENT. WHERE YOU
GETTING THIS INFORMATION FROM
THE AND WE HAVE ANY EVIDENCE
AND?
DATA THAT CAN SHOW.
THE PROFITABILITY MARGINS.
SO THE FIRST PLACE WE'RE
GETTING THIS DATA IS FROM OUR
SPOT.
THAT CLINICS AT THE CLINIC
LEVEL REPORT THEIR PROFITABILITY
EACH YEAR. AND ALSO REPORTED
GOVERNING ENTITIES WE CAN ROLL
THAT UP EASILY AND SO. OFTEN
DATA SHOWS THAT IN TWENTY
SIXTEEN THE DIALYSIS INDUSTRY
PROFITED ROUGHLY FOUR HUNDRED
AND SEVENTY MILLION DOLLARS JUST
HERE IN CALIFORNIA.
AND I WANT TO ANNOUNCE.
BETWEEN SEVENTEEN AND EIGHTEEN
PERCENT PROFIT MARGIN AND THAT'S
CONSISTENT WITH THE TOO LARGE
FOR PROFIT COMPANIES. PROFIT
MARGIN NATIONALLY AS WELL.
AND I DO WANT TO WANT TO FOCUS A
LITTLE BIT ON THAT FOUR HUNDRED
AND SEVENTY MILLION DOLLAR
NUMBER.
BECAUSE AS THE LA OVARIAN
CORRECTLY REPORTED.
THIS HAS THE POTENTIAL TO
GENERATE A FEW HUNDRED MILLION
DOLLARS.
IN REDUCTIONS IN WHERE THE
INDUSTRY IS CURRENTLY ABOVE THAT
REVENUE CAP.
SO EVEN IF
THAT FEW HUNDRED MILLIONS OF
DOLLARS IN WHICH THEY'RE
CURRENTLY ABOVE THE CAP.
ALL HAD TO BE ISSUED IN REFUNDS
THAT STILL LEAVES THE DIALYSIS
INDUSTRY WITH HUNDREDS OF
MILLIONS OF DOLLARS IN PROFIT.
AND SO I WANT TO POINT OUT THAT
ANY CLAIM THAT THERE WOULD BE.
NO PROFIT LEFT IN THIS INDUSTRY
OR THAT THERE WOULD NEED TO BE
SOME KIND OF REDUCTION IN
SERVICES BECAUSE THERE WOULD NOT
BE A RETURN ON CAPITAL.
IS REALLY CLAIMING THAT HUNDREDS
OF MILLIONS OF DOLLARS STILL
ISN'T ENOUGH.
AND THAT THAT'S NOT ENOUGH
PROFITS WERE NOT TALKING ABOUT.
WHAT A CLINIC PEOPLE WOULD OCCUR
DIALYSIS COMPANY BE PROFITABLE
OR NOT?
WE'RE SAYING ARE THEY STILL
GOING TO BE ABLE TO MAKE
SEVENTEEN EIGHTEEN PERCENT
PROFIT MARGINS OR THEY'RE GOING
TO HAVE TO COME MORE IN LINE
WITH FOR EXAMPLE THE FIVE
PERCENT PROFIT MARGIN THAT IS
THE AVERAGE FOR HOSPITALS IN
CALIFORNIA.
WE'RE NOT TRYING.
TO ELIMINATE.
PROFIT IN THIS INDUSTRY WE'RE
TRYING TO BRING IT INTO LINE
WITH WHAT THE REST OF THE
HEALTHCARE INDUSTRY.
VERY SUCCESSFULLY OPERATES WITH
IT IN LIMIT LET ME JUST SAY
AGAIN FOLLOW POLLUTED MORE AND
THE COMMENT YOU MADE AND. WITH
REGARD TO THE OVERALL
PROFITABILITY OF ANY ENTITY
WHETHER IT'S.
OVERALL.
COMBINED.
GROUP OF CLINICS SOME IS GONNA
READ A SECTION FROM THE.
INITIATIVE FOR THE PURPOSE OF
THIS SECTION THE FAIR TREATMENT.
PAYMENT AMOUNT SHALL BE THE
AMOUNT EQUAL TO ONE HUNDRED
FIFTY PERCENT OF THE SOME.
OF ALL DIRECT PATIENT CARE
SERVICES COSTS AND ALL HEALTH
CARE QUALITY IMPROVEMENT COSTS
INCURRED. BY GOVERNING ANTI AND
IT'S CHRONIC DIALYSIS CLINICS SO
EVEN IF YOU WERE TO HIRE MORE
NURSES INCREASE THE I. T. THAT
GOES THAT'S TAKEN INTO
CONSIDERATION AND THAT ON TOP OF
THAT STILL ALLOWS EVERY ENTITY
EVEN IF YOU HAVE. A GOVERNING
ENTITY THAT HAS SOME CLINICS
THAT ARE NOT AS WELL BUT THE
OVERALL TO HAVE AT LEAST A
FIFTEEN PERCENT PROFIT MARGIN.
WHICH
SEEMS TO ME FAIR AND REASONABLE
BUT WHEN IT ALSO TALK A LITTLE
BIT ABOUT MARKET CONSOLIDATIONS
AND SOME OF THE CONCERNS THAT I
HAVE.
IF YOU LOOK AT WHAT'S HAPPENING
IN OUR HEALTHCARE SYSTEM IN THE
COST SHIFTING IN THE LAND OF THE
EXPENSES THERE WERE HAVING
WITHIN THE SYSTEM. TO ME I THINK
THE BIGGEST AREAS AND THE
CONCERNS I HAVE IS EXACTLY THAT
OF MARKET CONSOLIDATION.
YOU LOOK AT HEALTH PLANS BY OF
HEALTH PLANS YOU LOOKING
HOSPITAL SYSTEMS BY AN
IMPOSSIBLE SIZZLE MEDICAL GROUPS
BY A MEDICAL GROUPS.
AND WHEN YOU HAVE CONSOLIDATION
IT COULD CREATE MONOPOLIZATION.
WHEN YOU'RE MONOPOLIZATION
UNFORTUNATE THAT COULD CAUSE
INCREASE BECAUSE THOSE ARE
PASSED ON TO THE CONSUMERS IN
THE FORM OF HIGHER PREMIUMS ARE
HEALTH CARE.
I GET
SO.
I'VE I BELIEVE THAT THERE IS
DEFINITELY A PROBLEM AND I THINK
THERE'S ANOTHER IN THE AREA THAT
WE NEED TO CONTROL COSTS
OBVIOUSLY HIS PRESCRIPTION DRUGS
BUT THAT'S ANOTHER CONVERSATION
FOR ANOTHER DAY WOULDN'T. ANYWAY
THOSE ARE MY QUESTIONS AND
COMMENTS THAT I HAVE THANK YOU
TO SCARE HER.
ANYONE ELSE.
THANK YOU VERY MUCH MUCH
PRESSURE.
WILL BRING UP OUR SECOND PANEL.
I FIGURED OUT
WHENEVER YOU'RE READY AS BEFORE
FIVE TO SEVEN MINUTES PER.
PER PERSON THANK YOU.
GOOD AFTERNOON MY NAME IS DANIEL
IN THE US ARE FROM SOME OF ROLE
TOWN OUTSIDE OF FRESNO. ALSO
BOARD OF DIRECTORS OF DIALYSIS
PATIENTS CITIZENS.
I'VE BEEN A MEMBER OF THE PC FOR
OVER TEN YEARS.
DALLAS PAGE SAID IS THAT IF THE
PATIENT LED NONPROFIT
ORGANIZATION DEDICATED TO
IMPROVING DALLAS'S CITIZENS
AUDIO LIFE BY ADVOCATING FOR
FAVORABLE PUBLIC.
POLICY WE HAVE MORE THAN TWENTY
EIGHT THOUSAND PAGE MEMBERS
INCLUDING SIXTY FIVE HUNDRED
PATIENTS IN CALIFORNIA.
WE ARE GRAVELY CONCERNED ABOUT
HIS BALLOT MEASURE WHAT
SIGNIFICANTLY LIMIT ACCESS TO
DALLAS'S CARE FOR PATIENTS AND
JEOPARDIZE THEIR HEALTH AND
THEIR LIVES.
WHEN I WAS TWELVE I GOT
DIAGNOSED WITH THAT KIDNEY
DISEASE AS A RESULT OF THE
BICYCLE ACCIDENT.
I'M THIRTY SEVEN SOME BLESSED
I ALSO I ALSO WAS ON DOUBTS AS
RETAIN YEARS PHONE VERY FAMILIAR
WITH THE CARE PROVIDED TO ME.
I WAS YOU WE CAN TRANSPLANT SAW
NO LONGER ANALYSIS
BUT I BECOME A PATIENT ADVOCATE
BECAUSE I KNOW FIRST HAND HOW
GRUELING THE PROCESS THAT THEY
ALSO USES.
I SPENT A LOT OF TIME IN TAOS
CLINGS HOPPING OTHER PATIENTS.
DEATH IS PATIENTS RECEIVE GAS IS
THREE TO FOUR TIMES.
A WEEK FOR FOUR HOURS AT A TIME.
WE ARE DEL THIS TAX AND NURSES
AND STAFF. ADEPTUS CLINK AS MUCH
AS WE SEE OUR FAMILIES.
I CAN TELL YOU FIRST HAND THAT
THE STATEMENTS MADE BY THE.
PROPONENTS OF THIS INITIATIVE DO
NOT REPRESENT THE CARE THAT I
RECEIVE NOR DO THEY MATCH WHAT
I'VE HEARD FROM PATIENTS
CURRENTLY TREATING TODAY.
I RECEIVED NOTHING BUT TOP NOTCH
CARE IN CLEAN AND HEALTHY
ENVIRONMENT.
ADVOCATES SENSES OF THAT MANY
DEATHS PAGES I TALK TO ALL THE
TIME.
IF.
IF WE WERE TO BE HONEST
OURSELVES WE HAVE NO QUESTION
ABOUT THE BORDERS OF THE
PROPONENTS.
S. C. I. E. W. YOU HW IS TRYING
TO ORGANIZE DAUSA THE WORKERS I
PERSONALLY DON'T CARE. ONE WAY
OR ANOTHER ABOUT IT.
BUT WHEN I DO CARE ABOUT THE
LITTLE MAKES ME VERY UPSET. IS
THAT IT APPEARS THAT YOU WHICH
W. IS USING PATIENT THAT'S PONDS
TO PUT PRESSURE ON DIALYSIS.
COMPANIES TO UNIONIZE
THAT'S NOT RIGHT.
THEY DRAFTED INITIATIVE THAT IS
ONLY GOING TO HARM PATIENTS.
TAKING MONEY OUT OF THE HOUSE IS
CARE WILL IMPROVE PATIENT CARE
IT WILL MAKE MORE PATIENTS WORSE
OFF BECAUSE THEY CAN LOSE ACCESS
TO CARE.
THIS MEASURE LIMITS THE PRIVATE
INSURANCE COMPANIES TO PAY THE
HOUSES COLLEAGUES TO PROVIDE
CARE. THESE THEM IS DO NOT
PROVIDE ENOUGH TO COVER THE
OPERATING COSTS OF A CLINIC.
AND INITIALLY IT WILL FORCE MANY
CLAIMS CLINICS TO SHUT DOWN OR
REDUCE HOURS.
AND NOTHING IN THIS MEASURE
REQUIRES INSURANCE COMPANIES TO
PASS EVEN ONE CENT. OF THE LOWER
COST ONTO PATIENTS.
THIS MEASURE MAY BE GOOD FOR A
FEW INSURANCE COMPANIES BUT IT
WILL BE TERRIBLE FOR SIXTY SIX
THOUSAND PATIENTS WHO RELY ON
DIALYSIS TO SURVIVE.
AND THE PATIENT WILL BE HURT
WHAT WORST ARE THE PATIENT LOW
INCOME COMMUNITIES AS RURAL
COMMUNITIES WE ACCESS TO CLINICS
ALREADY. THAT ALREADY STRAINED.
KENNY FAILURE IS PARTICULARLY
ACUTE AMONG MINORITIES LATINOS
AND AFRICAN AMERICANS WHO HAVE
HIGHER.
INCIDENT OF KIDNEY FAILURE THAN
OTHER POPULATIONS.
THIS INITIATIVE WILL HARM SO THE
MORE VERBAL PATIENTS IN
CALIFORNIA.
TAKE MY SITUATION FOR EXAMPLE I
LIVE IN SELMA.
A IF THAT MY CLINIC. LONGTIME
CLOSES THE NEAREST CLINIC IS
ABOUT TWENTY FIVE MILES AWAY. I
MIGHT BE ABLE TO GO THERE FOR
TREATMENT BUT WHAT IF IT THAT
ONE CLOSES.
THEN WHAT GORDO NEXT.
CLOSES WHEN WHAT IF ONE CAN TAKE
ME BECAUSE IT'S ALREADY FULL.
IF A PATIENT WHO HAVE TO TRAVEL
FURTHER TO DOWNSIZE BECAUSE THE
CLINIC IS CLOSED IT WILL PUT
FURTHER STRAIN ON THE PATIENT
AND THEIR FAMILIES.
EVEN WORSE IF CLINICS.
IF PLANTS CLOSE MANY PAVE WHO
WILL END UP AN EMERGENCY ROOM.
DUE TO COMPLICATIONS FOR MISSING
ANALYSIS AND PENSIONS WILL BEGIN
TO. GET INTO HOUSES IN THE
EMERGENCY ROOM INSTEAD OF
CLEANING CLINICS.
IT'S INFURIATING THAT PROPONENTS
WHAT PUT PATIENTS LIVES AT RISK
TO FURTHER THEIR POLITICALAND
UNION ORGANIZING AGENDA.
THIS INITIATIVE PUTS PATIENTS WE
REPRESENT IN GREAT DANGER AND
THAT'S SIMPLY UNACCEPTABLE.
AGAIN I HAVE NO PROBLEM WITH THE
YOU KNOW WANT TO TRY TO ORGANIZE
WORKERS BUT I HAVE A MAJOR
PROBLEM WHETHER YOU VULNERABLE
PATIENTS AS PAWNS.
THIS BALLOT INITIATIVE IS DEEPLY
FLAWED AND DANGEROUS THAT'S WHY
IS OPPOSED BY THE PATIENT
ADVOCACY GROUPS.
LIKE OURS THEY'RE GONNA SUPPORT
NETWORK THE CHRONIC DISEASE
COALITION AND DOZENS OF OTHER
GROUPS REPRESENT DOCTORS
PATIENTS AND NURSES AND OTHERS.
I APPRECIATE THE OPPORTUNITY TO
SPEAK TODAY AND GIVE YOUR VOICE
TO THE PATIENTS WHO WILL BE
NEGATIVELY IMPACTED.
IF THIS MEASURE PASSES THANK YOU
SO MUCH.
GOOD AFTERNOON MY NAME IS DOCTOR
AMY CHEN I'M A PHYSICIAN IN
FRESNO.
I SPECIALIZE IN THE PRODIGY I
TAKE CARE OF PATIENTS WITH
KIDNEY DISEASE I REALLY
APPRECIATE YOU GUYS TAKEN THE
TIME TO LISTEN TO US TODAY.
I BEGAN PRIVATE PRACTICE IN TWO
THOUSAND AND FOUR IN FRESNO AND
MY PARTNER AND I TOGETHER TAKE
CARE OF. OVER TWO HUNDRED
PATIENTS WHO HAVE AND STAGE
RENAL DISEASE AND THEY NEED
DIALYSIS TO SURVIVE.
MY PRIORITY AS A KIDNEY DOCTOR
IS SOLELY THE WELL BEING OF MY
PATIENTS AND THEIR FAMILIES.
I AM STRONGLY OPPOSED TO THIS
BALLOT PROPOSITION THAT WE ARE
DISCUSSING TODAY. THOUGH I DID
HEAR THE LAST.
PANEL MY CONCERN IS THAT
CLINICS WOULD CLOSE THAT SHIPS
WILL CLOSE.
AND THAT WOULD BE DISASTROUS FOR
MY PATIENTS AND FOR THE SIXTY
SIX THOUSAND PATIENTS IN
CALIFORNIA ON DIALYSIS.
I CAME TO SACRAMENTO TODAY TO
TESTIFY BECAUSE I HAVE YEARS OF
DIRECT AND PERSONAL EXPERIENCE
WITH ACCESS.
WITH DIALYSIS PATIENTS OBTAINING
ACCESS TO DIALYSIS.
WHEN I STARTED IN FRESNO THEIR
WERE LESS THAN A HANDFUL OF
CLINICS OPEN TO SERVE THE ENTIRE
AREA.
AND WHAT WAS GOING ON AT THAT
TIME IS THAT NEW DIALYSIS
PATIENTS WOULD DIAL EYES IN THE
HOSPITAL WHILE THEY WERE WAITING
FOR A CONFIRMED OUTPATIENT SPOT.
OFTEN THIS WOULD TAKE MONTHS
SO THESE PATIENTS WERE DIAL
ISING IN THE HOSPITAL FOR MONTHS
AT A TIME.
AND IT CAN TAKE A LONG TIME TO
BUILD A NEW FACILITY. AND EVEN
LONGER FOR THE DEPARTMENT OF
HEALTH TO APPROVE ITS USE.
DURING THE TIME THESE PATIENTS
WERE DIAL ISING IN THE HOSPITAL.
THEY'D THEY OF COURSE NEED A
CONFIRMED SPOT BEFORE THEY CAN
LEAVE. AND I HOPE THE REASONS
FOR THAT ARE CLEAR TO YOU.
MISSING DIALYSIS IS INCREDIBLY
DANGEROUS FOR THESE PEOPLE.
ONE MISS TREATMENT INCREASES THE
RISK OF DEATH BY THIRTY PERCENT
SO WE COULD NOT TAKE THAT RISK
THEY HAD TO STAY IN THE HOSPITAL
UNTIL THEY FOUND A SPOT.
THESE PATIENTS HAD NO OTHER
ACUTE ISSUES THEY WERE JUST IN
THE HOSPITAL TO RECEIVE
DIALYSIS.
THEY HAD TO TAKE TIME OFF FROM
WORK HAD TO BE AWAY FROM THEIR
FAMILIES THEIR OTHER
RESPONSIBILITIES. IT WAS A VERY
DIFFICULT TIME FOR THESE
PATIENTS AND THIS LASTED FOR
SEVERAL YEARS.
IT WAS A FRUSTRATING TIME TO BE
A PHYSICIAN AND A FRUSTRATING
TIME TO BE A PART OF THE TEAM.
THAT TRIED TO HELP THESE
PATIENTS.
SINCE THEN WE'VE MADE STRIDES IN
OBTAINING ACCESS TO PATIENTS.
BUT I THINK YOU CAN SEE HOW
LIMITING ACCESSCOULD REALLY
HAVE A NEGATIVE EFFECT ON
PATIENTS WHO NEED THE TREATMENT.
EACH CLINIC TREATS APPROXIMATELY
A HUNDRED TWO HUNDRED TWENTY
PATIENTS THOUGH SOME TO FIFTY UP
TO THREE HUNDRED PATIENTS.
WHAT IT WOULD HAPPEN IF JUST ONE
OF THOSE CLINICS IN MY AREA
CLOSES
IT'S ACTUALLY QUITE HARD TO
IMAGINE TWO HUNDRED AND FIFTY
PATIENTS? WITHOUT A PLACE TO GO.
NOW WHAT IF TO CLOSE.
FOR MORE.
WHERE WOULD THESE PATIENTS GO?
OF COURSE THE ONLY LOGICAL
OPTION AT THAT POINT WOULD BE
THE HOSPITAL.
FLORA SOMEBODY WHO HAS TRAVELLED
AROUND THE AREA FRESNO TO THE
RULE OUTLYING AREAS. WHERE THESE
NEW CLINICS HAVE POPPED UP TO
SERVE THE NEEDS OF THOSE
PATIENTS OUT IN THOSE AREAS I
CAN TELL YOU THAT THOSE CLINICS
THOSE COUNTRY CLINICS?
ARE LIFESAVING FOR THOSE
PATIENTS.
THEY IMAGINE IF THEY HAD TO
DRIVE AN EXTRA THIRTY FORTY FIVE
MILES AND THEIR FAMILY MEMBERS
HAD TO DRIVE THEM THEY WOULD
MISS TREATMENTS. INCREASE RISK
OF DEATH.
SO THOSE RULE OUTLYING CLINICS
ARE VERY IMPORTANT AND I FEAR
THOSE TO BE THE ONES MOST
AFFECTED BY THIS BY EITHER
CLOSING OR LOWERING SHIFTS.
OR WHAT NOT WHICH WOULD BE
DISASTROUS.
I BELIEVE IT COULD CREATE A
PUBLIC HEALTH CRISIS IN
CALIFORNIA.
OTHER UNITS I CAN TELL YOU CAN
NOT ABSORB PATIENTS THAT DO NOT
HAVE A PLACE TO DIE LIES. AND AS
YOU KNOW THE EMERGENCY ROOMS ARE
ALREADY PASSED THEIR CAPACITY.
IT'S CLEAR WHILE THE PHYSICIANS
ORGANIZATIONS THAT HAVE TAKEN A
POSITION ON THIS MEASURE HAVE A
POST.
THE RENO POSITIONS ASSOCIATION
OPPOSES AMERICAN COLLEGE OF
EMERGENCY PHYSICIANS OPPOSES
COUNTY MEDICAL SOCIETIES WE ALL
OPPOSE.
I DON'T THINK OF MY PATIENTS AS
POLITICAL PAWNS.
AND I THINK THAT THAT'S PRETTY
IRRESPONSIBLE TO DO SO.
THEY THESE ARE PEOPLE THEY HAVE
VERY DIFFICULT LIVES
THEY HAVE A DIFFICULT TIME
EVERYDAY.
AND I THINK THIS PROPOSAL WOULD
BE VERY DANGEROUS TO THEM.
THANK YOU.
GOOD AFTERNOON I'M CHRISTY FOR
AND I'M HERE REPRESENTING THE
CALIFORNIA DIALYSIS COUNCIL. AND
WE REPRESENT BOTH NONPROFIT AND
FOR PROFIT PROVIDERS A DIALYSIS
SERVICES IN CALIFORNIA.
OUR MEMBERS PROBABLY PROVIDE
HIGH QUALITY COMPASSIONATE CARE
TO SIXTY SIX THOUSAND
CALIFORNIANS WHO DEPEND ON
DIALYSIS TO STAY ALIVE.
EVERY COMPANY THAT PROVIDES
DIALYSIS IN CALIFORNIA ALONG
WITH THE DIALYSIS COUNCIL ARE
STRONGLY OPPOSE THIS BALLOT
MEASURE.
IT WOULD BE ABSOLUTELY
DEVASTATING.
AND SHADOW THE DIALYSIS PROVIDER
NETWORK.
SIMPLY PUT THIS INITIATIVE WOULD
MAKE THE BUSINESS OF OPERATING
OUTPATIENT DIALYSIS CLINICS IN
CALIFORNIA ECONOMICALLY
UNVIABLE.
AND THAT WOULD BE VERY
DISASTROUS FOR THE SIXTY SIX
THOUSAND PATIENTS IN CALIFORNIA
WHO DEPEND ON DIALYSIS TO STAY
ALIVE.
IT IS CLEAR THAT THIS INITIATIVE
WAS WRITTEN BY PEOPLE WHO ARE
UNFAMILIAR WITH OUR INDUSTRY.
THE INITIATIVE RATCHETS DOWN
WHAT DIALYSIS COMPANIES CAN
CHARGE PRIVATE INSURANCE
COMPANIES TWO HUNDRED AND
FIFTEEN PERCENT OF WHAT THE
PROPONENTS HAVE DEFINED. AS
PATIENT CARE SERVICES COSTS.
HOWEVER. THESE ALLOWABLE CHARGES
FAILED TO ACCOUNT FOR MANY OF
THE IMPORTANT EXPENSES NECESSARY
TO PROVIDE HIGH QUALITY PATIENT
CARE.
FOR INSTANCE
THE INITIATIVE SPECIFICALLY
PREVENTS CLINICS FROM BILLING
INSURANCE COMPANIES FOR
MANAGERIAL STAFF AND OTHER
CRITICAL EXPENSES NECESSARY TO
OPERATE A CLINIC.
THE INITIATIVE ALSO EXCLUDES THE
POSITION MEDICAL DIRECTOR.
A POSITION REQUIRED BY THE
CENTERS FOR MEDICARE AND
MEDICAID SERVICES.
THE MEDICAL DIRECTOR IS
RESPONSIBLE FOR OVERSEEING
CLINICAL QUALITY AND PATIENT
CARE.
IT EXCLUDES NURSE MANAGERS AND
EMPLOYEES WHO HELP PATIENTS
NAVIGATE THE FINANCIAL AND
COMMUNITY SERVICES. AS WELL AS
OTHER TEAM MEMBERS CRITICAL TO
PROVIDING HIGH QUALITY CARE.
IT MAKES NO SENSE.
OUR INDUSTRY HIRED FORMER
LEGISLATIVE ANALYST'S BILL HAM
AND HIS TEAM OF ECONOMIC
CONSULTANTS AT THE BERKELEY
RESEARCH GROUP.
TO CONDUCT AN INDEPENDENT
ANALYSIS OF THIS BALLOT MEASURE.
WHAT THEY FOUND WAS THAT THE
MEASURE WOULD LITERALLY SHATTER
THE ENTIRE INDUSTRY? BOTH FOR
PROFIT AND NONPROFIT PROVIDERS.
FOR STARTERS THIS INITIATIVE SO
CALLED PATIENT SERVICES COSTS
ONLY ACCOUNT FOR ON AVERAGE
SIXTY NINE PERCENT OF THE COST
OF OPERATING A CLINIC IN
CALIFORNIA.
MOST STARTLING ACCORDING TO
THEIR INDEPENDENT ANALYSIS IF
THIS INITIATIVE WERE TO PASS.
EIGHTY THREE PERCENT OF CLINICS
WOULD HAVE NEGATIVE OPERATING
MARGINS.
AND THE NEGATIVE IMPACTS ARE
SPREAD ACROSS ALL PROVIDER
TYPES.
FOR PROFITS NONPROFITS AND RULE
CLINICS URBAN CLINICS CLINICS
WITH HIGH PERCENT OF MEDICAL AND
MEDICARE.
THIS INITIATIVE IS
INDISCRIMINATE.
IT WOULD EQUALLY CRUSH ALL
MANNER IN TYPES OF DIALYSIS
CLINICS.
LET'S BE CLEAR.
IT'S MY IF MOST OR EVEN SOME OF
THE CLINICS WERE FORCED TO CLOSE
OR CUT BACK OPERATIONS BECAUSE
THE INITIATIVE. IT WOULD BE
DEVASTATING FOR PATIENTS.
THEY NEED FOR DIALYSIS IS
GROWING AT ABOUT FIVE PERCENT A
YEAR IN CALIFORNIA.
AND WE'VE HAD A HARD TIME AS IT
IS KEEPING UP WITH THE DEMAND
TODAY.
THE CLOSURE OF CLINICS WOULD BE
A PUBLIC HEALTH CRISIS.
PATIENTS WOULD BE FORCED TO
TREAT IN THE HOSPITAL OR BE
PUSHED INTO EMERGENCY ROOMS DUE
TO COMPLICATIONS FROM MISSING
TREATMENTS.
OUR INDUSTRY WILL WORK HARD TO
EDUCATE THE VOTERS AND DEFEAT
THIS MEASURE.
BECAUSE IF IT PASSES IT WOULD BE
DEVASTATING FOR THE PATIENTS.
THANK YOU.
A MUCH.
QUESTIONS.
COMING.
HERNANDEZ.
SO.
I DON'T DISAGREE THAT.
I THINK THE ABSOLUTE HIGHEST
PRIORITY OF OUR HEALTHCARE
SYSTEM IS TO MAKE SURE NUMBER
ONE WE HAVE ACCESS.
ACCESS TO THE MOST VULNERABLE
ACCESS AND RURAL INNER CITY.
AND I THAT'S SERVICE SEEMS TO BE
ENDEMIC OF THE PROBLEMS WE HAVE
IN OUR HEALTHCARE SYSTEM PERIOD
I MEAN.
WE JUST HAVE DOCTORS THAT DON'T
TAKE MEDI CAL ON THERE. IT
CENTRO.
SO THAT I MEAN OBVIOUSLY IF I
REALLY FELT THAT THIS INITIATIVE
WOULD GO IN THE OPPOSITE
DIRECTION AYE WHEN SUPPORTIVE
BUT I I DON'T SEE THAT AND THEN.
THE OTHER THING TOO IS I KEEP
HEARING REPEATING PATIENTS
AGAINST.
YOU KNOW.
THE INDUSTRY A END THAT. AN
ENTITY IS TRYING TO ORGANIZE.
SO HERE'S AND I DON'T KNOW HIM
AND HAVE A QUESTION YET BUT HERE
HERE'S SOME NOT.
I DECIDE I'M JUST EVER COLLIDED
STATEMENTS I THINK YOU NEED TO
MAKE RIGHT NOW.
AND BESIDES GONNA VOTE IN ON
THIS BECAUSE IT'S GOING TO BE
THE WILL OF THE PEOPLE THAT
ALREADY GOING TO VOTE AND THEN
THAT ENOUGH SIGNATURES HAVE BEEN
GATHERING AND THIS IS WHAT WE'RE
DOING OUR DUE DILIGENCE TO MAKE
SURE THERE'S. KIND OF ALL THE
INFORMATION IS OUT THERE.
BOB BUT HERE HERE'S THE CONCERN
THAT I HAVE.
THE CONCERN THAT I HAVE IS WE
HAVE AN EXTREMELY ROBUST HEALTH
CARE SYSTEM.
AND WE HAVE A HEALTHCARE SYSTEM
THAT IS NOW BECOMING.
CONSOLIDATED.
AND I'VE SEEN VERY VERY SMART SO
IN NUMEROUS MARKETS
THAT WE'VE GETTING
MONOPOLIZATION.
WE HAVE WOMEN OPPOSITIONS AND
HOSPITAL SYSTEMS HERE IN
NORTHERN CALIFORNIA WHERE
HOSPITAL SYSTEMS ARE CAUSING A
LOT MORE THAN SOUTHERN
CALIFORNIA.
AND WHEN YOU HAVE TO ENTITIES
ARE PRETTY MUCH DOMINATE THE
MARKET I CAN VERY EASILY SEE
THAT YOU CAN HAVE A MOP
MONOPOLIZATION.
SO.
THE PROBLEM THAT I SEE IS THAT
WHEN YOU HAVE THAT AND YOU ARE
GOING TO BE HAVING HIGH COST.
THERE ARE GOING TO BE PASSED ON
TO THE CONSUMER MARKET.
WELL GUESS WHAT.
GUESS WHO THAT'S GOING TO AFFECT
THE STATEMENT I MADE EARLY IT'S
GOING TO AFFECT THE OVERALL
HEALTH CARE MARKET IN THE
PREMIUMS THAT WE ALL PAY FOR.
IF YOU THINK ABOUT.
THE SUCCESS THAT WE'VE HAD IN
THE AFFORDABLE CARE ACT HERE IN
THE STATE OF CALIFORNIA. AND
WHEN I SPEAK TO COVER CALIFORNIA
THE NUMBER ONE CONCERN BY
CONSUMERS.
IN THIS STATE IN THIS COUNTRY.
IT'S NOT THEIR NARROW NETWORKS
IT'S NOT. WHAT DO YOU THINK IT
IS IT'S THE COST OF THEIR HEALTH
CARE?
OKAY.
KNOW WHEN YOU LOOK AT EIGHTY
PERCENT OF YOUR PATIENTS ARE THE
PATIENT DIALYSIS CLINICS ARE
MEDICARE WELL GUESS WHAT THE
FEDERAL GOVERNMENT IS GOING TO
SET THE PRICES.
AND I'VE WHENEVER I SPEAK TO
LARGE GROUPS OR ENTITIES
I THINK YOU KNOW WE HAVE TO BE A
FIGURE OUT HOW DO WE CONTROL
COSTS BECAUSE OF WE DON'T
CONTROL COST GUESS WHAT THE
CONSUMER IS GOING TO CONTROL
THEM FOR YOU.
IN THE FORMER WHAT'S HAPPENING
RIGHT NOW THE INITIATIVE.
SYSTEM SO. YOU KNOW I.
I REALLY BELIEVE THAT THIS IS AN
ISSUE THAT WE NEED TO LEASE HAVE
A SERIOUS CONVERSATION JUST IN
THIS COMMITTEE THERE WAS A BILL
THAT CAME THROUGH. THAT'S
DEALING WITH THE ENTIRE
HEALTHCARE SYSTEM.
AND I BELIEVE THAT IT'S THE
PUBLIC THAT'S THE POINT OF.
WHERE WE NEED TO START HAVING
SOME SERIOUS CONVERSATIONS?
AND AGAIN LET ME JUST I THINK
WHAT WAS.
.
MISS FOR A I THINK YOU MADE A
STATEMENT EARLIER ABOUT
EXCLUDING MEDICAL DIRECTORS OF
ON A MISTAKE I THINK SENATE I
MEAN DOCTOR WOULD SUMMER WOULD
CHAIRMAN ASKED A QUESTION
EARLIER AND I THINK IT WAS
ANSWERED AND UP.
IT WHAT MY UNDERSTANDING IS IT
WAS EXCLUDED.
ALL RIGHTS INCLUDED WITHIN THE
HOUR.
GOVERNING ENTITY SO IT IS THAT
INCORRECT OR NOT.
WELL IT'S OUR INTERPRETATION
WHEN WE LOOK AT THE LANGUAGE. IT
SAID THAT IT SHALL INCLUDE ONLY
NON MANAGERIAL.
STAFF AND THE MEDICAL DIRECTOR
IS A MANAGERIAL STAFF ALONG WITH
THE NURSE MANAGER CLINIC
ADMINISTRATOR. OKAY WE DON'T
REALLY KNOW THAT WE WILL NOT
COME UP AND CLARIFY THAT BECAUSE
I THINK WE'VE GOT A. RESPONSE
FROM THE PROPONENTS OF HOW
DURING THE AMENDMENT PROCESS
THAT THEY TRY TO ADDRESS THIS.
SO.
YES THANK YOU AGAIN.
JOHN ALLEN FOR THE CA YOU YOU
HW. AND YES IT IS IT IS OUR.
INTERPRETATION OF THE INITIATIVE
THAT WE'VE WRITTEN THAT MEDICAL
DIRECTORS WOULD.
BE INCLUDED AS AS PATIENT CARE.
IN I WOULD JUST SAY I THINK AS
THAT ELIOT STATED EARLIER THAT
STILL SOMETHING THAT'S OPEN TO
DISCUSSION SO I I I DON'T
BELIEVE THAT THERE'S. A
DEFINITIVE ANSWER TO THAT.
I THINK THE LA OVER.
POINTED OUT IN THEIR
PRESENTATION EARLIER. THAT IT
REALLY DOES DEPEND ON WHO IS
INCLUDED AND ARE READING OF THE
LANGUAGE THAT IS CURRENTLY.
GONNA BE PROPOSED FOR THE
BALLOT.
IS THAT IT'S NON MANAGERIAL
STAFF.
ARE THE ONLY ONES THAT ARE
INCLUDED SO MAYBE YOU CAN WORK
WITH THE PROPONENTS A FIX THAT
IN THE INITIATIVE PROCESS.
I THINK IS A LITTLE TOO LATE FOR
THAT I A GLOBAL LANGUAGE IS
ALREADY IN THE PAST. VIA.
LET ME WHICH MAKE THIS
INITIATIVE BETTER SO THAT WE CAN
INCLUDE.
BUT I I THINK THE PROBLEM NOW IS
THE WAY IT'S WRITTEN IN IT AND
UNFORTUNATELY THE LANGUAGE AS
AND THE INITIATIVE NOW.
DOES EXCLUDE THOSE EXTRA COSTS
AND I THINK THAT'S PART OF THE
PROBLEM AS TO WHY IN OUR
ANALYSIS.
IT'S GONNA HAVE SUCH A
DEVASTATING IMPACT ON THE
CLINICS IS BECAUSE THERE ARE SO
MANY OTHER STAFF MEMBERS THAT
ARE REQUIRED BY CMS THAT ARE NOT
INCLUDED. IN THIS COST ANALYSIS
SO LET'S SAY ASSUMING WE WORD
THAT WEREN'T THE CASE AND THERE
WAS A MINOR AMOUNT TO SEE
MANAGEMENT STAFF.
AND LET'S SAY WERE ADDRESS DO
YOU REALLY BELIEVE DO YOU
BELIEVE THAT A FIFTEEN PERCENT
PROFIT BILLY MARGINS FOR ALL
ENTITIES IS FAIR.
I THINK THE DIFFICULTY AGAIN IS
ON HOW YOU DEFINE IT AND I THINK
THAT'S A PROBLEM THERE ARE SO
MANY OTHER STAFF MEMBERS AND IT
DEPENDS ON EACH CLINIC. AND I
THINK THAT'S PART OF THE
PROBLEM.
AGAIN AS A LA O. EXPLAINED I
MEAN THAT WE'RE TALKING ABOUT
THE GOVERNMENT ENTITIES.
YES SO THE OVERALL GOVERNING AND
THE ABILITY OF A.
LET'S SAY A PARTICULAR GROUP
WHETHER IT'S FISTS FOR SENDING
OUT OR.
DE VITA.
THE THE OVERALL PROFITABILITY
THAT WOULD HE BE ABLE TO ALLOW
THAT ENTITY SO I GUESS THE
QUESTION I HAVE FOR YOU OF THOSE
QUESTIONS WERE. WORSE A FEISTY
WITH THE MANAGERIAL STAFF
EXCLUDING MEDICAL DIRECTOR
INCLUDING MEDICAL DIRECTORS
EMPLOYEES ETCETERA.
DO YOU BELIEVE A FIFTEEN PERCENT
MARGIN OF PROFITABILITY IS FAIR.
I HAVE NO IDEA WHAT THE FAIR
AMOUNT WOULD BE AMENDED AGAIN IT
WOULD DEPEND ON WHAT IS INCLUDED
IN THE EYES OF A LEVERAGES
FOR THREE TO FOUR TO FIVE
PERCENT. YEAH I WOULD HAVE KNOW
IDEA WHAT NUMBER DID PAIN AGAIN
ON THE DEFINITION OF WHO YOU
INCLUDED AND EACH SPECIFIC
CLINIC I HAVE NO IDEA WHAT WHAT
NUMBER WOULD BE. SETTLED ON TO
BE FAIR.
FAIR ENOUGH THOSE STATEMENTS AND
THANK YOU MISTER CHAIRMAN
PERSON.
I MISS A YEAR CAREER.
WELL MY MY MAIN COMMENT IS LIKE
I KEEP GOING BACK TO MY RURAL
COMMUNITIES I HAVE A VERY WORLD
COULD.
DISTRICT.
AND I I. I'M FEARFUL AND FEARFUL
OF SOMETHING CLOSES WHERE THEY
GO.
I'VE HAD FAMILY MEMBERS ARE ON
DIALYSIS.
IN FACT FIRST DIALYSIS STEPS
PLEASED TO HAVE IN THE NINETEEN
SIXTIES WHEN SHE IS ONE OF THE
VERY FIRST.
AND I JUST REMEMBER AND I'VE
SEEN PEOPLE DIED. CENTERS THEIR
VERY FRAIL. AND THE FARTHER THE
DISTANCE THEY ARE THAT THEY HAVE
TO DRIVE AFTER TREATMENT MAKES
ME CRINGE.
BECAUSE IT'S NOT A SMOOTH RIDE
HOME WHEN YOU'RE NOT FEELING
WELL.
ND TO MAKE THAT ANY FARTHER
THAN SOME OF THESE ARE. DOUBTS
WERE I COME FROM ON THIS IS
BECAUSE SPENT ACCESS.
AND.
IT'S.
FRIGHTENING TO ME SO.
I'M HOPING WE CAN WORK
SOMETHING OUT BECAUSE IT JUST
SEEMS LIKE.
OF THEIR ROLE GOING WANTING TO
GO THE SAME DIRECTION THAT WE'VE
GOT A FEW THINGS WE NEED TO
CLEAN UP BUT.
HIS INITIAL PROCESS I DON'T KNOW
UP TO SET THE TABLE. POUNDED OUT
BUT MUCH RATHER SEE THAT.
SENATOR.
THANK YOU MISTER SO A QUESTION
FOR MS FOISTED.
JUST TO TOUCH ON SOMETHING THAT
SEND HERNANDEZ. MENTIONED
REGARDING CONSOLIDATION AND AND
AND IF YOU WOULD. I'M IT'S NOT
OFTEN YOU SEE OTHERWISE VERY
PROBABLE INDUSTRIES THAT ARE
THAT CONSOLIDATED MUST THERE ARE
SERIOUS BARRIERS TO ENTRY SO
COULD YOU.
AND REALLY SIMPLISTIC TERMS CAN
YOU EXPLAIN.
Y. THE DIALYSIS INDUSTRY IS HAS
CONSOLIDATED TO THE POINT WHERE
THERE'S REALLY ONLY TWO MAJOR
PLAYERS IN CALIFORNIA.
I CAN TELL YOU ONE OF THE MAJOR
PROBLEMS WITH ENTRY INTO THE
MARKET IS BUILDING A NEW UNIT.
IN THE PAST IF YOU WANT TO COME
INTO CALIFORNIA AND BUILD A NEW
DIALYSIS CLINIC YOU NEED TO
ACTUALLY. FIND A PIECE OF
PROPERTY.
BUILDING AT LEAST SET WHATEVER
PAY FOR THAT HIGHER ALL YOUR
STAFF IT ALL OF THE EQUIPMENT IN
PLACE AND THEN YOU HAVE TO WAIT
FOR BOTH LICENSE SCENE BY THE
DEPARTMENT PUBLIC HEALTH. AND
THEN ALSO FOR CERTIFICATION
THROUGH CMS AND UNFORTUNATELY.
THAT SEEM INTO THE DEPARTMENT
OF PUBLIC HEALTH ALSO HAS
OVERSIGHT OVER NURSING HOMES AND
THEY'RE AT A HIGHER TIER. AND SO
THEY GET SURVEYED AND THEY.
HOW THE STAFF GO OUT THERE
FIRST SO WE'RE KIND OF AT THE
BOTTOM OF THE WAITING LIST? AND
SO THE PROBLEM HAS BEEN THAT
THAT FACILITY HAS TO SIT THERE
FULLY OPERATIONAL WAITING. AND
SO YOU HAVE TO HAVE A LOT OF
CAPITAL IN ORDER TO HAVE THAT IN
PLACE BECAUSE IT TAKES ON
AVERAGE MONTHS TO JUST GET YOUR
INITIAL LICENSING. AND THEN
AFTER YOU HAVE YOUR LIST INITIAL
LICENSING ONLY AT THAT POINT CAN
YOU THEN REQUEST YOUR CMS
CERTIFICATION. AND FOR YEARS AND
YEARS NOW IT'S BEEN A MINIMUM OF
TWELVE MONTHS THAT YOU HAVE TO
SIT AND WAIT FOR YOUR CMS
CERTIFICATION.
AND SO YOU CANNOT START SEEING
THOSE PATIENTS UNTIL YOU GET
THAT CERTIFICATION SO YOU
LITERALLY HAVE TO HAVE ENOUGH
CAPITAL HEARING CALIFORNIA TO
HAVE THAT FACILITY ALL OF YOUR
STAFF IS BEING PAID ALL OF YOUR
EQUIPMENT IN PLACE. FOR UPWARDS
OF TWELVE MONTHS BEFORE YOU CAN
ACTUALLY OPEN.
YEAH WE WOULD THAT ALSO BE TRUE
OF IF YOU KNOW OTHER KIND OF CAP
ATTENTIVE. MEDICAL THOSE SECTORS
LIKE SURGICAL CARE CENTERS IS IT
THAT DIFFERENT WHAT WHY WHEN OUR
SPITTLE IS ALSO INVEST. IN OUT.
AND YOU KNOW I'M JUST A DOCTOR I
DON'T KNOW A LOT OF THIS ARE NOT
JUST A DOCTOR ALL THIS
GOBBLEDYGOOK BUT AND I CAN TELL
YOU AGAIN FROM EXPERIENCE AND.
WHEN I WHEN I FIRST MOVED TO
FRESNO THERE WERE MULTIPLE
DIFFERENT COMPANIES
AND THEY WERE SMALL INDEPENDENT
COMPANIES THAT MANAGED THESE
DIALYSIS UNITS.
AND.
THEY WERE VERY POORLY RUN
BECAUSE THERE WERE NOT PROTOCOLS
THEY CAME CENTRALIZED ON HOW TO
TAKE CARE OF PATIENTS.
AND WHEN WE IT WAS BROUGHT UP
THAT SOME OF THESE PATIENTS.
OPERATE IN THE RED YOU NEED TO
HAVE A LARGE AMOUNT OF OTHER
CLINICS IT AS SOME OF THE I'M
SORRY CLINICS OPERATED THE RED
YOU NEED TO HAVE A LOT OF THEM.
TO OFFSET SOME OF THE MORE RURAL
AREAS WHERE ALL THE PATIENTS ARE
MEDICARE OR MEDICARE OR WHATEVER
AND YOU JUST YOU DON'T MAKE
MONEY. THAT THESE THESE PLACES
ARE NOT MAKING MONEY. AND SO
THEY HAD YOU KNOW ONE OR TWO
UNITS IN FRESNO THEY WERE A
POORLY RUN AND AGAIN BECAUSE IT
DIDN'T HAVE AN ORGANIZED.
SNOW TEAM OF DOCTORS AT THE
HEAD OF THE CORPORATION THAT
SENT DOWN SOME OF THE. THEM
DETAILS ON HOW TO MANAGE SOME OF
THE.
THAT THE PATIENTS AND NUMBER
TWO. THE PURCHASING POWER THE
OPERATING CLINICS THAT WERE IN
POOR AREAS AND THE NEEDING OTHER
CLINICS TO OFFSET THAT. SO
THAT'S JUST SOME OF THE
EXPERIENCE THAT I SAW INITIALLY
WHEN I WHEN I CAME HERE AND THEY
WERE. BASICALLY CONVERTED THOSE
THOSE DIALYSIS UNITS WERE
CONVERTED TO LARGER COMPANIES.
CHUCK PREACHER THAT'S A DOCTOR
DOCTOR CHEN.
MY UNDERSTANDING IS THAT MOST A
PHRENOLOGIST IN CALIFORNIA.
ARE ALSO CONCERT IN MOSTLY
WORKING EITHER FOR WITH THE TWO
MAJOR COMPANIES IS THAT CORRECT
I KNOW SO I AM A MEDICAL
DIRECTOR BECAUSE.
CMS REQUIRES THAT ALL OF THE
DIALYSIS UNITS HAVE A MEDICAL
DIRECTOR. SO IN FRESNO IF YOU'RE
IF YOU'RE WORTH YOUR SALT AND
YOU BASICALLY OUR MEDICAL
DIRECTOR IS BECAUSE EVERY UNIT
NEEDS ONE.
I AM NOT IT I DON'T OWN ANY
PART OF THE DIALYSIS FACILITIES
I DON'T KNOW WHETHER MOST
NEPHROLOGIST HAVE PART SHARE.
I CAN TELL YOU THAT THAT THE
NEPHROLOGIST THAT I WORK WITH.
MY PARTNER AND WE ALSO HAVE SOME
SOLO PEOPLE THAT WE.
SHARE CALL WITH WE DO NOT HAVE
ANYTHING TO DO WITH THE BUSINESS
OF THE UNITS SHOULD IN YOUR CASE
HAS CENTER MISS FOR IT WOULD
GENERALLY SPEAKING ACROSS THE
INDUSTRY.
WHAT EXTEND TO WHAT EXTENT DO
DOCTORS HAVE A DEBATE AN EQUITY
INTEREST IN
DIALYSIS CLINICS
I WOULDN'T KNOW ANY PERCENTAGE?
OF THAT OF ANY EIGHT BIGGER
SMALL KIND OF VARIES.
THE BIG DISMAL.
.
ACTUALLY I WOULDN'T EVEN KNOW I
WOULD I I MEAN AGAIN I WHICH I
WOULD SAY SMALL VIA MY WITH A
SMALL.
NURSE BE DIFFERENT THAN MY
UNDERSTANDING BUT THANK YOU
CLAIMS CHECK.
THE GODS HAVE COUPLE COUPLE
QUESTIONS.
.
AND THIS ON ON BALANCE.
.
YOU KNOW WHAT IN WHAT PERCENT OF
THE HEALTHCARE DOLLAR IS
ACTUALLY.
FOR PROFIT.
AND HOW MUCH IS REINVESTED IN
PATIENT CARE MEANWHILE SEE THE
PROFIT BUT IS THERE ARE YOU KNOW
IS THERE IN INDUSTRY PHILOSOPHY
ABOUT HOW. HOW MUCH IS
REINVESTED BACK INTO INTO
PATIENT CARE?
AND HOW HOW DOES THAT WORK IN
THE INDUSTRY. I WOULD SAY AGAIN
LIKE I'VE I POINTED OUT EARLIER
IN ORDER TO BUILD A NEW FACILITY
IT'S A VERY LARGE INVESTMENT.
BECAUSE YOU DO HAVE TO HAVE IT
UP AND RUNNING FOR UPWARDS OF
TWELVE MONTHS SO THERE'S A LOT
OF INVESTMENT IN THAT.
AND AGAIN BECAUSE UNFORTUNATELY
IN CALIFORNIA WE HAVE A GROWING
POPULATION OF PATIENTS AND THAT
ARE BECOMING. IN IN MEDIAN
DIALYSIS TREATMENT AND SO THERE
IS A LARGE INVESTMENT.
THERE HAS BEEN IN THE PAST.
IN BEING ABLE TO START UP NEW
FACILITIES IN AREAS THAT NEED
IT.
IF THAT WILL CONTINUE AFTER THIS
PASSES IT'S VERY HARD TO SAY.
MY PLEASURE MORE INTERESTED IN
THE ON THAT PUT PUT NEW
FACILITIES DECIDE WHAT IS HOW
MUCH IS REINVESTED IN ENSURING
THAT PATIENTS ARE GETTING THE
HIGHEST QUALITY CARE THAT WAS
REALLY MORE MY QUESTION YEAH AND
AND AGAIN THERE'S A LOT OF
ADVANCEMENTS THAT ARE CURRENTLY
BEING MADE THERE'S LOT. OF
IMPROVEMENTS ALL THE MACHINES
AND A LOT OF DIFFERENT OPTIONS
FOR PATIENTS I MEAN AND PATIENTS
CAN DIE LIES IN THE FACILITY OR
THEY CAN ALSO VIOLATES AT HOME.
AND THERE'S CONSTANTLY
INVESTMENTS BEING MADE IN TRYING
TO PRODUCE NEW MACHINES TO HELP
WITH THAT PROCESS. SO I THINK
THAT'S A NEW TECHNOLOGY IS A LOT
OF AREAS WHERE YOU HAVE THE
INVESTMENT ALSO.
SO YES I GUESS I'M TRYING TO GET
IS IT IS THERE A PAY PHILOSOPHY
OF A.
MEDICAL LOSS RATIO ASSOCIATED
WITH WHICH TO WORK.
THERE'D DEBT THERE'S.
THERE'S NO NUMBER THERE'S NO
NUMBER ASSOCIATED THAT MEANS NO
PHILOSOPHY AROUND THAT I I DON'T
KNOW ANY SPECIFIC NUMBER IT IT
JUST DEPENDS ON.
WHERE THEY WANT TO MAKE THE
INVESTMENT IT EFFORTS IN
DEVELOPING NEW PRODUCTS OR AND
WORKING ON NEW TREATMENT
PROTOCOLS? WOULD BE SPECIFIC TO
EACH COMPANY.
YOU MENTIONED A STUDY.
WOULD YOU BE WILLING TO SHARE
THAT WITH OUR COMMITTEE STAFF.
SURE I DON' BELIEVE IT'S
COMPLETE YET BUT IS SOON AS A
STUDY IS COMPLETE I WOULD BE
HAVE TAKEN WHAT ARE YOU GUYS.
TO SEE IT SO A SECOND.
HE ANY OTHER QUESTIONS.
PHONE BOOTH.
WALDRON A LOT OF ITEMS IN ASK.
HASN'T BEEN ASKED BUT I'M JUST
YOU KNOW.
LIKE ANY CLINIC THERE'S GONNA BE
YOU KNOW PEOPLE WHO DEAL WITH
ALL INSURANCE BILLING.
YOU KNOW HIRING AND. I'M SURE
HIGHER CLEANING STAFF AND THINGS
LIKE THAT HOW IS THAT AFFECTED
OR NOT.
MY IS IN IT'S NOT RIGHT THAT
WOULD BE LIKE ANY OF OUR HR OR
IF WE. ARE ACCOUNTING SERVICES
ARE IN BILLION OR YOU THINK
THAT.
THAT WOULD NOT BE INCLUDED. IN
THE COST.
SO IF A PATIENT I MEAN CAN A
PATIENT SPEAK TO THOSE PEOPLE IF
THEY HAVE AN ISSUE WITH THEIR
INSURANCE OR. YOU KNOW THEY WORK
WITH THEM SU YES CURRENTLY WE
HAVE.
STAFF THAT CAN HELP THEM EAT
YOU KNOW EVEN JUST FILLING OUT
FORMS ARTHUR CONFUSED OR IF THEY
NEED HELP EXPLAINING THINGS AND
EVEN TO SOME THEIR PERSONAL
LIFE.
YOU WE HAVE VARIOUS STAFF THAT
CAN HELP THE PATIENTS AND.
THAT IS A DIFFICULT PART THAT.
IT IS.
VERY LIMITED ON WHAT IS
INCLUDED IN THAT COST TO DO THE
CALCULATION.
I'M.
OKAY SO.
ANOTHER ISSUE HARM.
SOMETIMES THERE'S PATIENTS WHO
COME IN AND THEY CAN ACTUALLY.
DO THEIR DIALYSIS AT HOME.
A IN THE EVENINGS.
AND THEY'RE TRAINED YOU KNOW
AGAINST TO THE CLINIC.
I DON'T KNOW HOW OFTEN THEY COME
INTO THE CLINIC.
.
HOW WAS THAT AFFECTED IN THE
INITIATIVE OUR IS IT IS LOOKING
LIKE THIS?
ENCOURAGED THAT STILL OR
AFFECTED IN ANY WAY IS COVERED
ON THE THE COST CAP WAS.
YES ARE RIGHTS ARE UNDERSTANDING
THAT THE HOME CARE IS INCLUDED
AS A PART OF IT SO AGAIN.
BANG THERE'S THAT DIFFICULTY
WHEN YOU LOOK AT THAT AT THE
COST.
IT ONLY IS.
WHAT SPECIFICALLY LISTED IT
SAYS SHALL INCLUDE ONLY AND THE
FOLLOWING AND NON MANAGERIAL?
CRIED DALLAS'S CLINIC IN STAFF
AND SO THAT'S THE PROBLEM IS
THAT THERE ARE OTHER STAFF THAT
DO WORK WITH PATIENTS AND ASSIST
WITH OTHER PARTS OF THEIR CARE
THAT ARE INCLUDED IN THE COST.
OTHER PEOPLE AVAILABLE LIKE IN
THEM IN THE NIGHT.
YOU NO IF THEY HAVE QUESTION IF
THERE HAVE BEEN ISSUE WHEN
THEY'RE DOING AT HOME DIALYSIS
YES OF COURSE. NEED THEIR TWO
TYPES OF HOME DIALYSIS TO DO AND
THERE'S TWENTY FOUR HOUR ON CALL
NURSES OF COURSE THE PHYSICIAN
IS ALWAYS ON CALL. LIGHT AND
THERE'S ALSO.
.
SUPPORT WITH TYPICALLY THAT THE
COMPANY THAT MANAGES THE
EQUIPMENT SO WHAT THAT'S BAXTER
OR WHATEVER. SO THERE'S MULTIPLE
AREAS.
FOR RESOURCE.
BUT ALSO.
YOU MENTIONED HOME TREATMENTS.
AND ONE OF THE THINGS THAT
THESE.
TO LARGE COMPANIES PROVIDE IS.
FREE EDUCATION PRIOR TO
DIALYSIS ON ALL THE TYPES OF.
DIALYSIS MODALITY INCLUDING
TRANSPLANT.
AND SO THEY HAVE KIND OF A TEAM
THAT'S A COMPLETELY FREE THING
TO THE PATIENT.
AND THEY CAN HAVE AS MANY
SESSIONS AS THEY WANT.
WHERE THEY THAT THE PATIENT
COMES TO WHATEVER LOCATION THAT
THAT TEAM HAS HAS BEEN USING?
AND.
THE PATIENT LEARNS
THE INS AND OUTS OF OF THE TWO
TYPES OF HOME TREATMENT THAT YOU
ALLUDED TO. AS WELL AS DIETARY.
EDUCATION AND EDUCATION ON
TRANSPLANT AND ALL THAT HAPPENS.
IN THE PRE DIALYSIS TIME PERIOD
SO THAT COULD BE PATIENTS THAT
ACTUALLY NEVER MAKE IT TO
DIALYSIS ACTUALLY WERE ABLE TO
KEEP THEM. YOU KNOW WITH KIDNEY
FUNCTION GOOD ENOUGH TO STAY OFF
THE MACHINE.
BUT IT'S A PREPARATORY THINGS
THAT THEY HAVE THE KNOWLEDGE AND
EDUCATION WHICH IS SOMETHING
THAT IS PROVIDED TO THEM THREE.
AND THROUGH THE COMPANY'S.
WHICH ON I DON'T KNOW IF THAT
WOULD BE ABLE TO BE CONTINUE
THAT'S AN INVESTMENT THAT WAS
BROUGHT UP BEFORE.
THINKING.
ANY OTHER QUESTIONS.
I HAVE ONE FINAL QUESTION AND
AND.
.
THE.
ALL THE START UP COSTS AND AND
THE COST TO MAINTAIN A FACILITY
WHAT'S GOING TO LICENSE SEEN ALL
THOSE WOULD BE INCLUDED.
AS.
EXPENSES RELATED TO THE.
TO THE CAP.
CERTAINLY ARE ATTENTION THAT ANY
OF THE COSTS THAT ARE RELATED
THEIR TO THAT.
RAMPING UP TOWARD A PATIENT
CARE WOULD CERTAINLY.
BE INCLUDED.
FIFTH PATIENT CARE COSTS
INCLUDE THE UTILITIES.
A FACILITY IMPROVEMENTS.
.
AND.
WE DON'T SEE ANY REQUIREMENT
THAT THE CLINICAL READY BE FULLY
CMS CERTIFIED BEFORE THOSE COSTS
CAN START TO COUNT TOWARD. THE
ENTITY LEVEL PATIENT CARE COSTS.
SO WE ACTUALLY SEE THIS AS
CREATING AN INCENTIVE TO OPEN
NEW CLINICS.
ESPECIALLY AN AREA IN RURAL
AREAS OR UNDERSERVED COMMUNITIES
WERE OTHERWISE THE ECONOMICS
MIGHT NOT HAVE WORKED OUT.
BECAUSE NOW WE ARE CREATING THAT
ABILITY TO POOL THOSE PATIENT
CARE COSTS
WITH THE PATIENT CARE COSTS OF
FACILITIES IN. AREAS WITH MORE
RICH COMMERCIAL PAYER NEXUS.
AND SO BECAUSE WE'RE CREATING AN
ENTITY WIDE.
PAYER MIX POOL.
WE'RE HOPING THAT IT ENCOURAGES
CLINICS IN RURAL AREAS IN
UNDERSERVED AREAS TO OPEN.
ANNE JEFFERY COMMENTS ON THE.
BUT AGAIN I THINK IT'S JUST
KIDS.
DIFFICULT BECAUSE YOU HAVE TO
LOOK AT YOU KNOW ALL THE COSTS
ARE INCLUDED IN THERE'S OTHER
THINGS THAT WE'VE MENTIONED.
THAT WON'T BE INCLUDED AND OTHER
STAFF AND FOR EACH INDIVIDUAL
CLINIC ALTHOUGH IT IS LOOKED AT.
AS A WHOLE IS A COMPANY. THE
COMINGS AND LOOK AT EACH
INDIVIDUAL CLINIC AND WORST
LOCATED THAT HAVE TO MAKE A
DECISION. YOU KNOW AT THAT
CLINIC ITSELF IS ECONOMICALLY
VIABLE.
THE OTHER QUESTIONS.
OKAY THANK YOU VERY MUCH
APPRECIATED.
AT THIS POINT WE'RE GONNA GO TO
PUBLIC COMMENT. I WILL BE ASKING
PEOPLE JUST YOUR NAME.
AND POSITION ON THE INITIATIVE
PLEASE
.
ARE WE READY. ANY TIME THAT.
A MY NAME IS MIKE MONTGOMERY
WITH THE CONGRESS OF CALIFORNIA
SENIORS WE'RE IN FAVOR OF
KEEPING COSTS REASONABLE.
THAT MEANS KEEPING PROFITS
REASONABLE SO WE SUPPORT THE
PROPOSITION OR BE HOPEFUL
PROPOSITION. THANK YOU.
AS I SAID JUST YOUR NAME EMAIL
POSITION IN YOUR REACTION.
ARMENIANS TODAY SO FAR ó I AM
THE ASSISTANT TO OUR EXECUTIVE
DIRECTOR. I'M WITH THE
CALIFORNIA HISPANIC COMMISSION
ON DRUG AND ALCOHOL ABUSE AND
WE'RE HERE TO SUPPORT THIS
INITIATIVE.
THANK YOU.
CAPTAIN IS SET THREE BUT THROUGH
GOVERNMENT RELATIONS
REPRESENTING AMERICAN.
AND VETS DEPARTMENT CALIFORNIA
AMERICAN GI FORM OF CALIFORNIA
MILITARY OFFICERS ASSOCIATION OF
AMERICA.
NATIONAL GUARD ASSOCIATION
CALIFORNIA CALIFORNIA
ASSOCIATION OF COUNTY VETERANS
SERVICE OFFICERS.
AMERICAN LEGION DEPARTMENT OUGHT
CALIFORNIA OWN OPPOSITION.
REBECCA GONZALEZ NATIONAL
ASSOCIATION OF SOCIAL WORKERS
CALIFORNIA WE REPRESENT TEN
THOUSAND SOCIAL WORKERS IN THE
STATE OF CALIFORNIA AND WEARING
SUPPORT.
MISTER CHAIRMAN MEMBERS MARK
MENDOZA WITH US HERE YOU
CALIFORNIA AND STRONG SUPPORT.
MY NAME IS OF ARE FOCUSED AND
INTIMIDATE US VISION HIS SUPPORT
DISINCENTIVE.
MY NAME CECILIA GOMEZ GONZALEZ
UP.
BOTH MY PARENTS WERE DALE'S
PATIENTS. AND I SUPPORT THIS
INITIATIVE.
MY APOLOGIES BUT I AM AN
ADVOCATE.
AND YES AFTER FORTY YEARS
PRICE CONTAINMENT I AM
SUPPORTING OF THIS INITIATIVE.
GOOD AFTERNOON BILL BARNABY ON
BEHALF OF TO VETO ALSO HAVING
FAMILY MEMBERS TO HAVE.
GONE THROUGH DIALYSIS.
THE THE LANGUAGE ACTUAL
LANGUAGE OF THE LAW OVER RULES.
THE INTENT.
HE COULD HAVE WONDERFUL INTENT
BUT THE ACTUAL LANGUAGE DOESN'T
CARRY IT THROUGH.
THEN IT DOESN'T MATTER.
THANK YOU BILL BARNABY WITH THE
BEAT.
NAME AND POSITION.
ERIC HARRIS WHAT THE CALIFORNIA
NAACP IN OPPOSITION.
LOUIS SOME TACO WITH THE
CALIFORNIA LACKEY LEAGUE OF
UNITED LATIN AMERICAN CITIZENS
WE HAVE NUMEROUS COUNCILS
THROUGHOUT CALIFORNIA AND WE ARE
IN STRONG SUPPORT OF THIS
INITIATIVE.
MY NAME IS IS THAT I THE MAGICAL
AYE IMITATION GET ADMISSION
STRONG SUPPORT TO THIS BILL.
MANY WAS AS ROB BOSSY ARMONK
DOWSERS WORKER AND I'M SUPPORT
OF THIS BILL.
EVEN GONZALEZ DIALS'S WORKER AND
A CARETAKER FOR MY FATHER WHO'S
BEEN ON DIALYSIS TWENTY ONE
YEARS AND I'M IN STRONG SUPPORT
OF THIS BALLOT MEASURE THINKING.
RAQUEL KUZMAN AND BOMB A
REGISTERED NURSE TWENTY EIGHT
YEARS AND BALANCES. BY OFTEN
HAVE MY SON WHOSE FATHERS ON
DIALYSIS. WAS FORCED TO.
TAKEN OUT OF THE CLINIC BECAUSE
OF THE CONDITIONS AND DO IT AT
HOME.
THANK YOU.
M. SIMPLY DO A PATIENT CARE
TECHNICIAN.
TWENTY TWO YEARS EXPERIENCE
THAT WORK FOR THE VITA AND
PERSON USE FOR OVER SEVENTEEN
EIGHTEEN YEARS. I.
STRONGLY SUPPORT THIS
INITIATIVE.
MANY GONZALEZ DIALYSIS
TECHNICIAN TO VETO FOR SENIORS
TWENTY YEARS STRONGLY SUPPORT.
SHERRI ACHES UP PATIENT CARE
TECHNICIAN. I STRONGLY SUPPORT
THIS BILL.
I'M EW BARIA OUR I'M A
REGISTERED NURSE HALL AT THE
ALLEY CISNEROS AND I STRONGLY
SUPPORT THIS INITIATIVE.
I AM USED IN THE PINYON
DESTINATION PUT HAVE YOU DONE
BUSINESS FOR EIGHTEEN YEARS AND
I STRONGLY STRONGLY SUPPORT
THIS.
BALLOT INITIATIVE.
LORRAINE LOW IF A PATIENT. AT
THE VETO THREE YEARS HEMO
DOLLARS LISTEN THREE YEARS HOME
DIALYSIS. I'M VERY STRONGLY
SUPPORT THIS BILL THANK YOU.
GOOD AFTERNOON SENIOR SANDOVAL
PATIENT CARE TECHNICIAN FOR
TWELVE YEARS WITH FRESENIUS SEND
A VITA. AND I STRONGLY SUPPORT
THIS INITIATIVE.
MY IDEA ABOUT CRIME AND THE END
FOR THE VFR TWENTY YEARS IN
SUPPORT.
EMMY DARBAND WITH THE CALIFORNIA
MEDICAL ASSOCIATION AND
OPPOSITION.
ROXANNE GOULD REPRESENTING THE
AMERICAN NURSES ASSOCIATION IN
OPPOSITION.
LARA GONZALEZ TAKING CARE OF
PATIENTS FOR TWENTY TO TWENTY
TWO YEARS AS A PCT I'LL POST.
CAROLINE MEMBER AUCKLAND
DIALYSIS SOCIAL WORKER FOR
MY NAME IS KENDRA BLANCHETTE I'M
A DIALYSIS REGISTERED DIETITIAN
FOR OVER TWENTY YEARS AND A
PATIENT ADVOCATE AND I WILL BE
VOTING AGAINST THIS INITIATIVE.
CARL FULLER YOUR SOCIAL WORKER
NOT POST.
JOHN NOLAN FORMER PATIENT CARE
TECHNICIAN AYE OPPOSED.
JOE MORRELL CARE GIVER AND I
OPPOSE.
MY NAME IS CELIS I'M OF A
SUPPORT TO SOLICIT THE.
I AM ANDREA I AM A PATIENT CARE
TECH FOR SEVENTEEN YEARS AND I
OPPOSE.
I'M STILL JONES NUMBER PATIENT
CARE TECHNICIAN AND I OPPOSE.
MY NAME IS SHEILA NAM A
REGISTERED DIETITIAN WORKING
WITH DIALYSIS PATIENTS AND I
OPPOSE.
HEATHER DALY PATIENT CARE
TECHNICIAN FOR NINETEEN YEARS
AND I OPPOSE.
ANGELA CHAVIS I'VE WORKED FOR
W. TO AND FOR SERIOUS AND
SEVENTEEN YEARS. I OPPOSE.
EDNA BARNES IN MY CLINIC MANAGER
AND I OPPOSE.
STACY MARTIN CLINIC MANAGER
NURSE AND I OPPOSE.
I AM I THE SHAUN HOMMAGE AND
I'VE WORKER FOR SENIORS AND I
OPPOSE THIS.
I'M MARIE OUT BARRIO SPECIES
AND I OPPOSE.
I'M RACHEL PUT THE LEANER
REGISTERED NURSE I OPPOSE.
I MENSHEVIK TORINO CLINIC
MANAGER AND I OPPOSE.
I MARILYN DIS ON CLINICAL
MANAGER AND I OPPOSE.
I'M CECILIA JACOB PRECEPTOR FOR
FIFTEEN YEARS I'M OPPOSED.
I'M SYLVIE GIRL SPARE FOR
SENIORS CHARGE NURSE AND I
OPPOSE.
MARIO BALAAM THIRTY YEARS PCP
AND I OPPOSE.
SIMON ESCOBAR FACILITY
ADMINISTRATOR PCT FOR TWENTY
YEARS AND I OPPOSE.
LARA SPERBER CLINIC MANAGER ARE
AND EIGHTEEN YEARS OPPOSE.
I WEAR LACE TRIED NOW WORKING
FOR SENIORS FOR TEN YEARS AYE
OPPOSED.
SUPPLE TRAVIS OF A PATIENT FOR
SERIOUS.
UNABLE TO DEVELOP.
HOPE PROFESSORS.
ROBERT RENO EVER HOME A DALLAS
IS PATIENT AND I SUPPORT THE
INITIATIVE.
JAMES THAT ISN'T OURS FOR
THIRTEEN YEARS I SUPPORT.
AMMAR BY TORY TYPES SOCIAL
WORKER AND A DIALYSIS PATIENT
AND I'M SO IN SUPPORT OF THIS.
MY YEAH MORALLY OR WHAT DOES
THAT HAVE THAT YOU UP FOR YOUR
KNEES HAVE PEOPLE. BASED THAT
SOON.
KARINA MELGAR DIALYSIS PATIENTS
OF ELEVEN YEARS A STRONG.
SUPPORT THIS INITIATIVE. AND MY
LIFE IS.
WORTH MORE THAN YOUR PROFITS.
ANYONE ELSE.
YEAH NO ONE WE WILL.
THAT WANT TO THANK EVERYBODY
FOR PARTICIPATING DAYS
ESPECIALLY THOSE PUT PEOPLE
TRAVEL FROM LONG DISTANCES THANK
YOU TO THE WITNESSES FROM BOTH
SIDES.
AND THAT WILL CONCLUDE THE
HEARING ON THIS INITIATIVE AND
WILL BE MOVING ON TO OUR. OUR
SECOND INITIATIVE.
WILL BE INVITING BACK.
.
IT RIDES COMING BACK.
THERE ANY COMMENTS FROM ANYBODY.
THERE WERE FORWARD I THINK WE
CAN.
CAN NO THE PROCESS NOW SO.
GIVE US GIVE JUST A SECOND TO
OKAY FOR TO GO AHEAD. THANK YOU
MISTER CHAIR AGAIN RYAN WILL THE
WITH THE LA NO AND WILL BE.
PRESENTING AS BEFORE JUST A
QUICK BACKGROUND ON THE MEASURE
I'LL. SKIP THROUGH AND
DESCRIBING OUR OWN THE PROCESS
SINCE WE DID THAT ON THE LAST
ONE.
STRAIGHT TO THE BACKGROUND ON
THE MEASURE.
STATE LAW. IDENTIFIES EIGHT
PRIVATE NONPROFIT HOSPITALS AND
THE CHILDREN'S PROGRAMS THAT THE
FIVE UNIVERSITY OF CALIFORNIA
ACADEMIC MEDICAL CENTER CAMPUSES
AS CHILDREN'S HOSPITALS.
AND THESE HOSPITALS FOCUS ON
TREATING INJURED DISABLED. AND
SICK INFANTS AND CHILDREN AND
THE MAJORITY OF THEIR FUNDING
COMES FROM THE FEDERAL STATE
MEDICAID PROGRAM.
THEY ALSO RECEIVE FUNDING FROM
COMMERCIAL HEALTH COVERAGE.
OTHER GOVERNMENT HEALTH COVERAGE
PROGRAMS PRIVATE DONATIONS.
AND TO NAME A FEW.
AND THE UC MEDICAL CENTERS.
DO APPEAR ACCORDING TO BUDGET
DOCUMENTS RECEIVE A SMALL AMOUNT
OF STATE SUPPORT.
ONE OF THE GOVERNMENT COVERAGE
PROGRAMS THAT WILL SPECIALLY
MENTION IS THAT CALIFORNIA'S
CHILDREN SERVICE
SERVICES PROGRAM WHICH. AND PAYS
FOR SPECIALIZED TREATMENT AND
OTHER SERVICES FOR CHILDREN WITH
SPECIAL HEALTHCARE NEEDS.
AND.
AND WILL ALSO NOTE AT THIS POINT
THAT IN ADDITION TO THE.
THIRTEEN SPECIFICALLY
IDENTIFIED CHILDREN'S HOSPITALS
MANY OTHER HOSPITALS IN THE
STATE HAM. ALSO FOCUS TO VARYING
DEGREES ON TREATING CHILDREN AND
MANY OF THEM. ARE APPROVED TO
TREAT CHILDREN THE CCS PROGRAM.
SOME OF THESE HOSPITALS ARE
OPERATED BY LOCAL GOVERNMENTS
SUCH AS.
LOCAL HEALTH CARE DISTRICTS
AND THOSE DISTRICTS DO YOU
PROVIDE SOME LOCAL GOVERNMENT
FUNDING SUPPORT.
AND THEY JUST REALLY BRIEFLY.
BACKGROUND ON ON BONDS AND THE
STATE MAY BORROW TO PAY FOR LONG
TERM CAPITAL PROJECTS BY ISSUING
GENERAL OBLIGATION BONDS.
AND THE STATE REPAYS THESE BONDS
USING.
GENERAL FUND DOLLARS AND THEY
MUST BE APPROVED BY A MAJORITY
OF VOTERS.
AND IN THE PAST THIS AND VOTERS
HAVE TWICE PREVIOUSLY APPROVED.
STATE GENERAL OBLIGATION BONDS.
FOR CAPITAL PROJECTS AT THE
THIRTEEN CHILDREN'S HOSPITALS
AND THERE WAS SEVEN HUNDRED
FIFTY MILLION DOLLARS APPROVED
IN TWO THOUSAND FOUR THROUGH
PROPOSITION SIXTY ONE. AND AN
ADDITIONAL NINE HUNDRED EIGHTY
MILLION APPROVED IN TWO THOUSAND
EIGHT THROUGH PROPOSITION THREE.
AND FUNDS FROM THESE PREVIOUS
MEASURES.
ARE ANTICIPATED TO BE FULLY
COMMITTED TO PROJECTS HAT. I'M
ELIGIBLE HOSPITALS BY THE END OF
THE SUMMER.
ON PAGE FOUR.
WE DESCRIBE.
HOW THE FUNDING FROM THIS
MEASURE WHICH WOULD PROVIDE ONE
POINT FIVE BILLION DOLLARS
IN GENERAL OBLIGATION BOND
FUNDING FOR CAPITAL IMPROVEMENT
PROJECTS WOULD BE ALLOCATED.
AND AS WITH THE PREVIOUS
MEASURES.
CERTAIN AMOUNTS ARE SET ASIDE
FOR THE PRIVATE NONPROFIT
CHILDREN'S HOSPITALS AND THE
FIVE.
UNIVERSITY OF CALIFORNIA
CHILDREN'S HOSPITALS AND IN THE
AMOUNTS THAT ARE SHOWN IN THE
TABLE.
UNLIKE THE PREVIOUS TWO
MEASURES AND THE MEASURE THAT.
WE'RE DISCUSSING TODAY WOULD
ADDITIONALLY PROVIDE ONE HUNDRED
FIFTY MILLION DOLLARS.
OF FUNDING.
FOR.
ROUGHLY ONE HUNDRED AND FIFTY
PUBLIC AND PRIVATE NONPROFIT
HOSPITALS THAT PROVIDE SERVICES
TO CHILDREN IN THE CALIFORNIA
CHILDREN SERVICES PROGRAM.
AND FOR THAT THIRTEEN HOSPITALS
AMOUNTS ARE DOWN A FIGHT IN THE
MEASURE THAT THE HOSPITALS
COULD.
APPLY FOR FUNDING UP TO AM NO
SPECIFIC AMOUNT IS IDENTIFIED IN
THE MEASURE FOR THE ONE HUNDRED
AND FIFTY OR SO. AND OTHER
HOSPITALS THAT WOULD BE MORE ON
A COMPETITIVE BASIS.
I'M ON PAGE FIVE AND BRIEFLY THE
FUNDS.
ARE ALLOWED BY THE MEASURE. AND
TO BE USED FOR VARIOUS PURPOSES
AND SOME THAT ARE OUTLINED IN
THE MEASURE INCLUDE CONSTRUCTION
EXPANSION REMODELING RENOVATION.
REFINANCING AND TO NAME SOME
EXAMPLES HOSPITALS WOULD APPLY
AND TO RECEIVE THESE FUNDS TO
THE CALIFORNIA HEALTH FACILITIES
FINANCING AUTHORITY. WHICH
OPERATES OUT OF THE STATE
TREASURER'S OFFICE.
AND.
THIS AUTHORITY WOULD.
DECIDE WHETHER TO AWARD A GRANT
BASED ON VARIOUS FACTORS
AND INCLUDING THE EXTENT TO
WHICH THE.
FUNDS WOULD HELP.
IMPROVE ACCESS FOR CHILDREN
AND THEY'RE ELIGIBLE FOR
GOVERNMENT HEALTH PROGRAMS AND
WHETHER IT WOULD IMPROVE CHILD
HEALTH OR OTHER PEDIATRIC
PATIENT OUTCOMES OR WHETHER IT
WOULD PROMOTE. PEDIATRIC OR
RESEARCH PROGRAMS.
.
AT AT THE HOSPITALS.
IN TERMS THE FISCAL EFFECTS AND
THERE WOULD BE SOME STATE BOND
REPAYMENT COSTS WHICH AND WE
ESTIMATE WOULD TOTAL TWO POINT
NINE BILLION DOLLARSTO PAY OFF
BOTH THE PRINCIPLE OF ONE POINT
FIVE BILLION. AND THE INTEREST
OF ONE POINT FOUR BILLION. OVER
THIRTY FIVE YEAR PERIOD AND
THIS.
PENCILS OUT TO ABOUT EIGHTY
MILLION DOLLARS.
OF GENERAL FUND COST ANNUALLY.
WE ALSO WOULD JUST KNOW THAT
SINCE SOME OF THE HOSPITALS THAT
WOULD BE APPLYING FOR THESE
FUNDS TO RECEIVE.
.
STATE AND LOCAL GOVERNMENT
SUPPORT IT IS POSSIBLE THAT IN
SOME CASES RECEIVING FUNDS FOR
THIS MEASURE WOULD AFFECT THE.
AND OTHER STATE LOCAL GOVERNMENT
FUNDS THAT ARE AND INVOLVED WITH
THOSE HOSPITALS FOR EXAMPLE AT.
A DISTRICT HOSPITAL MIGHT.
PURSUE AT SOME FUTURE POINT
DOWN ITS OWN BOND MEASURE TO
FINANCE CONSTRUCTION THAT MIGHT
BE LESS BECAUSE THEY RECEIVE
FUNDS FROM FROM THIS MEASURE.
AND WITH THAT WOULD HAPPY TO
ANSWER ANY QUESTIONS.
THE QUESTION.
SIR.
THANK YOU GOOD AFTERNOON.
I'M MY NAME IS OUT RONALD
WASHINGTON I'M THE EXECUTIVE
DIRECTOR OF DAY CALIFORNIA
EDUCATIONAL FACILITIES
AUTHORITY.
I'M OUT OF THE TREASURES OFFICE
UNDER TREASURER JOHN CHIANG.
AND THEN WITH ME TODAY AS
CAROLINE APPROVAL SHAR SHE'S THE
ARE THE PROGRAM MANAGER OVER.
CHAFFETZ GRANT PROGRAMS.
SO WHERE I AM HAPPY TO BE HERE
TODAY. AND I'M JUST SORT OF
THERE AND ONTO WHAT RYAN IS.
INDICATED.
I'D LIKE TO JUST PROVIDE JUST A
GENERAL OVERVIEW OF THE OF. THE
SUCCESS OF.
THE PROP SIXTY ONE IN AND PROP
THREE PROGRAMS
AND THEN.
TALK TO YOU A LITTLE BIT ABOUT
WHAT CHAPTER DOES IN OUR
RESPONSIBILITY OVER THE ON THE
CHILDREN'S HOSPITAL GRANT
PROGRAM.
AND THEN MAYBE JUST BRIEFLY.
TOUCH ON.
.
AN ITEM OR TWO ON.
THE BALLOT INITIATIVE AND THEN
WE'RE HAPPY OF COURSE TO ANSWER
ANY QUESTIONS THAT YOU MIGHT
HAVE ON THE PROGRAM.
SO.
AS YOU KNOW.
.
CHAPTER HAS ALREADY.
ADMINISTER TO GRANT PROGRAMS A
PROP SIXTY ONE AND PROP THREE
BARNES.
INITIATIVES.
.
EACH OF THOSE PROGRAMS ARE. ARE
RUN OUT OF IT.
I CHAPLAIN THE CHARGES OFFICE
AND THE EACH ARE RUN. FAIRLY
IDENTICALLY THE THE DIFFERENCES
ARE IN EACH OF THOSE PROGRAMS
ARE JUST THAT DOLLAR AMOUNT.
OUTSIDE OF THE DOLLAR AMOUNT ON
EACH OF THE PROGRAMS.
WERE.
DIVIDED EIGHTY PERCENT TO THE
NONPROFIT HOSPITALS AND TWENTY
PERCENT.
TWO THE I'M THE FIVE YOU SEE
HOSPITALS.
WE ARE HAPPY TO ANNOUNCE THAT
OF THE FUNDS FOR. OTHER PROP
SIXTY ONE WHICH WAS SEVEN
HUNDRED AND FIFTY MILLION. AND
HAS ALL BEEN FULLY COMMITTED TO
SO WE HAVE A WAR AT ALL OF THOSE
FUNDS.
AND THEN WE EXPECT ALSO WANTED
A PROP THREE.
THE NINE HUNDRED EIGHTY MILLION
DOLLAR A PORTION OF THAT
PROGRAM.
I WE FULLY EXPECT THAT BY THE
END OF JUNE THIRTIETH WE WILL
HAVE AWARDED.
ALL THE FUNDS FOR THEIR PROGRAM.
SO WE BOMB.
AND WE HAVE SEEN.
.
I LOUDEST PROCESS AND HOW WE
HAVE RUN THE PROGRAMS WERE
PLEASED.
OUR TO SEE ANOTHER.
INITIATIVE ON THE BALLOT I'M AS
WE HAVE WORKED OUR WAY THROUGH.
THREE SEPARATE FUNDING ROUNDS.
THERE PROP SIXTY ONE AND THEN
ANOTHER FUNDING ROUND ON THE
PROP THREE.
.
SO.
I'M NOT JUST SORT OF A GENERAL
OVERVIEW OF THE PROGRAM. ARE
CHECK FOR THOSE RUN OBVIOUSLY
OTHER BONDING AND LOAN PROGRAMS
BUT THIS GRANT PROGRAM
PARTICULAR
HAS BEEN VERY SUCCESSFUL.
AND WE HAVE WORKED WITH.
TO CHILDREN'S HOSPITAL
ASSOCIATION AS WELL AS.
THE CALIFORNIA HOSPITAL
ASSOCIATION ON.
ON THIS MEASURE AND SPECIFICALLY
WHAT TO CHILDREN'S HOSPITAL
ASSOCIATION.
WITH THE EXISTING I'M A
CHILDREN'S HOSPITALS.
AND SO JUST BRIEFLY ARM I WANNA
JUST TOUCH ON REALLY WHAT
SHOPPERS ROLE. HAS BEEN ON THE
TWO THOUSAND AND FOUR TWO
THOUSAND AND EIGHT BALLOT
MEASURE.
.
AND THAT WOULD ALSO THEN BE
CONSISTENT WITH.
OF THE INITIATIVE.
FOR TODAY.
AND REALLY SORT OF ONE OF OUR
OUR PRIMARY OBJECTIVES IS TO
REALLY DEVELOP.
.
REGULATIONS THROUGH THE OFFICE
OF ADMINISTRATIVE LAW FOR EACH
OF THESE PROGRAMS.
THEY ARE.
.
PROGRAMS THAT WE ASK SO THAT
EACH OF THE HOSPITALS COMPLY TO
THOSE REGULATIONS. EACH OF THE
THIRTEEN HOSPITALS HAS.
.
SEE.
SUCCESS THROUGH EACH THOSE
REGULATORY PROCESSES.
AND SO ON WILL CONTINUE THAT ON
THE.
THIS INITIAL.
.
LOOK AT THE ARM.
THE I'M INITIATIVE AS BEING
CONSIDERED TODAY.
OTHER ITEM THAT I WANT TO
MENTION IS THAT SO WE HAVE AN
APPLICATION PROCESS THAT WE GO
THROUGH AND.
WE DEVELOP GRANT AGREEMENTS ALL
THE DOCUMENTS RELATED TO EACH OF
THE PROGRAMS.
ARE.
CHAFF ABOARD THEN APPROVES.
.
EACH OF A OUR RECOMMENDATIONS
MADE BY STAFF AND THEN STABBING
WORKS BUT ARE SPECIFICALLY WITH
EACH OF AT THIRTEEN HOSPITALS.
IN ORDER TO.
.
ACCESS THOSE GRANT FUNDS AND
THEN. FOR A SUCCESSFUL A
DEVELOPMENT OR RE FABRICATION
ARE PROJECTS OR BUILDING UP
THOSE FACILITIES.
SO.
THAT'S REALLY OUR OUR ROLE.
ARE WITH THE PROJECT.
.
AND THEN JUST BRIEFLY THIS.
THE CHILDREN'S HOSPITAL BOND
ACTOR TWENTY EIGHTEEN IS
VIRTUALLY IDENTICAL TO OBVIOUSLY
OTHER TO BOND ACTS WITH THE
EXCEPTION BEING. A RATHER THAN
IT BEING A TWENTY EIGHTY SPLAYED
IT IS A.
SEVENTY TWO EIGHTEEN SPLIT WITH
THE TEN PERCENT AS RYAN MENTION.
BEING SET ASIDE FOR ON THE
OTHER.
PUBLIC AND PRIVATE NON PROFIT
HOSPITALS.
THAT TREAT.
.
OF THOSE WITH AYE CCS SERVICES.
BUT.
THEY ARE AGAIN.
ARM IN EVERY EVERY OTHER RESPECT
IDENTICAL TO EACH OF THE TWO BAR
PROGRAMS WHICH WE HAVE SEEN.
OF SIGNIFICANT SUCCESS ON SO.
WE LOOK FORWARD TO WORKING ON
THIS INITIATIVE AND.
I WITH THE HOSPITALS THAT WILL
BE COMING FORWARD AND.
IT REALLY SUPPORT THIS AFTER.
AND WE CAN ANSWER ANY QUESTIONS
THAT YOU MIGHT HAVE.
THANK YOU VERY MUCH.
SEEN NO QUESTIONS AT THIS TIME.
WILL MOVE ONTO THE PROPONENTS.
ITEM NUMBER FOUR.
WE HAVE ANNA LOUISE COONS
PRESIDENCY ó CALIFORNIA
CHILDREN'S HOSPITAL WE HAVE.
.
JENNA JENSEN SHE FONG GOVERNMENT
RELATIONS CHILDREN'S HOSPITAL
ORANGE COUNTY AND JENNIFER PAIGE
PARENT AND PARENT IT CHILDRENS
HOSPITAL OF LOS ANGELES.
AND PLEASE PROCEED WELCOME.
THANK YOU MISTER CHAIRMAN GOOD
AFTERNOON.
I AM INCLUDES AN ON THE
PRESIDENCY OF THE CALIFORNIA
CHILDREN'S HOSPITAL ASSOCIATION
AS YOU MENTIONED WITH ME TODAY
AGENDA JOHNSON THE CHIEF
GOVERNMENT AFFAIRS OFFICER FOR
TALK CHILDREN'S HOSPITAL IN
ORANGE COUNTY AND JENNIFER PAIGE
THE PARENT OF A CHILD WHO HAS
BEEN TREATED FOR THE PAST
THIRTEEN YEARS AT. CHILDREN'S
HOSPITAL LOS ANGELES.
THE CALIFORNIA CHILDREN'S
HOSPITAL ASSOCIATION IS PLEASED
TO BE SPONSORING THE CHILDREN'S
HOSPITAL BOND ACTIVE TWENTY
EIGHTEEN. A BOND MEASURE THAT WE
EXPECT TO QUALIFY FOR THE
NOVEMBER BALLOT.
THE ACT WILL PROVIDE UP TO ONE
POINT FIVE BILLION DOLLARS TO
EXPAND AND RENOVATE CHILDREN
CALIFORNIA'S CHILDREN'S
HOSPITALS AND TO PURCHASE STATE
OF THE ART LIFESAVING MEDICAL
EQUIPMENT.
TO TREAT MOST SERIOUSLY ILL AND
INJURED CHILDREN IN THE STATE.
EVERY YEAR CALIFORNIA'S
CHILDREN'S HOSPITALS TREAT OVER
ONE MILLION CHILDREN'S IN
INJURIES AND ILLNESSES WITHOUT
REGARD TO FAMILIES ABILITY TO
PAY.
OUR HOSPITALS PROVIDE
SPECIALIZED CARE TO TREAT
CHILDREN AND YOUNG ADULTS.
ADULTS WITH THE MOST SERIOUS AND
LIFE THREATENING ILLNESSES LIKE
CHILDHOOD LEUKEMIA HEART
DEFECTS.
SICKLE CELL DISEASE DIABETES AND
CYSTIC FIBROSIS.
CCJ MEMBER HOSPITALS PERFORM
NINETY SEVEN PERCENT OF ALL
PEDIATRIC ORGAN TRANSPLANTS.
AND NINETY SIX PERCENT OF ALL
PEDIATRIC HEART SURGERIES.
AND CONDUCT SEVENTY SIX PERCENT
OF ALL PEDIATRIC CANCER
TREATMENTS IN CALIFORNIA.
THEY ALSO SERVICE REGIONAL
TERTIARY CARE AND TRAUMA
CENTERS.
FINALLY THERE ARE SOME OF THE
NATION'S PREMIER PEDIATRIC
RESEARCH CENTERS MAKING THEM A
MAJOR SOURCE OF SCIENTIFIC
DISCOVERIES IN BIOMEDICAL
RESEARCH BENEFITING ALL
CHILDREN.
CALIFORNIA'S CHILDREN'S
HOSPITALS FACE PARTICULAR
CHALLENGES WHEN IT COMES TO
FINANCING INFRASTRUCTURE.
MEDI CAL WHICH IS ONE OF THE
MOST PIN URAEUS PAIRS IN THE
NATION IS RESPONSIBLE FOR
REIMBURSING ABOUT SIXTY SIX
PERCENT OF ALL OF OUR HOSPITAL
STAYS.
THIS IS TWICE THE STATEWIDE
AVERAGE FOR ALL HOSPITALS.
IT'S VERY DIFFICULT TO SET ASIDE
MONNING FOR BUILDINGS AND
EQUIPMENT WITH THAT PAYER MIX.
AT THE SAME TIME PUBLIC AND
NONPROFIT CHILDREN'S HOSPITALS
DO NOT HAVE ACCESS TO EQUITY
MARKETS IN THE WAY THAT FOR
PROFIT ORGANIZATIONS DO.
THIS IS WHY WE'RE SEEKING ACCESS
TO BOND FUNDS FOR LARGE SCALE
INFRASTRUCTURE PROJECTS THAT
BENEFIT CHILDREN THROUGHOUT THE
STATE.
THE CHILDREN'S HOSPITAL BOND
ACTOR TWENTY EIGHTEEN WILL BUILD
ON THE SUCCESS OF TWO PREVIOUS
CHILDREN'S HOSPITAL BONDS.
PROPOSITION SIXTY ONE WHICH
REYES SEVEN HUNDRED FIFTY
MILLION FOR CHILDREN'S HOSPITALS
IN TWO THOUSAND FOUR.
AND PROPOSITION THREE WHICH
MILLION DOLLARS FOR CHILDREN'S
HOSPITALS IN TWO THOUSAND AND
EIGHT.
THESE PREVIOUS BOND PROGRAMS
ENABLE THEIR HOSPITALS TO BILL
PATIENT TOWERS THAT MEET TWENTY
THIRTY SEISMIC STANDARDS
PURCHASE NEW EQUIPMENT INCLUDING
IT SOFTWARE AND HARDWARE.
AND ACQUIRE NEW MEDICAL
TECHNOLOGY FOR THINGS LIKE PET
SCANS.
THE RESULT IS THAT CHILDREN'S
HOSPITALS HAVE MADE SUBSTANTIAL
PROGRESS IN MODERNIZING
FACILITIES THROUGHOUT THE STATE.
THESE FUNDS HAVE NOW BEEN
DISPERSED TO FINANCE PROJECTS
THAT WERE LONG OVERDUE.
IN THE INTERVENING TEN YEARS
DEMAND FOR OUR SERVICES HAS
GROWN AND TECHNOLOGY HAS
CONTINUED TO EVOLVE.
CHILDREN'S HOSPITALS ARE SEEING
MORE AND MORE REFERRALS FROM
LOCAL COMMUNITY HOSPITALS AS
REGIONALIZATION OF PEDIATRIC
SPECIALTY CARE IN CALIFORNIA HAS
INTENSIFIED.
IN ADDITION WE ARE SEEING
CHILDREN WITH MEDICAL COMPLEXITY
LIVE LONGER BUT WITH CONTINUED
NEED FOR MEDICAL CARE.
FOR EXAMPLE CHILDREN WITH CYSTIC
FIBROSIS DID NOT USE TO SURVIVE
PAST EARLY ADOLESCENCE BUT ARE
NOW LIVING WELL INTO ADULTHOOD.
SIMILARLY VERY PREMATURE BABIES
ARE NOW SURVIVING IN SITUATIONS
THAT WOULD NOT OF IMPOSSIBLE A
DECADE AGO.
BUT THEY'RE LIVING WITH LIFELONG
MEDICAL NEEDS THAT REQUIRE
CONTINUE TREATMENTS FOR
NEUROLOGICAL IMPAIRMENTS.
THESE TRENDS HAVE MEANT THAT
SOME OF OUR HOSPITALS ARE
OPERATING AT CLOSE TO CAPACITY
FOR MANY MONTHS OF THE YEAR.
AT THE SAME TIME THE COST OF
HOSPITAL CONSTRUCTION CONTINUES
TO INCREASE WHICH MAKES ALL OF
THESE NEEDED IMPROVEMENTS IN
EXPANSIONS MORE EXPENSIVE.
WE ESTIMATE THAT OUR HOSPITAL
CONSTRUCTION COSTS HAVE GROWN BY
THIRTY FIVE PERCENT SINCE TWO
THOUSAND AND EIGHT. AND THAT
CONSTRUCTION COSTS FOR BETTER
NOW ABOUT THREE MILLION DOLLARS.
BASED ON THESE TRENDS WE HAVE
BUILT A FISCAL ESTIMATE FOR
FUTURE CHILDREN'S HOSPITAL
INFRASTRUCTURE NEEDS OVER THE
NEXT FIFTEEN YEARS.
THESE INCLUDE FIRST BUILDING
CAPACITY IN SPECIALTY AREAS
WHERE THE NEED IS GROWING. LIKE
CARDIAC LABS FOR CHILDREN WITH
CONGENITAL HEART ABNORMALITIES
AND OUTPATIENT CLINICS FOR
CHILDREN WITH BEHAVIORAL HEALTH
NEEDS.
SO THAT WAIT TIMES FOR SERVICES
ARE REDUCED.
SECOND ADDING ADDITIONAL BEDS IN
HOSPITALS THAT ARE NEAR
CAPACITY.
AND THIRD MAKING SURE THAT ALL
HOSPITAL BUILDINGS MEET THE MOST
STRINGENT STANDARDS FOR SEISMIC
SAFETY.
IT WILL ALSO BE USED TO ENSURE
THAT CHILDREN'S HOSPITALS HAVE
THE MOST UP TO DATE INFORMATION
TECHNOLOGIES SO THAT CHILDREN'S
MEDICAL RECORDS CAN BE
APPROPRIATELY ACCESSED AND
SECURED.
AS THE LA OR DESCRIBE THE ACT
WILL PROVIDE HUNDRED THIRTY FIVE
MILLION DOLLARS TO EACH OF THE
EIGHT FREESTANDING NOT FOR
PROFIT CHILDREN'S HOSPITALS IN
FIFTY FOUR MILLION DOLLARS TO
EACH OF THE FIVE PUBLIC
UNIVERSITY OF CALIFORNIA
CHILDREN'S HOSPITALS.
THIS ALLOCATION IS BASED ON THE
APPROXIMATE SPLIT OF HOSPITAL
BEDS BETWEEN THIS TWO TYPES OF
HOSPITALS.
JACK WILL ALSO PROVIDE HUNDRED
FIFTY MILLION TO ADDRESS
PEDIATRIC INFRASTRUCTURE NEEDS
AND OTHER PUBLIC AND NONPROFIT
HOSPITALS IN CALIFORNIA THAT
SERVE CHILDREN IN THE CALIFORNIA
CHILDREN SERVICES PROGRAM.
THESE FUNDS WILL BE AVAILABLE TO
ELIGIBLE HOSPITALS FOR PERIOD OF
UP TO FIFTEEN YEARS.
IT'S IMPORTANT NOTE THAT THE
CALIFORNIA THAT THE CHILDREN'S
HOSPITAL BOND AFTER TWENTY
EIGHTEEN HAS STRICT OVERSIGHT
CRITERIA TO ENSURE THESE FUNDS
CAN ONLY BE USED FOR
INFRASTRUCTURE AND ONLY FOR
PROJECT PROJECTS THAT WILL
IMPROVE PEDIATRIC ACCESS AND
HEALTH CARE OUTCOMES.
ALL REQUESTS FOR FUNDS MUST BE
CAREFULLY REVIEWED AND APPROVED
BY CHAFF AS MISTER WASHINGTON
JUST DESCRIBED.
IN ADDITION PERIODIC REVIEWS BY
THE INDEPENDENT BUREAU OF STATE
AUDITS INSURERS THAT FUNDS ARE
USED APPROPRIATELY.
AUDITS A PREVIOUS CHILDREN'S
HOSPITAL BOND PROJECTS HAVE
DETERMINED THAT THE PRIDE
PROGRAM IS OPERATING CONSISTENT
WITH THE LAW.
THE PURPOSE OF THE CHILDREN'S
HOSPITAL BOND ACT IS TO ENSURE
THAT CHILDREN'S HOSPITALS CAN
ACQUIRE THE TECHNOLOGY AND NOW
THE CAPACITY TO MEET THE MEDICAL
NEEDS OF THE MOST MEDICALLY
COMPLEX CHILDREN AND ULTIMATELY
SAVE MORE LIVES.
WE HOPE YOU WILL CONSIDER
SUPPORTING IT.
WITH YOUR PERMISSION MISTER
CHAIRMAN I'D LIKE TO ASK MS
JOHNSON AND THE MRS PAGE TO MAKE
SOME COMMENTS AND THEN WE'D BE
HAPPY TO ANSWER ANY QUESTIONS
YOU MAY HAVE.
GOOD AFTERNOON CHAIR WOULD CHAIR
HERNANDEZ AND MEMBER SIDE AS AND
SAID JANET JANSEN WITH TALK
CHILDREN'S HOSPITAL WHICH IS AN
ORANGE COUNTY CALIFORNIA.
I'M CHIEF GOVERNMENT RELATIONS
OFFICER AND I'D BEEN WITH CHALK
FOR TWENTY FIVE YEARS.
I AM SO I WAS AT CHALK WHEN WE
PASSED PROP THREE AND PROP SIXTY
ONE IN THOSE DOLLARS CAME IN AND
WE USE THOSE DOLLARS TO BUILD A
NEW TOWER TO TAKE CARE OF
CHILDREN ORANGE COUNTY THE BILL
HOMES TOWER.
IS FOUR HUNDRED AND TWENTY FIVE
THOUSAND SQUARE FEET WE OPENED
IT AND TWENTY THIRTEEN AND IT
REALLY CHANGED THE FACE OF
PEDIATRIC MEDICINE AND ORANGE
COUNTY. IT ALLOWED US TO BRING
SOME VERY IMPORTANT SERVICES
INTO OUR HOSPITAL FOR THE FIRST
TIME. PRIOR TO OPENING THE BILL
HOMES TOWER WE SHARED EMERGENCY
DEPARTMENT OPERATING ROOM LAB.
RADIOLOGY WITH OUR NEXT DOOR
NEIGHBOR AND SEEN JOSEPH
HOSPITAL SHE IS A WONDERFUL
PARTNERSHIP FOR MANY MANY YEARS
BY.
WAS VERY IMPORTANT FOR US TO BE
ABLE TO BRING THOSE SERVICES
INTO OUR OWN HOSPITAL BECAUSE
WITHOUT WE WERE ABLE TO PROVIDE.
SALINAS THERE REALLY DESIGNED
SPECIFICALLY FOR CHILDREN AND
STAFF THAT IS SPECIFICALLY
TRAINED TO TAKE CARE OF CHILDREN
SO IT REALLY DID CHANGE THE WAY
WE PROVIDE CARE AT CHALK
CHILDREN'S.
AND IN ADDITION.
I ONE YEAR AFTER OPENING THAT
BUILDING WE WERE ABLE TO BECOME
THE FIRST DESIGNATED PEDIATRIC
TRAUMA CENTER THAT ORANGE COUNTY
HAS EVER HAD THAT WAS A VERY
IMPORTANT SERVICE TO PROVIDE FOR
OUR COMMUNITY THAT WE WOULD NOT
HAVE BEEN ABLE TO DO. WITHOUT
HAVING OUR OWN EMERGENCY
DEPARTMENT AND IT'S BEEN A GREAT
SUCCESS.
SO IT HAS BEEN JUST A TREMENDOUS
BENEFIT TO THE CHILDREN OF OUR
COMMUNITY AND TO THOSE DOLLARS
FROM PROP THREE AND PROPS PROP
SIXTY ONE REALLY ALLOWED US. TO
MOVE FORWARD WITHOUT PROJECT.
SO A LITTLE BIT I WANT TO TELL
YOU A LITTLE BIT ABOUT WHAT'S
NEXT FOR US SO WHAT KIND OF
PRIORITIES ARE ON THE HORIZON
FOR CHALK CHILDREN'S AND I NEED
TO TELL YOU THAT ONE OF OUR
BIGGEST PRIORITIES RIGHT NOW. IS
PEDIATRIC AND ADOLESCENT MENTAL
HEALTH.
WE KNOW THAT ONE IN FIVE
CHILDREN SUFFERS A DIAGNOSABLE
MENTAL HEALTH DISORDER.
AND THAT SUICIDE IS THE SECOND
LEADING CAUSE OF DEATH AMONG
BOTH CHILDREN AGES TEN TO
FOURTEEN AS WELL AS FIFTEEN TO
TWENTY FOUR RIGHT NOW IN OUR
COUNTRY.
ON BEHALF OF PEOPLE WHO HAVE
MENTAL ILLNESS IN ADULTHOOD DID
EXPERIENCE SYMPTOMS BY AGE
FOURTEEN.
AND YET ONLY ONE THIRD OF THOSE
FOLKS RECEIVED OF HELP THEY
NEEDED AND CHILDHOOD AND THAT
CONTINUES TO BE A HUGE PROBLEM.
AND YOU ALSO MIGHT SURPRISE BE
SURPRISED TO KNOW THAT IT TAKES
AN AVERAGE OF TEN YEARS TO
DIAGNOSE.
A PEDIATRIC MENTAL HEALTH
DISORDERS TO WHEN YOU THINK
ABOUT IF WE HAD ANY OTHER
CHRONIC DISEASE. THAT WE WERE
LETTING GO FOR TEN YEARS BEFORE
WE IDENTIFIED AND TREATED IT YOU
CAN JUST IMAGINE HOW. THESE
THINGS BECOME OUT OF CONTROL AND
WE WOULD NOT TOLERATE IT WITH
ANY OTHER DIAGNOSIS AND WE
SHOULDN'T TOLERATE IT WITH
MENTAL HEALTH.
SO THREE YEARS AGO WE LAUNCHED A
COMPREHENSIVE MENTAL HEALTH
INITIATIVE THAT CHALK CHILDREN'S
WE STARTED OUT BY CONVENING A
LARGE MULTI DISCIPLINARY TASK
FORCE FROM COMMUNITY MEMBERS TO
ADVISE US AND HELP US SET
PRIORITIES.
WE NEED TO MOVE FORWARD WITH
INTENSIVE OUTPATIENT SERVICES.
AND THEN JUST RECENTLY WE OPENED
OUR COUNTIES FIRST
PEDIATRIC MENTAL HEALTH UNIT WE
SERVE CHILDREN BETWEEN AGES
THREE AND SEVENTEEN. IT'S AN
EIGHTEEN BED UNIT WITH ALL
PRIVATE ROOMS WE OPENED IT JUST
ABOUT THREE OR FOUR WEEKS AGO I
WOULD SAY.
AND SO WITH THE OPENING OF THIS
ITEM WE INCREASE THE CAPACITY
FOR OUR STATES.
A MENTAL HEALTH SERVICES FOR
CHILDREN UNDER TWELVE BY
EIGHTEEN PERCENT.
BEFORE THAT THERE WERE ONLY ONE
HUNDRED BEDS FOR CHILDREN UNDER
TWELVE IN OUR STATE AND WE HAVE
SIX MILLION CHILDREN UNDER
TWELVE IN OUR STATE.
SO I KNOW YOU KNOW THAT WAS NOT
ENOUGH SO WAS A BIG DEAL TO OPEN
THOSE BEDS.
THE FIRST PATIENT WE ADMITTED
WAS JUST FIVE YEARS OLD.
THAT CHILD HAD BEEN SITTING IN
AN EMERGENCY DEPARTMENT FOR
QUITE SOME TIME WAITING FOR
CARE.
AND THERE WERE REALLY NOT ANY
GOOD OPTIONS ON THE HORIZON FOR
THAT CHILD SO WE WERE VERY GLAD
TO BE ABLE TO OPEN OUR DOORS AND
TAKE CARE OF THAT CHILD.
SECOND PATIENT WAS ONLY EIGHT
YEARS OLD.
WE NO THIS UNIT IS GOING TO BE
FULL WITHIN MONTHS WE HAD A
WAITING LIST WITHIN TWENTY FOUR
HOURS OF CHILDREN WHO NEEDED TO
GET INTO THE UNIT.
AND WE KNOW THE NEED IS
CONTINUING TO GROW.
WE ALSO BEGAN SCREENING ALL
CHILDREN. OVER THE AGE OF ELEVEN
WHO COME INTO OUR EMERGENCY
DEPARTMENT FOR ANY REASON AT
ALL.
SO IF THAT ELEVEN YEAR OLD OR
OLDER CON SAN WITH A BROKEN BONE
OR WITH A HIGH FEVER ORREALLY
ANYTHING AT ALL.
OUR STAFF SCREENS THEM TO FIND
OUT IF THEY'VE BEEN EXPERIENCING
SUICIDAL THOUGHTS IF THEY'VE
SUICIDAL IDEATION.
STUNNINGLY IN THE FIRST THREE
WEEKS THAT WE STARTED CONDUCTING
THE SCREENING WE HAD EIGHTY FIVE
CHILDREN TELL US THAT THEY HAD
BEEN HAVING THESE THOUGHTS.
MANY OF THEIR PARENTS WERE
EXTREMELY SHOCKED IN FACT MOST
OF THEM WERE EXTREMELY SHOCKED
AND WE CONTINUE TO HAVE A TEN TO
TWELVE PERCENT POSITIVE
SCREENING RATE. AND ARE
MERCHANTS THE DEPARTMENT WITH
KIDS WHO WE ASK THAT QUESTION
OF.
SO WE'VE DONE A LOT BUT WE NEED
TO DO MORE AND WE WANT TO DO
MORE IN THIS IMPORTANT AREA.
WE NEED MORE OUTPATIENT THERAPY
WE OPENED AN INTENSIVE
OUTPATIENT PROGRAM AND WE FILLED
IT UP WITHIN WEEKS THAT PROGRAM
IS FOR TEENAGERS WHO ARE
EXPERIENCING A SERIOUS
DEPRESSION AND ANXIETY.
WE NEED MORE INPATIENT BEDS WE
KNOW WE NEED INPATIENT PSYCH
BEDS AND OTHER PARTS OF OUR
COUNTY THAT CURRENTLY AREN'T
BEING SERVED CLOSE TO HOME.
AND THEN WE NEED BETTER SERVICES
AND MORE SERVICES FOR CHILDREN
WITH AUTISM. WE RECENTLY AND
RECEIVED A TEN MILLION DOLLAR
LEAD GETS TO OPEN IN NEW AUTISM
CENTER A CHALK CHILDREN'S AUTISM
CENTER. AND AROUND THE CORNER
FROM OUR HOSPITAL. WE KNOW TEN
MILLION DOLLARS IS A GREAT START
BUT WE'RE GONNA NEED MORE FUNDS
TO REALLY OPEN AND EQUIPPED DOT.
FACILITY AND WE'RE GONNA NEED TO
SURROUND IT WITH OTHER
SUPPORTIVE SERVICES ESPECIALLY
FOR CHILDREN BETWEEN THE AGES
OF.
I ZERO ONE EIGHT SO CHILDREN UP
TO EIGHT THAT'S WHERE WE HAVE
THE POST THE BEST CHANCE.
TO MAKE A DIFFERENCE FOR KIDS
WITH AUTISM AND YET THOSE HIGH
ACCESS TO THOSE SERVICES IS
REALLY AN ADEQUATE AND OUR STATE
SO WE'RE EAGER TO DO THAT.
SO THE CHILDREN'S HOSPITAL BOND
WOULD REALLY GIVE US A HUGE HEAD
START.
TO TRY AND MEET ALL THESE NEEDS
THAT WE'VE NEWMAN AND NUMERATORS
WE ALSO NEED.
BETTER ACCESS AND MORE ACCESS TO
SPECIALTY CARE SERVICES WE NEED
MORE ACCESS TO OUTPATIENT
SERVICES BECAUSE WE KNOW THAT'S
WHERE THE DEMAND IS MOVING. AND
WE ALSO NEED TO INVEST IN
INNOVATIVE PROGRAMS THAT ARE
GOING TO BRING OUR SERVICES INTO
THE COMMUNITY WHERE AND WHEN
FAMILIES NEED THEM AND WANT THEM
NOW.
AND HIS AND TOLD YOU THE DEMAND
FOR SERVICES IS GROWING BUT IT'S
A GOOD STORY IT'S A STORY ABOUT
SAVING CHILDREN'S LIVES WHEN I
STARTED WORKING AT CHOCOLATES
AND SAT I REMEMBER.
THAT VERY YOUNG KIDS WERE DYING
FROM CYSTIC FIBROSIS WE HAD A
LOT OF KIDS WHO WOULD DIE FROM
LEUKEMIA AND NOW I'VE SEEN THE
CURE RATES JUST SKYROCKET.
SO WE'RE TAKING CARE OF THESE
KIDS THEY NEED ONGOING CARE SO
THEY'RE SURVIVING BUT THEY NEED
CONTINUING CARE FROM US AND THAT
IS ONE REASON WHY THE DEMAND FOR
SERVICES IS GROWING.
WE'RE ALSO SEEING OTHER
HOSPITALS IN THE COMMUNITY
RIGHTLY AND IMPORTANTLY FOCUSING
ON AGING POPULATION WE SEE A
SHIFT OF FOCUS TO CAPACITY FOR
THAT GROWING SEGMENT OF AGING
ADULTS.
AND THEREFORE WE SEE EVEN A
GREATER NEED FOR CHILDREN'S
HOSPITALS TO BE THERE FOR
CHILDREN AND WE WANT TO BE THERE
AND WE'RE EXCITED ABOUT BEING
THERE FOR THEM. BUT WE'RE GOING
TO NEED SOME HELP TO DO IT
BECAUSE AT CHALK FOR SIXTY FIVE
PERCENT NOT A COW AND WE KNOW
WE'RE NOT GOING TO GET THERE ON
MEDI CAL REIMBURSEMENT.
SO FOR ALL THESE REASONS WERE
ASKING VOTERS TO VOTE YES ON
CHILDREN'S HOSPITALS IN NOVEMBER
AND WE HOPE YOU'LL SUPPORT US AS
WELL THANK YOU SO MUCH.
MY NAME IS JENNIFER PAIGE AND I
HAVE THE PRIVILEGE TO REPRESENT
THE FAMILIES THAT ARE SERVED BY
THE CALIFORNIA CHILDREN'S
HOSPITALS. AND I'M HERE ALSO IN
HONOR OF MY SON MAX.
MAX WAS BORN IN TWO THOUSAND
FOUR WITH.
CANNELLA HEART DISEASE CALLED
TETRALOGY FOLLOW MEANS THAT FOR
MAJOR THINGS WRONG WITH HIS
HEART. HE HAD HIS FIRST SURGERY
WHEN HE WAS THREE MONTHS OLD AND
OUR JOURNEY AND SO FAR HE'S HAD
THREE PULMONARY BOWS REPLACED
FOR PACEMAKERS THIRTEEN
SURGERIES AND ALL.
MOST RECENTLY WHICH WAS THREE
MONTHS AGO HE HAD OPEN HEART
SURGERY TO REPLACE A PULMONARY
VALVE.
BUT BECAUSE OF THE GREAT CARE HE
RECEIVED THAT'S NOT HAS TOTAL
STORY. HE LOVES LEARNING HIM AS
ACADEMIC SEASON ATHLETE HE'S AN
ACTOR SOME OF YOU MAY KNOW HIM
AS THE MANY DARTH VADER FROM A
SUPERBOWL COMMERCIAL IF YEARS
AGO. WHERE HE WAS A LITTLE GUY
THAT WAS STARTING THE CAR?
AND THAT ALSO LEAD TO A
PLATFORMER HIS AN ADVOCATE THIS
MORNING MAX WAS SPEAKING IN
ORANGE COUNTY TWO HUNDRED
EXECUTIVES ENCOURAGING THEM TO
DONATE TO HEART VALVE RESEARCH.
MAX IS LIVING PROOF OF PATIENTS
THAT. WHOSE LIVES ARE SAVED AND
THE QUALITY IMPROVES
BECAUSE OF THE TECHNOLOGY
ADVANCES THAT INDUSTRIES MAKING
AND OUR OUR CENTERS WHERE
RESEARCH IS DONE. THE
INFRASTRUCTURE ENHANCEMENTS AND
IMPROVE PATIENT CARE FOCUS ON A
PATIENT CENTERED CARE WHERE
FAMILIES ARE NOW INVOLVED.
IN TWO THOUSAND FOUR AS MAX
FOUGHT FOR HIS LIFE IN THE NICK
YOU IN OUR LOCAL COMMUNITY. WE
HAD MY IS AT AN I HAD VISITING
HOURS AND AN OCCASIONAL CONSUL
THE IF WE'RE LUCKY ENOUGH TO BE
THERE AT THE SAME TIME AS THE
DOCTOR.
TODAY WE SLEEP IN A ROOM WITH
SHOWER IN ROOM.
FOOD IS BROUGHT TO US SO WE
NEVER HAVE TO LEAVE MAX.
ASKED US IN WHEN HE WAS TWELVE
YEARS AND FOR A VERY LONG SAY
AND AND MOST RECENTLY. PLEASE
DON'T LEAVE ME ALONE FOR ONE
SECONDS.
AND THIS IS THE KID THAT IS OF
AS A PRACTICE PATIENT HE KNOWS
HOW TO BE PATIENT. AND HE THAT
HE WANTS OUT AYE WITH THEM AT
ALL TIMES BECAUSE WHAT HAPPENS
IS A DOCTOR OR A NURSE WILL COME
AND WERE NOT THERE AND THAT ALSO
AND THINGS WILL BE SAID THINGS
WILL BE SAID OVER HIS HEAD AS IF
HE DOESN'T HERE. AND IT'S A
CONFUSING SCARY TIME EVEN FOR
SOMEONE AS CONFIDENT AS MAX.
WE ALSO NOW PART OF THE DECISION
WERE NOT FORCED OUT OF THE ROOM
FOR ROUNDING WERE INCLUDED IN
THE ROUNDING AT MAX'S INCLUDED
ALSO. AND A LOT OF DECISIONS
THAT ARE MADE.
IN TWO THOUSAND FOUR OUR SURGEON
TOLD US THAT AND HE HAD AN IDEA
OF WHAT WE'RE GOING AFTER BASED
ON THE DIAGNOSTIC TESTING AT THE
TIME BUT THAT WHEN HE GOT INTO
MAX'S HEART THERE MIGHT BE SOME
SURPRISES AND PREPARES FOR THE
SURPRISES. YOU CAN ONLY GIVE US.
HIS ADVICE FROM THAT VANTAGE
POINT.
TODAY WE HAVE THREE D.
ECHOCARDIOGRAM TO GIVE A MUCH
CLEARER PICTURE OF WHAT'S
ACTUALLY GOING ON AND WE HAVE
THREE D. PRINTING OF INDIVIDUAL
CHILDREN'S HEARTS
SO NOW BEFORE HIS INTERVENTIONAL
CARDIOLOGISTS OR HIS SURGEON
CUTS INTO HIM. MACS THEY HAVE A
REALLY CLEAR GAME PLAN AND NOW
THEY'RE NOT WASTING TIME ON THE
HEART LUNG BYPASS MACHINE THEY
KNOW WHAT THEY'RE DOING BEFORE
THEY GO WHEN THEY HAVE A. SAVE
THEM SO MUCH TIME.
IN TWO THOUSAND FOUR THE ONLY
OPTION TO REPLACE A PULMONARY
DOLLARS OPEN HEART SURGERY THAT
WAS IT.
TODAY WE HAVE.
SOME PATIENTS QUALIFY FOR
MILLION BASE OF SURGERY THAT CAN
PUT IN A PULMONARY VALVE OR
OTHER VALVES.
AND THREE ARE GROWING POSSIBLY
OUR NECK DEPENDING ON HOW HOW.
BIG THE CHILD THIS.
WE SAW THIS A MAX WAS TEN HE
RECEIVED ABOUT THIS WAY.
WHEN THAT MAX WAS SEVENTY HAD
OPEN HEART SURGERY IT WAS A SIX
MONTH RECOVERY IS VERY PAINFUL
AND HE WAS SIDELINED FROM HIS
WIFE. WHEN HE WAS TEN HE
RECEIVED ONE OF THESE VALVES
MEMBER INVASIVE ALSO WE LEFT THE
NEXT DAY OF THE TYLENOL AND A
BANDAID.
SO IT'S IT'S TRANSFORMATIVE WHAT
CAN HAPPEN THAT ONLY HAPPENS IF
THE HOSPITALS CAN KEEP UP WITH
THE INFRASTRUCTURE TO KEEP UP
WITH TECHNOLOGY THAT INDUSTRIES
PROVIDING.
BUT I'LL TELL YOU IS SITTING
THERE WATCHING HIM JUMP UP AND
DOWN AND I WAS BEGGING HIM NOT
TO EVEN THOUGH THE DOCTOR WAS
TELLING HIM TO IT'S AS IF YOU'RE
WATCHING A SCI FI MOVIE RIGHT
THAT TRANSFORM RIGHT BEFORE YOUR
EYES.
THESE.
PAST BONDS AND THIS PAST
PROPOSITION SIXTY ONE AND THREE
THEY HELPED CREATE TODAY WITHOUT
THOSE I DON'T KNOW THE
CHILDREN'S HOSPITALS ANGELUS
WOULD HAVE BEEN AS PREPARED FOR
MAX.
THIS PROPOSITION WILL HELP
CREATE TOMORROW AND TOMORROW IS
VERY IMPORTANT OF THOSE CHILDREN
LIKE MAX WHO LIVE WITH LIFELONG
DISEASE MAX IS NEVER GOING TO BE
CURED. HE'S ALWAYS BEEN NEED A
PACEMAKER EVENTUALLY RUN OUT OF
BATTERY JUICE HE'S GONNA BE NO
VOWS BECAUSE ARTIFICIAL THOUGH
WEAR OUT. AND SO WE ALWAYS HAVE
ON OUR MIND WHAT THAT WHAT THE
HORIZON IS.
I'VE LIVED IN THESE CHILDREN'S
HOSPITALS NOW RADIS TALK
CHILDREN'S HOSP LOS ANGELES FOR
THE LAST THIRTEEN YEARS.
AND IN MY OPINION JUST AS A MOM
AN OUTSIDE OBSERVER.
THERE'S FOUR THINGS THAT MAKE
THEM SUCCESSFUL ONE IS THE
HOSPITAL'S ATTRACTING THE TOP
TALENTS CALIFORNIA AND KEEPING
IT IN CALIFORNIA.
TWO IS OUR LOCAL COMMUNITIES
THAT WE SUPPORT WE HAVE AN
OBLIGATION TO INSPIRE AND INFORM
THEM OF WHY IT'S IMPORTANT TO
TAKE CARE OF CHILDREN'S HOSPITAL
ESPECIALLY FOR THOSE WHO DON'T
THINK THEY'LL EVER NEED IT. NONE
OF US EVER THINK WE'LL NEED IT
AND SO WE DO.
THE PATIENT FAMILIES LIKE MINE
WE HAVE.
NOT JUST CONSUMER HEALTH CARE WE
HAVE A RESPONSIBILITY TO
CONTRIBUTE BACK TO IT.
WHETHER IT'S SHARING OUR STORIES
OUR TALENTS OUR TIME OUR
TREASURE HOWEVER WHATEVER WE CAN
DO TO HELP KEEP THEM OPEN FOR
THOSE WHO COME BEHIND US.
AND THE FOURTH ONE IS OUR
GOVERNMENT AS YOU HEARD THE
REIMBURSEMENTS OR HOSPITAL
PRIMARILY COME FROM THE
GOVERNMENT BY STATE AND LOCAL
AND AND FEDERAL AND WE ARE SO
GRATEFUL THAT YOU ALSO HAVE THAT
THE GREATEST ABILITY TO MAKE AND
CREATE TRANSFORMATIVE CHANGE TO
THESE HOSPITALS. ON THIS WOULD
BE REVOLUTIONARY FOR THESE
HOSPITALS A HUNDRED AND THIRTY
FIVE MILLION DOLLARS I'M ON THE
BOARD AT CHL AND I KNOW HOW FAR
THAT. THAT COULD GO FOREST'S.
THIS IS THE PART THAT'S THE MOM
PART IT'S A LITTLE DIFFICULT BUT
I'VE SPENT MANY NIGHTS IN THE
HOSPITAL WATCHING MY SON SLEEP.
AND MY PRAYER WAS THAT HIS LIFE
NO MATTER HOW LONG THROUGH TURN
THEM OVER SO MANY TIMES THAT
NINE COULD GET HIM BACK.
WOULD MATTER THAT IT COULD BE
THAT THE STORY COULD MEAN
SOMETHING MORE.
AND BE SERVED AS A HIGHER
PURPOSE AND I APPRECIATE YOU
LISTENING TODAY AND HAVING ME
HERE BECAUSE THIS IS ONE OF
THOSE MOMENTS. WHERE EVERYTHING
HE ENDORSE ALL THE PAIN ALL THE
FEAR?
CAN MATTER TODAY BECAUSE HIS
STORY COMMENDED VOICE AND BE AN
EXAMPLE AS TO WHAT THESE
CHILDREN FIGHT FOR. AND WHERE
WE'VE COME INTO WHERE WE'RE
GOING SO I THINK YOU FOR HELPING
US REACH TODAY.
BECAUSE MAX THE BENEFICIARY
DIRECT BENEFICIARY OF THESE
DOLLARS
AND I THANK YOU FOR HELPING US
CREATE TOMORROW.
JUST
A COMMENT I LIKE TO COMMEND MISS
PAGE
FOR YOUR TESTIMONY IS VERY
COMPELLING.
REALLY ENJOYED YOUR STORY AND
THANK YOU FOR ME ALL I SEE ALL
OF YOU FOR BEING HERE.
THANK YOU THANK YOU.
LIKEWISE THANK YOU ALL FOR BEING
HERE REALLY REALLY APPRECIATE
THAT THANK YOU. THANK YOU.
AT THIS POINT THAT WOULD MOVE ON
TO PUBLIC COMMENT.
.
TO SECURE.
NAME AN ORGANIZATION BE GREAT
THANK YOU. GOOD AFTERNOON KATIE
LADEN ON BEHALF OF THE CHILDREN
SPECIALTY CARE COALITION
REPRESENTING OVER TWENTY FIVE
HUNDRED PEDIATRIC SPECIALTY
PHYSICIAN THROUGHOUT THE STATE
AND STRONG SUPPORT.
VERY MUCH
SIR ANYONE ELSE.
IT'S NICE TO SEE AN INITIATIVE
WHERE THERE'S NO OPPOSITION.
OR THANK EVERYONE FOR BEING HERE
TODAY.
THANK YOU.
TO THE WITNESSES AND ARE THE
ALEJO AND.
.
WE WOULD THAT WITH THAT WE'LL GO
AHEAD AND CONCLUDE OUR MEETING
THANK YOU VERY MUCH