Assembly Bill A3166

                            
                    S T A T E   O F   N E W   Y O R K
________________________________________________________________________

                                  3166

                       2009-2010 Regular Sessions

                          I N  A S S E M B L Y

                            January 23, 2009
                               ___________

Introduced by M. of A. BRADLEY, BENEDETTO, BENJAMIN, SCHIMEL, ZEBROWSKI,
  GUNTHER,  BROOK-KRASNY, JAFFEE -- Multi-Sponsored by -- M. of A. COOK,
  DelMONTE, GALEF, JOHN, KOON, MAYERSOHN, REILLY, TOWNS -- read once and
  referred to the Committee on Health

AN ACT to amend the public health  law,  in  relation  to  hospital  and
  physician clinical integration

  THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
BLY, DO ENACT AS FOLLOWS:

  Section 1. Legislative findings and  determinations.  The  legislature
finds and determines that in order to promote the quality and continuity
of  care  provided  to residents of the state, it shall be the policy of
this state  to  encourage  cooperative,  collaborative  and  integrative
arrangements among general hospitals, among physicians, and among gener-
al  hospitals  and  physicians involving clinical integration. The know-
ledge provided through multiple providers working  together  is  key  to
improving clinical care and outcomes.
  The  legislature further finds and determines that in order to improve
patient care and increase the efficiency of delivering the highest qual-
ity of care at the lowest costs possible, clinical, economic and  policy
experts  across the nation are recommending increased integration of the
management of patient care. Within  this  context,  integration  is  the
sharing  of  best  practices  through  group  interaction  and planning,
including the documentation and measurement of patient outcomes based on
documented standards of care, comparing future performance  to  baseline
measures  that  are  currently  available  pursuant to publicly reported
state and federal quality measures.
  The legislature additionally finds and  determines  that  despite  the
anticipated  and  documented  benefits, there currently exist only a few
such venues for such sharing of information and advancement of medicine.
Such collaboration and integration represents an important shift in  the
practice of medicine away from the current culture of blame and informa-

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD03355-01-9
              

A. 3166                             2

tion  suppression  to  a  culture  of  informed,  interconnected  health
systems. As a result, collaborations acknowledge that everyone is striv-
ing toward the same high quality care,  everyone  experiences  successes
and shortcomings in their practices, and everyone can learn from others'
experiences.
  S  2. The public health law is amended by adding a new section 2821 to
read as follows:
  S 2821. HOSPITAL  AND  PHYSICIAN  CLINICAL  INTEGRATION.  1.  FOR  THE
PURPOSES OF THIS SECTION, THE TERM "CLINICAL INTEGRATION" SHALL MEAN:
  (A)  THE  ESTABLISHMENT  OF  GOALS RELATING TO QUALITY AND APPROPRIATE
UTILIZATION OF SERVICES BY THE  PROVIDERS  PARTICIPATING  IN  THE  JOINT
VENTURE;
  (B)  THE  DEVELOPMENT AND APPLICATION OF PRACTICE STANDARDS AND PROTO-
COLS TO GOVERN TREATMENT AND UTILIZATION OF SERVICES;
  (C) THE REVIEW OF THE CARE RENDERED BY  THE  PROVIDERS  IN  THE  JOINT
VENTURE  IN  LIGHT OF THESE STANDARDS AND PROTOCOLS WITH REMEDIAL ACTION
FOR POOR PERFORMANCE;
  (D) THE MONITORING OF PATIENT SATISFACTION;
  (E) THE DEVELOPMENT OF INFORMATION SYSTEMS NECESSARY TO GATHER  AGGRE-
GATE  AND  INDIVIDUAL PROVIDER DATA ON THE COST, QUANTITY, AND NATURE OF
SERVICES PROVIDED BY THE PROVIDERS;
  (F) THE MEASUREMENT OF PERFORMANCE OF THE JOINT VENTURE AS A WHOLE AND
THE INDIVIDUAL PROVIDERS IN THE JOINT VENTURE AGAINST COST  AND  QUALITY
BENCHMARKS; AND
  (G) THE PUBLICATION OF DETAILED PUBLIC REPORTS ON THE COST AND QUANTI-
TY  OF  SERVICES PROVIDED, AND ON THE JOINT VENTURE'S SUCCESS IN MEETING
ITS GOALS.
  2. (A) THE DEPARTMENT SHALL HEREBY INSTITUTE A  PROGRAM  TO  ENCOURAGE
COOPERATIVE,  COLLABORATIVE  AND  INTEGRATIVE ARRANGEMENTS AMONG GENERAL
HOSPITALS, AMONG PHYSICIANS, AND AMONG GENERAL HOSPITALS AND  PHYSICIANS
INVOLVING CLINICAL INTEGRATION. IT SHALL BE THE POLICY OF THE DEPARTMENT
IN  INSTITUTING  SUCH  PROGRAM  TO SEEK IMPROVEMENTS AND EFFICIENCIES IN
HEALTH CARE RESULTING FROM CLINICAL INTEGRATION. IN  THE  IMPLEMENTATION
AND  EFFECTUATION  OF  THIS  PROGRAM, THE DEPARTMENT SHALL ENCOURAGE THE
NEGOTIATION OF REIMBURSEMENT  RATES  WITH  PAYERS  ON  BEHALF  OF  THEIR
PARTICIPANTS.
  (B)  THE DEPARTMENT'S CLINICAL INTEGRATION ENCOURAGEMENT PROGRAM SHALL
SUPPORT THE POLICY OF  CLINICAL  INTEGRATION  REGARDING  BEST  PRACTICES
WITHIN  AND  AMONG  PHYSICIAN  OFFICES  AND HOSPITALS. SUCH POLICY SHALL
FURTHER SEEK TO USE CLINICAL INTEGRATION IN A MANNER TO PROVIDE THE BEST
QUALITY OF CARE, IN THE MOST EFFICIENT MEANS POSSIBLE, FOR THE PEOPLE OF
THE STATE OF NEW YORK. SUCH POLICY SHALL ALSO SEEK TO USE CLINICAL INTE-
GRATION TO PRODUCE SAVINGS REALIZED  THROUGH  IMPROVED  EFFICIENCIES  OF
HEALTH EXPENDITURES BY REDUCED DUPLICATION OF TESTING, IMPROVED RAPIDITY
OF DIAGNOSIS AND TREATMENT, AND A REDUCTION IN MEDICAL ERRORS.
  (C)  THE DEPARTMENT'S CLINICAL INTEGRATION ENCOURAGEMENT PROGRAM SHALL
FURTHER SEEK THE RESULT, WHERE PARTICIPATING  HOSPITALS  AND  PHYSICIANS
WILL  HAVE  MET THE FEDERAL THRESHOLD FOR CLINICAL INTEGRATION, AND HAVE
THE ABILITY TO ENTER  GROUP  NEGOTIATIONS  WITH  HEALTH  INSURERS.  SUCH
PROGRAM  SHALL THEREBY ATTEMPT TO REBALANCE THE OBTAINMENT OF REIMBURSE-
MENT AT LEVELS SUFFICIENT TO OFFER EVIDENCE-BASED CLINICAL  ADVANCEMENTS
TO  THE  COMMUNITIES  SERVED  BY SUCH PARTICIPATING HOSPITALS AND PHYSI-
CIANS.
  3. THE COMMISSIONER SHALL  HAVE  OVERSIGHT  AND  MANAGEMENT  OVER  THE
DEPARTMENT'S  PROGRAM  TO ENCOURAGE COOPERATIVE, COLLABORATIVE AND INTE-
GRATIVE ARRANGEMENTS AMONG  GENERAL  HOSPITALS,  AMONG  PHYSICIANS,  AND

A. 3166                             3

AMONG  GENERAL  HOSPITALS AND PHYSICIANS INVOLVING CLINICAL INTEGRATION.
WHETHER A PROVIDER JOINT VENTURE INITIALLY MEETS, AND CONTINUES TO MEET,
THE CRITERIA FOR CLINICAL INTEGRATION AS DEFINED IN SUBDIVISION  ONE  OF
THIS  SECTION  SHALL  BE  DETERMINED BY THE COMMISSIONER. THE DEPARTMENT
SHALL  HAVE  THE  AUTHORITY  TO  ISSUE  REGULATIONS  TO  EFFECTUATE  THE
PROVISIONS AND TERMS OF THIS SECTION.
  4.  TO THE EXTENT THE DEPARTMENT'S CLINICAL INTEGRATION ENCOURAGEMENT,
OR THE CLINICAL INTEGRATION MEASURES CONDUCTED  THEREUNDER,  ARE  DEEMED
ANTI-COMPETITIVE  WITHIN  THE  MEANING OR INTENT OF ANY FEDERAL OR STATE
ANTITRUST LAW OR REGULATION, STATE ACTION IMMUNITY UNDER SUCH  ANTITRUST
LAWS  AND  REGULATIONS IS HEREBY CONFERRED WITH RESPECT TO THE PLANNING,
IMPLEMENTATION AND  OPERATION  OF  SUCH  CLINICAL  INTEGRATION  MEASURES
AND/OR  JOINT  VENTURES.  SUCH MEASURES AND JOINT VENTURES SHALL ALSO BE
DEEMED EXEMPT FROM THE PROVISIONS OF ARTICLE TWENTY-TWO OF  THE  GENERAL
BUSINESS LAW INVOLVING CONTRACTS OR AGREEMENTS IN RESTRAINT OF TRADE.
  S 3. This act shall take effect immediately.