Category: Daily News

Kaiser Permanente’s hospital-at-home program (HaH) has grown significantly in the past year, nearly quadrupling its capacity. The program’s average daily census has increased from 22.5 to 80.6 across all regions. Some of the areas where Kaiser Permanente offers Care at Home services include: Northern California, Southern California, Georgia, Mid-Atlantic states, Northwest, and Washington state.

Kaiser Permanente has been developing infrastructure to support the program’s growth, and building confidence in the program among patients and staff. The program is also encouraging more admissions from the emergency department and inpatients.

Research from Kaiser Permanente published last year reveals that its hospital-at-home program was scaled successfully, creating hospital capacity; however, the program’s care quality as it was being scaled could not be determined. Published in The American Journal of Managed Care, the study aimed to assess the feasibility of scaling a hospital-at-home program within an integrated healthcare delivery system.

Such programs are well established in England, Canada, Israel, and other countries where payment policies encourage – or at least do not discourage – the provision of health care services in less costly venues.

In Victoria, Australia, for example, every metropolitan and regional hospital has a hospital at home program, and roughly 6 percent of all hospital bed-days are provided that way. For specific conditions, the use of at-home care is significantly greater: nearly 60 percent of all patients with deep venous thrombosis (DVT) were treated at home in 2008, as were 25 percent of all hospital patients admitted for acute cellulitis.

A 2018 study by the Cincinnati Veterans Affairs Medical Center examined hospital readmissions, costs, mortality, and nursing home admissions of veterans who received Hospital-in-Home (HIH) services. Average per person costs were $7,792 for HIH services and $10,960 for traditional inpatient care (P<0.001). HIH veterans were less likely to use a nursing home within 30 days of discharge (3.1%) than non-HIH veterans (12.6%) (P<0.001). Thirty-day readmission rates and mortality were not statistically different between HIH and non-HIH veterans.

And a recent article in Forbes said that Since 2020, hospital-at-home programs have gained substantial traction as a patient-centered alternative to hospital care. Although available in the U.S. since the 1990s, these programs – delivering acute medical care in a home setting through care coordination, telehealth and remote patient monitoring (RPM) – are on the rise.

Forbes reports that with the Centers for Medicare & Medicaid Services’ waiver, over 350 hospitals across the U.S. have implemented or are planning to launch HaH programs. While high initial costs and implementation challenges remain, research shows that HaH care is 32% less expensive than inpatient care. As hospitals increasingly adopt these programs, evidence continues to support HaH as an affordable, viable model for acute care delivery.

Traditional hospital care requires substantial resources to maintain inpatient beds, utilities and facility management. Operating a hospital involves constant operational costs – from electricity and water to the cleaning and upkeep of facilities. HaH programs alleviate much of this financial burden by shifting care to the home setting and minimizing the need for expensive infrastructure.

The Leapfrog Hospital Safety Grade is the only hospital ratings program focused exclusively on preventing medical errors and patient harm. It is fully transparent, free to the public and updated biannually in the fall and spring.

The Group released its fall 2024 Hospital Safety Grade, evaluating nearly 3,000 hospitals on their ability to prevent medical errors, accidents and infections.

The Hospital Safety Grade uses up to 30 performance measures to assign an “A,” “B,” “C,” “D” or “F” to individual hospitals and uses a public, peer-reviewed methodology, calculated by top patient safety experts under the guidance of a National Expert Panel. It is transparent and free to the public. Leapfrog analysts use the data to observe national performance trends and state rankings.

For fall 2024, Utah ranks number one with the highest percentage of “A” hospitals for the third cycle in a row, followed by Virginia and Connecticut in second and third. The latest Grades also show hospitals are making progress in patient safety across several performance measures including notable improvements in healthcare-associated infections, hand hygiene and medication safety.

“Preventable deaths and harm in hospitals have been a major policy concern for decades. So, it is good news that Leapfrog’s latest Safety Grades reveal that hospitals across the country are making notable gains in patient safety, saving countless lives,” stated Leah Binder, President and CEO of The Leapfrog Group. “Next, we need hospitals to accelerate this progress – because no one should have to die from a preventable error in a hospital.”

Key findings on state performance on the fall 2024 Leapfrog Hospital Safety Grade include:

– – The states with the highest percentages of “A” hospitals are Utah, Virginia, Connecticut, North Carolina, New Jersey, California, Rhode Island, Idaho, Pennsylvania, Colorado and South Carolina.
– – Utah ranks #1 in percentage of “A” hospitals for the third Safety Grade cycle in a row.
– – California ranks in the top 10 for the first time since fall 2014.
– – There were no “A” hospitals in Iowa, North Dakota, South Dakota or Vermont.

Regrettably, Pacifica Hospital of the Valley in Sun Valley California received a grade of “F” and seventeen California hospitals received a grade of “D.” Pacifica Hosptial was rated “D” in fall of 2021, and fell to “F” in sprint 2022 and has remained at “F” ever since.

Detailed hospital performance information, including patient experience and safety measures, as well as grades for individual hospitals searchable by states and localities is available at HospitalSafetyGrade.org.

In 1938, President Roosevelt signed the Fair Labor Standards Act (FLSA) into law. It was a landmark piece of civil rights legislation designed to protect the rights of workers.

At the time, there was a fear that people with disabilities would be disadvantaged by the law and experience high rates of unemployment if employers had to pay comparable wages to people with and without disabilities. Therefore Section 14(c) of the FLSA (14(c)) was written into the law to allow employers to pay workers with disabilities lower wages.

Accordingly, California also included similar exemptions in its state Labor Code, in Sections 1191 and 1191.5.

The Fair Labor Standards Act authorizes the Secretary of Labor to issue certificates allowing employers to pay productivity-based subminimum wages to workers with disabilities, but only where such certificates are necessary to prevent the curtailment of opportunities for employment. Employment opportunities for individuals with disabilities have vastly expanded in recent decades, in part due to significant legal and policy developments.

Section 14(c) was little known and rarely used until the 1950s when sheltered workshops began to flourish. Sheltered workshops were started with good intentions as parents were seeking a way to keep their children out of institutions. The law currently has about 40,000 American workers laboring for half the minimum wage or less, according to the Labor Department.

However a proposed new rule, announced on December 4 with a Notice of Proposed Rulemaking (NPRM), would end the issuing of 14(c) certificates, which permit businesses to pay people with disabilities below the federal minimum wage of $7.25 an hour. If implemented, the proposal would phase out 14(c) certificates altogether over a 3-year period, ending subminimum wage nationwide.

The Labor Department’s proposal follows a review of the program, and the new rule would not take effect until a public comment period ends on Jan. 17, 2025, days before President-elect Donald Trump takes office. The new administration could review and respond to the comments and issue a final rule, or withdraw it entirely.

If finalized, the proposed federal rule would not require workers with disabilities to leave their current places of employment and would not require current section 14(c) certificate holders to amend the employment setting or type of services they provide.

Subminimum wage for disabled workers in California will however end this January.

In 2021, Disability Rights California sponsored legislation to phase out subminimum wage in California. With the passage of SB 639 (Durazo), subminimum wage for Californians with disabilities will be fully phased out at the start of 2025.

California joins more than a dozen states and the District of Columbia that have already banned the program.

Today, unemployment rates among people with disabilities remain disproportionally high, despite the continued use of 14(c) and California exemptions. In 2019, California ranked 22nd in the nation for its employment of people with disabilities. People with disabilities experienced employment rates at 36.9 percent compared to 75.6 percent for their peers. Additionally, people with disabilities also represent a larger portion of the population not included in the labor force. Nationally, about 8 in 10 were not in the labor force in 2019, compared with about 3 in 10 of those with no disability.

Safety National® is a specialty insurance and reinsurance provider with its corporate headquarters in St. Louis Missouri . It is a wholly-owned subsidiary of Tokio Marine Holdings, Inc., a Tokyo-based global insurer with a presence in over 40 countries.

Safety National just announced the winners of its annual Safety First Grant Program. Three policyholders will be awarded matching grants in order to develop the creative risk control ideas they submitted into formal safety programs.

“As a market leader and safety advocate, we are committed to identifying industry innovation that reduces the risk of employee injury and illness,” said Mark Wilhelm, Executive Chairman of Safety National. “Over the last 10 years, the Safety First Grant Program has funded 32 risk control projects, responding to the emerging needs of our clients while building a blueprint for safer workplaces.”

Winners of the 2024 program included:

– – First Place: Berry Global was awarded the $10,000 matching grant for the addition of radar technology capable of detecting human motion inside of an industrial robot cell. This innovation will prevent dangerous machine restarts, which can result in significant injury.
– – Second Place: Bigge Group was awarded the $5,000 matching grant toward the implementation of an enterprise-wide system used to monitor workplace temperature. These sensors can detect rising heat levels, mitigating heat-related illnesses.
– – Third Place: Lam Research was awarded the $2,500 matching grant to install ergonomic improvement equipment, including over 30 pneumatic and electric adjustable tables. This technology will eliminate problematic manual material handling tasks that lead to musculoskeletal disorders.

Nominees for the annual Safety First Grant Program must be an active Safety National policyholder with a risk-reducing solution that applies to the workers’ compensation line of coverage. The applied solutions must relate to an identifiable and quantifiable loss source and include an anticipated estimate of injury cost savings for the policyholder.

“Each year, our applicants submit increasingly impressive innovative and creative risk management ideas for this program, finding new ways to build a safer workplace for their employees,” said Matt McDonough, Assistant Vice President Risk Control of Safety National. “In celebrating these winning submissions, we hope other organizations are inspired to discover their next great risk-reducing solutions.”

Full details on the 2024 Safety First Grant Program winning solutions can be found on its website.

The 2025 grant application period will open in June 2025.

Nowhere Santa Monica and eight other Nowhere LLCs operate nine organic grocery stores and cafes known as Erewhon in the Los Angeles area. A tenth LLC, Nowhere Holdco, is their managing member.

Edgar Gonzalez worked for Nowhere Santa Monica at its Erewhon market for approximately five months. As a condition of employment, Gonzalez entered into an individual (i.e., non-class) arbitration agreement with Nowhere Santa Monica which provided that any dispute “between Nowhere Santa Monica, LLC DBA Erewhon-Santa Monica” and Gonzalez relating to his employment would be submitted to arbitration.

On May 25, 2022, Gonzalez filed suit against the ten Nowhere entities,defining them as “Defendants” those ten entities plus “any of their parent, subsidiary, or affiliated companies.” He alleged that he and the putative class members “were employees or former employees of Defendants covered by” the Labor Code and applicable Industrial Welfare Commission Wage Orders.

In ten causes of action Gonzalez alleged defendants violated the Labor Code by failing to pay minimum and overtime wages; provide meal or rest periods; provide timely wages and accurate wage statements; indemnify employees for expenses; or pay for vested vacation time on termination of employment. These violations, Gonzalez alleged, constituted unfair business practices.

The complaint, a 20-page block of unbroken, nondescript boilerplate, mentioned no employment agreement, described no work performed or control exerted over such work, and made no distinction between any of the ten defendants.

The ten Nowhere entities filed a joint motion to compel Gonzalez to arbitrate his claims on an individual, non-class basis and to dismiss his class allegations. In support of the motion, Tom Wong, Nowhere Holdco’s Chief Financial Officer, declared that each Erewhon market had its own management team that supervised its own employees. Wong declared that Gonzalez worked for Nowhere Santa Monica at the Erewhon market in Santa Monica from May 27, 2021 to October 15, 2021, and never worked at any other Erewhon market or was employed by any defendant other than Nowhere Santa Monica.

Gonzalez opposed the motion on the ground the non-Santa Monica Nowhere entities were not parties to the arbitration agreement.

The trial court found no evidence that Gonzalez was “attempting to enforce any benefit as to the [non-Santa Monica] Defendants while refusing to arbitrate with them,” and thus no evidence demonstrating that his “claims against the nonsignatory Defendants were ‘intimately founded in and intertwined with’ Plaintiff’s arbitrable claims against Nowhere Santa Monica.” The court therefore granted the motion to compel individual arbitration as to Nowhere Santa Monica but denied it as to the other Nowhere entities. Gonzalez thereafter dismissed his complaint against Nowhere Santa Monica.

The other Nowhere entities appeal. The Court of Appeal reversed in the published case of Gonzalez v. Nowhere Beverly Hills LLC -B328959 (December 2024).

It is undisputed that an arbitration agreement exists between Gonzalez and Nowhere Santa Monica. The non-Santa Monica entities admit they are nonsignatories to this agreement, but contend they may enforce it under principles of equitable estoppel because Gonzalez’s (and the class’s) claims against all Nowhere entities depend on and are intertwined with Nowhere Santa Monica’s obligations under the employment agreement with Gonzalez. The Court of Appeal agreed.

“Because arbitration is a matter of contract, the basic rule is that one must be a party to an arbitration agreement to be bound by it or invoke it – with limited exceptions.” One exception is the doctrine of equitable estoppel, which as a general matter precludes a party from asserting rights it otherwise would have had against another when its own conduct renders assertion of those rights inequitable.

In the arbitration context, “If a plaintiff relies on the terms of an agreement to assert his or her claims against a nonsignatory defendant, the plaintiff may be equitably estopped from repudiating the arbitration clause of that very agreement. In other words, a signatory to an agreement with an arbitration clause cannot . . . ‘on the one hand, seek to hold the non-signatory liable pursuant to duties imposed by the agreement, which contains an arbitration provision, but, on the other hand, deny arbitration’s applicability because the defendant is a non-signatory.”

Applying these principles, the Court of Appeal concluded that the trial court incorrectly denied the non-Santa Monica entities’ motion to compel arbitration because all of Gonzalez’s claims against them are intimately founded in and intertwined with the employment agreement with Nowhere Santa Monica, an agreement which contains an arbitration provision.