Current Issues

Working Group on Comprehensive Access

Online Public Comment Period Ends

Chair’s report to be discussed at Regents in May

February 21, 2020 | 5 p.m. PT

The online public comment period has ended for the Working Group on Comprehensive Access (WGCA) Chair’s Report. The University thanks everyone who took the time to provide feedback on this important issue. More than 4,500 public comments were submitted from January 28 through February 21, 2020.

The Chair’s report outlines two potential paths for the University’s consideration as it examines affiliations between its academic health systems and non-UC medical facilities, particularly those that have policy-based restrictions on certain types of health care.

Public comments to date will be reviewed along with additional information that President Janet Napolitano requested from UC Health. No decisions have been made. The Chair’s report will be discussed at the May meeting of the Board of Regents.

The Chair’s report and associated correspondence remain available below for review at this link.

Letters sent to the University after February 21 will continue to be accepted consistent with University practice, but submissions received after March 16 may not be included in the analysis and input process.

Please be aware that correspondence may be read or answered by members of President Napolitano's staff or appropriate campus personnel. Please also note that the Office of the President retains copies of all correspondence sent to the president, and that all correspondence is considered a matter of public record and is, therefore, subject to disclosure under the California Public Records Act.

 


WGCA Chair’s Report Available for Review

Public Comment Period Runs Through February 21, 2020

January 28, 2020

In August of 2019, President Napolitano convened a Working Group on Comprehensive Access (WGCA) comprised of academic and health leaders from across the University. The WGCA was provided 90 days to develop recommendations that “would ensure UC’s values are upheld when its academic health systems collaborate with other health systems” and “to ensure that UC personnel will remain free, without restriction, to advise patients about all treatment options and that patients will have access to comprehensive services.”

The WGCA met six times during the fall of 2019. The members reviewed a wide range of materials, perspectives and arguments.

While there was important agreement on many issues, the working group did not reach consensus on the central question of whether UC should have affiliations with health care organizations that have institutional policies limiting the services provided at their facilities. Examples of such institutional policies include prohibitions on the use of contraception, abortion, assisted reproductive technology, gender-affirming care for transgender people, and the full range of end-of-life options.

The University has affiliations with a wide range of non-UC medical facilities to help fulfill its public service mission of providing care to all Californians and to provide additional training sites for rotations of health professional students who need field experience in various settings. 

The WGCA held its last meeting in mid-December. In late December, the Chair of the WGCA prepared a report that attempted to summarize the viewpoints of WGCA members and outlined the two options discussed by WGCA committee members. One path would prohibit patient care and training agreements with institutions that have policy limitations on care, while the other path would allow such affiliations but only if certain protections, monitoring and compliance protocols are put in place. The report was transmitted to the president in late December for her consideration.

Although the work of the WGCA and submission of the Chair’s report are significant milestones, they are not the end of the process.

Today, the University published the Chair’s report and associated correspondence and initiated a public comment period that will continue through February 21, 2020. View the report and access the feedback mechanism at ucal.us/wgca.

The report will also be presented to the Board of Regents at its May 2020 meeting.

 


Progress Update: Public Comment Period to Begin Later This Month

January 7, 2020

The Working Group on Comprehensive Access (WGCA) has completed its deliberations. The WGCA is one of three action steps announced by the University in August to address concerns about certain agreements with non-UC medical facilities, including faith-based hospitals.

UC President Janet Napolitano would like to thank members of the working group, who spent considerable time and effort examining a complicated and important set of issues. The chair’s report is now with the president, who will consider it along with additional input from employees, regents and the public over the coming months.

Later this month, the University will make the report available to the public along with an online mechanism for comment. Current plans call for a presentation and discussion of the report at the May 2020 meeting of the Board of Regents.

UC is committed to thoughtfully considering its future policies and practices around affiliations with non-UC medical facilities. UC seeks to contribute meaningfully to an ongoing national dialogue about how and when public entities form affiliations with outside organizations that may have both shared and differing values.

The just-completed report is an important step, but it is not the end of the input or consideration process.  

 


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.