A Progress Update: UC Addresses Concerns with Health Service Agreements
November 15, 2019
The University of California is providing this update on efforts to address concerns about its agreements with non-UC medical facilities, including faith-based healthcare facilities.
The University recognizes the broad set of complex issues involved. Earlier this year, UC Health began to take steps to ensure its expectations are clearly articulated in these agreements and understood by UC personnel working off-site at non-UC medical facilities. These affiliations allow the University to remain focused on increasing access to care for medically vulnerable or underserved patients who seek care at community clinics and community hospitals. Services include oncology, care for stroke and cardiovascular conditions, neonatal intensive care and mental health, all of which are enhanced through the expertise of UC clinicians at these facilities.
The action steps taken to date include:
- Pursuing amendments to certain existing contracts to revise language that may be inconsistent with UC values and expectations. Thus far, several dozen agreements are in the process of being updated and more such revisions are expected to follow.
- Implementing interim guidelines for agreements under which our providers and trainees work with other health systems until longer-term guiding principles and compliance measures have been adopted. These guidelines are in place.
- Convening the Working Group on Comprehensive Access (WGCA), a multidisciplinary group of academic and health system leaders to evaluate current practices and provide recommendations to ensure UC values are upheld in affiliations with other health care organizations.
The WGCA will submit its report and recommendations to President Napolitano by the end of this year as part of a continuing process. After carefully evaluating the report and consulting with the UC Board of Regents and others, the president may also request additional information or input, initiate steps necessary to formalize some of the recommendations or pursue a variety of other options.
Given the complexity of this issue, a large number of stakeholders involved and the potential implications for patient care, teaching and research, UC is approaching this issue in a careful, deliberative manner that respects a variety of perspectives.
While this process continues, the University wants to reassure the public that UC personnel who are working or training at non-UC facilities will make clinical decisions consistent with the highest standards of care and their independent professional judgment, which considers the needs and wishes of each patient. This includes informing patients of all of their health care options, whether or not a particular option is available at the site where they are being seen; prescribing any interventions that are medically necessary and appropriate, whether or not dispensed at that site; and referring patients to other facilities when the care such patients need is not available where they are being seen.
UC President Convenes Group to Develop Recommendations Regarding Terms of Agreements with Other Health Systems
August 2, 2019
University of California President Janet Napolitano today announced the launch of a working group to ensure that UC’s values are upheld when its academic health systems collaborate with other health systems.
The Working Group on Comprehensive Access (WGCA) will review common types of health system agreements where patient access to care might be limited due to policy restrictions on services provided, and provide written recommendations to guide future collaborations. The intent is to ensure patients under the care of UC personnel at non-UC facilities have access to a full range of health care services.
The University of California’s health enterprise includes six health systems and 18 health professional programs. UC’s clinical expertise is often sought out by other health care organizations to strengthen or augment clinical capabilities, and UC physicians often provide services at non-UC facilities. UC also operates the largest training program in the state for health professionals. UC’s medical, nursing, pharmacy and public health students, residents, and other trainees broaden their educational and field experience by rotating through a variety of settings, including non-UC facilities.
The WGCA is an outgrowth of recent public debate about the University’s ability to ensure patients receiving care from UC personnel at non-UC facilities retain access to a comprehensive range of clinical services. The University withdrew from negotiations to expand its relationship with another health system earlier this year after concerns were raised that UC had not provided sufficient assurance of non-interference in access to care.
“The vigorous debate around that proposed agreement demonstrated we must do more to ensure UC’s values are embedded in all of our collaborative efforts and to address the concerns that were raised,” said UC President Janet Napolitano. “Our expectation has always been that UC health professionals provide UC-level expertise to all patients, including at health facilities operated by other organizations.”
Affiliations and other health services and training agreements allow UC to serve patients at facilities that are best suited to their care requirements or their geographic location. UC’s medical centers are often full, and agreements enabling UC providers to care for patients at non-UC hospitals and clinics allow more patients to receive UC’s high quality medical care. Additionally, hospitals in underserved areas have difficulty recruiting certain types of providers. Agreements for UC physicians to care for patients in non-UC facilities increase the number of access points in a community, which is important to fulfill the University’s service mission. However, this expanded access must be accompanied by clear expectations that preserve physician autonomy and allow patients to evaluate and choose from all appropriate care options.
The WGCA includes leadership from campuses, medical centers, and the University’s Academic Senate and will consider a broad array of collaboration scenarios – encompassing respect for a diversity of opinions. The group will review concerns raised about patient access in other health systems, as well as UC’s operational, training and patient care needs. The group’s main charge is to develop written recommendations for consideration by President Napolitano regarding the terms under which UC academic health systems will enter into affiliations with other health systems to protect patient access to comprehensive care. The Working Group’s written preliminary recommendations are expected in the fall.
UC has a long-standing expectation that its physicians will remain free to counsel patients about all treatment options, and that patients will have access to comprehensive services. However, the language used in some agreements with other health systems may appear to contradict these expectations. As such, and in parallel to the forward-looking efforts of the Working Group, the University is seeking to amend current agreements to clarify expectations of UC trainees and health professionals when providing care at non-UC health facilities. Additionally, the University has developed interim guidelines that will govern new agreements and renewals of expiring contracts deemed critical to UC's clinical and academic missions.
About UC Health
The University of California’s health enterprise, UC Health, includes six academic medical systems, health professional schools in medicine, nursing, dentistry, optometry, pharmacy, public health and veterinary medicine, clinical oversight of student health and counseling centers, and oversight of self-funded health plans offered to UC employees.