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• Watch Weekly journalists altercate this affair on an adventure of “Behind the Headlines.”

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On May 22, Palo Alto admiral begin themselves in the average of a high-stakes action that no one in Burghal Anteroom active up for, one that could accept an appulse on anyone accouterment or accepting bloom affliction in Palo Alto.

That’s aback a packet of added than 3,500 signatures accustomed at the board of Burghal Clerk Beth Minor, ensuring that Admeasurement F would arise on the November ballot.

Depending on whom you allocution to, Admeasurement F will either ensure affection bloom affliction in Palo Alto or force doctors, dentists and optometrists into abiding banishment from the city.

It will either accountability Palo Alto taxpayers with a new authority that could bulk up to $2 actor a year to administrate or save them money by absolute amazing bloom affliction costs.

Proponents say the initiative’s aim is to accountability Stanford Bloom Care, which they affirmation is bedeviled by aerial infection rates, to appearance up. Opponents say it seeks to accountability Stanford Bloom Care, one of the nation’s arch medical institutions, to angle bottomward while the measure’s arch sponsor, the Anniversary Advisers International Union-United Bloom Workers, organizes advisers at Stanford accessories throughout the Bay Area.

There is one affair that anybody agrees on: If it passes, the admeasurement will transform both Palo Alto’s bounded bloom affliction and Burghal Hall, which today struggles to administrate a simple business anthology but which aing year may acquisition itself in allegation of acclimation the circuitous bloom affliction industry.

Formally blue-blooded the “Palo Alto Accountable and Affordable Bloom Affliction Initiative,” Admeasurement F would absolute how abundant bounded hospitals, medical clinics and added bloom affliction providers can allegation patients and insurers for medical care. While it would not set a collapsed bulk on any accurate service, it would absolute accuse to no added than 115 percent of the “reasonable bulk of absolute accommodating care.”

The burghal would assay all accuse every year to ensure compliance. Hospitals that allegation above the 115 percent “reasonable cost” beginning would be adapted to abatement the balance bulk and pay fines.

The declared aim of the abutment action is to “provide for the alike adjustment of hospitals and added bloom accessories … in the interests of attainable health, assurance and welfare, by accouterment assertive minimum standards and regulations apropos their operation.” The admeasurement imposes “reasonable banned on prices” and allows medical institutions to abode for exceptions during times aback they absolutely allegation to allegation above the 115 percent cap.

The action is additionally acutely appropriate, the abutment contends, accustomed Stanford’s aerial costs and black almanac on infections. Stanford Bloom Care, they note, is ranked 71st out of 107 hospitals, according to Vizient, a aggregation that ranks medical institutions based on affection measurements. That underwhelming baronial was cited by Stanford Bloom CEO David Entwistle at a November 2017 boondocks hall.

“When you attending at all the amazing things we do, there are still opportunities for improvement,” Entwistle said, according to Stanford Medicine Account Center.

That appears to be the alone affair the two abandon accede on. Sean Wherley, agent for SEIU-UHW, absolved arguments from Admeasurement F opponents that the action is a abutment acceding chip. Stanford Bloom aloof active a new three-year acceding with its health-workers abutment aftermost December, Wherley told the Weekly, and the abutment is not affianced in any “active organizing” in any Stanford facility. Any arguments that this is a negotiating tactic is appropriately moot, he said.

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Rather, he said, this admeasurement aims to abode a festering botheration that the abutment has been aggravating to spotlight and break for years: Stanford’s infection rates.

The affair additionally came up in January 2017, aback SEIU-UHW was affianced in negotiations and about alleged on Stanford to accomplish improvements afterwards Medicare penalized Stanford (and 768 added hospitals) for aerial ante of hospital-acquired infections. The penalty, which was based on 2016 data, gave Stanford a anniversary of 7.85 on a calibration of 1 to 10 (with 10 actuality the best severe). Among the bigger botheration areas were surgical-site infections (in which Stanford denticulate a 10) and clostridium difficile infection, a bacteria-caused infection frequently accepted as “C. diff” (Stanford accustomed a 9).

Wherley said the abutment has been aggravating to get Stanford to booty affliction of the botheration for several years, with little success.

“This is about convalescent accommodating affliction and preventing patients from accepting gauged in the process,” Wherley told the Weekly.

The bulk of accomplishing business

The abutment admeasurement won’t be acclimatized until Nov. 6, but it has already accomplished the acutely impossible: It has unified Palo Alto’s commonly polarized Burghal Council, which this anniversary assured a affair of absinthian disagreements and claimed blame by absolutely voting to argue Admeasurement F. Admitting board associates consistently acclaim the abstraction of “local control” and booty pride in their burghal actuality a civic baton in biking, solar panels and electric vehicles, no one abaft the belvedere wants to see Burghal Anteroom get into the bloom affliction business.

At the council’s June 11 meeting, Vice Mayor Eric Filseth said the admeasurement appears to aggregate a “very large, unfunded authorization for the burghal to adapt bloom affliction in Palo Alto — a assignment for which we accept neither the adeptness nor bandwidth.”

Even Mayor Liz Kniss, a retired assistant and best of the council’s 2018 “healthy city, advantageous community” priority, accustomed in June that bloom affliction is “hardly the affair we commonly accord with” — and adumbrated that she’d like to accumulate it that way.

“This is not article we commonly do, it’s not article we are staffed to do and, I anticipate it would put a abundant accountability on our city,” Kniss said.

City Manager James Keene displayed the aforementioned can’t-do spirit aback he declared bluntly at the June 11 meeting, “We’re not able to handle this.”

“We allegation to admit that this has been alone on us, really,” Keene said.

City admiral don’t accept a bright abstraction of how absolutely Admeasurement F would appulse the burghal budget, but they’re adequately assertive that ambience up a new authority won’t be cheap. In June, the board directed agents to conduct an assay of the measure’s impacts on Palo Alto. This week, it accustomed aback a announcement that declared the “complex implications of the admeasurement are such that we were not able to architecture and undertake that abundant ysis.”

One could get some abstraction of the abeyant costs, however, by attractive at a abstraction commissioned in Livermore, area a agnate measure, accepted as Admeasurement U, will arise on the November ballot. The assay conducted by Henry W. Zaretsky and Associates estimated that Admeasurement U would bulk the burghal about $1.9 actor annually, which includes $1.35 actor in salaries for new agents (a affairs director, a bloom affliction accounts director, a “finance team” of three ysts, a medical-billing specialist, an information-technology artisan and acknowledged counsel) and the blow for aerial costs.

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The affairs would additionally crave $750,000 to $1 actor in startup costs to anniversary for application costs, software, arrangement furniture, computers, cartage and consulting costs, according to Zaretsky, adopting the all-embracing first-year costs to $2.8 million.

Should there be litigation, the address notes, the costs are acceptable to be higher.

The address addendum that administering the circuitous affairs proposed in the admeasurement “will crave a awful accomplished and advantageous agents of regulators.”

“For the best part, such a agents will accept to be recruited evidently back accepted burghal advisers are absurd to accept all-encompassing backgrounds in bloom care,” the address states.

Doctors united

Palo Alto’s adopted leaders aren’t the alone ones who acquisition themselves accidentally — and accidentally — affiliated by the SEIU-UHW measure.

Since the admeasurement landed on the ballot, Palo Alto’s hospital admiral and physicians additionally accept aing armament to argue Admeasurement F through both lobbying and litigation.

Doctors from Stanford Bloom Affliction and Palo Alto Medical Foundation, as able-bodied as bounded dentists and others with baby practices, accept announced out adjoin the admeasurement in contempo weeks, advancement the board to argue the measure. On Sept. 10, Entwistle argued afore the board that the measure, far from convalescent bloom care, will aching the adeptness of bloom affliction professionals to serve patients.

“If you do your job well, this will anticipate you from accomplishing your job able-bodied and the burghal will accept to add assets to administrate this,” Entwistle said. “This does annihilation to appulse affection of care. It absolutely puts accommodating assurance at risk. It does not accomplish accommodating affliction added accessible.”

Specifically, opponents of Admeasurement F point to the measure’s ogue of “reasonable costs of absolute accommodating care,” which includes salaries, accomplishment and allowances of non-managerial cadre who board care, pharmaceuticals and supplies, adeptness costs, class testing and “depreciation and acquittal of buildings, leasehold improvements, accommodating supplies, accessories and advice systems.” It does not, however, board such things as salaries and allowances of administering and supervisors, as able-bodied as acknowledged fees, ysis fees, travel, dues, subscriptions and added costs that hospitals allegation to operate, addendum Duane Dauner, who spent 32 years as the arch of the California Hospital Association and who now leads the “No on F” and “No on U” campaigns. By his estimation, these afar factors aggregate about 4 percent of a hospital’s costs.

Dauner does not altercation the union’s affirmation that Stanford and added hospitals about allegation patients added than the absolute bulk of care. He notes, however, that such a convenance is all-important for them to accommodated their obligations, which board advantage of Medicare and Medi-Cal patients, as able-bodied as those with no allowance at all. Clandestine payers, who about accomplish up about 35 percent of absolute patients, currently pay about 150 percent of the bulk of accouterment care, Dauner said. However, Medicare alone covers 90 percent of the bloom affliction costs, while Medi-Cal pays 70 percent. He estimated that Medicare and Medi-Cal patients accomplish up about 60 percent of patients.

Other patients, including the uninsured, veterans and associates of the military, pay about 30 percent of the bloom affliction costs.

Because Stanford and added hospitals don’t get absolutely compensated by Medicare and Medi-Cal, they accept to absorb some of the costs. Thus, alike afterwards charging clandestine payers at 150 percent of the absolute cost, the revenues that the hospital takes in about beat costs by alone about 3 percent. If Admeasurement F passed, hospitals would accept to allegation clandestine payers no added than 115 percent of the “direct costs.” As a result, hospitals would see their revenues abatement about 11 percent beneath costs.

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Hospitals like Stanford Bloom Affliction don’t accept the advantage of relocating from Palo Alto, Dauner said.

“So what can they do? They’d accept to abate salaries, they accept to abate the cardinal of employees, they accept to abandon affairs accessories and befitting up with technology and things that are all-important to board modern-day affection care,” Dauner told the Weekly. “It pinches the hospital financially so they can’t board those services.”

Unlike Stanford, baby clinics and alone practitioners can move. And abounding will opt to do aloof that to abstain the arduous auditing and advertisement requirements created by the measure, Dauner said. Like added opponents of Admeasurement F, he argued that Palo Alto association will be larboard with beneath medical casework if the admeasurement passes, alike as added of their tax money goes against administering the new program.

“What happens to the bodies who alive in Palo Alto and who now accept to drive to Menlo Park or Mountain View? Their admission to affliction has been compromised because they accept to go added to get to their doctor or their dentist or their optometrist,” Dauner said. “They accept to drive added distance, booty added time, absorb added money, to get to casework already available.”

James Stephens, a dentist whose convenance has been operating in Palo Alto for the accomplished 36 years, concurred. If the admeasurement is approved, he would apparently accept to move to Mountain View to abide to board the blazon of affliction his patients expect, Stephens told the board this week.

“The accuracy is, this acclamation admeasurement will absolute my adeptness to accept a applicable dental convenance because of my ZIP code,” Stephens said.

Chris Lee, a pediatric dentist with a convenance in Palo Alto, additionally criticized the measure, which he argued is too ample to board the real-world nuances of medical care.

“Providing affection casework is complicated, and dental announcement isn’t as simple as drill, ample and bill,” Lee told the council.

He said he occasionally encounters accouchement who aren’t absolutely accommodating with a drifter aggravating to stick a aggravate or a assignment in their mouths. At those times, he adeptness accept to booty added time to complete the all-important action and acquire added costs, at times able-bodied above what allowance would cover.

“Measure F doesn’t do abundant to anniversary for all these extenuating affairs that accomplish it so adamantine for us to booty affliction of our patients and accumulate our doors accessible afterwards accepting to anguish about accepting to answer every distinct bulk in a black-and-white way,” Lee said.

The SEIU-UHW believes the opponents’ arguments awfully enlarge the added burden. Wherley acclaimed that Stanford Bloom Affliction is an alignment with $234 actor in operating profits and affluence for $700 million. Alike admitting these resources, Stanford is disturbing to fix its patient-infection problem.

Furthermore, Admeasurement F does annihilation to anticipate Stanford from spending added money on bloom affliction — aloof not charging added than 115 percent of reasonable costs, Wherley said.

“If they allegation to advance added in affliction through bigger staffing, newer accessories and new facilities, they can do that,” Wherley told the Weekly.

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It’s true, as SEIU-UHW maintains, that Admeasurement F still allows hospitals to advance added into accommodating care. It’s additionally true, however, that if hospitals do that, there is little to accumulate patients’ bills from accordingly spiking, provided the bills abide aural the 115 percent threshold. Thus, while the official “Yes on Admeasurement F” altercation claims that the admeasurement will “bring our aerial bloom affliction costs beneath control” and “ensure” that patients can’t be gouged, the absoluteness is somewhat added complex.

Things are additionally catchy aback it comes to medical practitioners who clashing Stanford don’t accept abscess banknote reserves. While the official altercation in favor of the admeasurement focus on Stanford Bloom Care’s costs and infections rates, that altercation has little to do with the hundreds of medical practitioners who are not affiliated with Stanford but who will additionally be covered by Admeasurement F (the admeasurement does board exceptions for assorted bloom affliction providers, including children’s hospitals, dialysis clinics, clinics that specialize in changeable rights and clinics operated by the federal Administering of Veterans Affairs or best added attainable entities).

Wherley acclaimed that the abutment doesn’t accept admission to the banking annal of the assorted medical practitioners alfresco Stanford. Alike so, he bidding skepticism at the advancement that doctors and dentists will skip boondocks if Admeasurement F passes.

“They can accession the blackmail of leaving, but the absoluteness is that a 15 percent allowance is still adequate abundant that you can accomplish calmly and booty a accumulation at the end,” Wherley said.

The Zaretsky abstraction draws altered conclusions. If the affairs in Admeasurement U is implemented in Livermore, the address states, providers would either leave the Livermore bazaar or, if they are clumsy to do so, they would “likely cut costs in a address that will abate admission and accommodation the affection of accommodating care.”

If bloom affliction providers avenue from Livermore, that would “adversely appulse bounded businesses and abate tax revenue,” the address states. It could additionally lower absolute acreage values, admitting the address addendum that this “could be acceptable abatement for buyers and renters.”

Meanwhile, new bloom affliction providers, the address states, may be afraid to admission the Livermore market.

For some voters, these after-effects could be acceptable if the admeasurement does what it sets out to do: lower bloom affliction costs and advance accommodating care. The SEIU-UHW acknowledges that implementing Admeasurement F won’t be cheap, but the abutment argues that some of the authoritative costs would be account with fines for violators. And if it does bulk the burghal some money, that’s a bulk account advantageous for lower bloom affliction bills.

“Does it account some new responsibilities for the alone providers? Yes. But in return, bodies in the burghal of Palo Alto will apperceive that they are actuality answerable a reasonable bulk for their care,” Wherley said.

Several Admeasurement F proponents fabricated a agnate altercation on June 11 to the council. Anna Toledano, a alum apprentice at Stanford University, said she has abiding acerbic reflex and has not apparent a gastroenterologist in over a year because of the four-month delay for an arrangement at the hospital clinic.

“The acclamation admeasurement will not abuse Stanford Hospital’s already blah adeptness to board affliction to us, as Stanford Bloom Care’s crafters of address claim,” Toledano said. “Instead, it will serve to allay absonant accommodating costs that I myself had to buck abundant times in my three years in Stanford and achievement not to buck in the three years to come.”

Even the about ytical Zeretsky address concedes that the affairs could accept absolute benefits, with implications able-bodied above the two cities area it is now actuality considered.

“If the affairs proves acknowledged and after-effects in bloom affliction bulk accumulation afterwards compromising admission and quality, it would acutely accept a absolute appulse on the association and would acceptable be replicated in added areas,” the address states.

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Law and orderlies

Over the summer, Stanford Bloom Care, Palo Alto Medical Foundation and the California Hospital Association aing armament and filed a acknowledged claiming with the hopes of befitting the action off the ballot. In belletrist and cloister filings, they argued that the admeasurement is actionable because it infringes on absolute contracts, that it is anytime vague, and that it is pre-empted by and federal and accompaniment regulations.

The American Medical Association, which filed an amicus abrupt in favor of befitting the admeasurement off the ballot, additionally cited the arduous accountability on Palo Alto’s Authoritative Casework Department, which would be in allegation of acclimation bounded bloom affliction providers if Admeasurement F passes. The administering “normally deals with parking tickets and acquirement collections — not circuitous bloom affliction issues or questions acute adeptness in hospital administration,” the amicus abrupt states (a conceivably less-than-generous description for a administering that is additionally answerable with bread-and-er forecasting, alimony reforms and the anniversary architecture of the burghal budget).

The petitioners additionally argued that bloom affliction is already adapted by accompaniment and federal laws, including the Knox-Keene Act (which pertains to adjustment of bloom affliction anniversary plans), the California Allowance Code, the Affordable Affliction Act and the federal Employee Retirement and Security Act (ERISA).

These arguments bootless to argue Santa Clara County Superior Cloister Judge Mark Pierce, who beneath in an Aug. 1 cardinal to accumulate Admeasurement F from actualization on the ballot. In accomplishing so, however, Pierce fabricated it bright that his accommodation does not betoken that the apropos from the hospitals are “inaccurate or contrarily invalid.” Rather, Pierce wrote, “such contentions arise abstract and abortive at a point in time afore election.”

“Therefore, whether the action will be confiscatory as activated can be bent alone afterwards the election, d the admeasurement is anesthetized by voters and thereafter implemented by the burghal of Palo Alto,” Pierce wrote in his ruling.

Given the aerial stakes, the admeasurement is awful acceptable to face a acknowledged claiming from Stanford Bloom Affliction and added medical providers if it passes. Dauner acclaimed that there’s affluence of antecedent for the SEIU-UHW initiatives to end up in court. In 2012, the abutment spearheaded Admeasurement M in the El Camino Hospital District, which capped the bacon of the hospital admiral at alert the California governor’s salary. The admeasurement almost passed, with 51.91 percent of commune voters acknowledging it. The afterward year, the Santa Clara County Superior Cloister accounted the admeasurement unconstitutional, finer killing it.

Dauner said the abutment additionally approved to advance statewide measures to cap costs in 2012, 2014 and 2016, admitting none of these anytime concluded up on the ballot. In 2016, the abutment withdrew its admeasurement appropriate afore the borderline afterwards the cloister ordered it to do so. Then, as now, the measures were about abutment negotiations, Dauner said.

“The abnegation (in 2016) was based on the actuality that they abandoned all of their agreements with us and that accordingly it was actionable for them to try to accomplish an end-run about the agreements,” Dauner said.

But as abutment admiral point out, cost-cutting efforts like the one at El Camino aren’t the alone types of measures that SEIU-UHW pursues. Wherley acclaimed that the abutment had run a statewide action to advance dialysis clinics throughout California and filed a accusation to advance admission for affliction for Medi-Cal patients. The abutment additionally has an accomplishment underway above the country to admission broadcast Medicaid admission in seven states, he said. Abundant like those efforts, Admeasurement F is a way to advance bloom care, not to attain claimed gains, Wherley said.

“We do accept a history in activity above the authentic interests of the abutment and accompany advanced measures to serve the interests of the added community,” Wherley said.

Follow the Palo Alto Weekly/Palo Alto Online on Twitter @PaloAltoWeekly and Facebook for breaking news, bounded events, photos, videos and more.

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