DCH 04-15-2014

ED Language Hearing

Comments from

HomeTown Health, LLC

A business association of rural; hospitals

Presented by

Jimmy Lewis, CEO

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RULES OF

DEPARTMENT OF COMMUNITY HEALTH

HEALTHCARE FACILITY REGULATION DIVISION

REVISE CHAPTER 111-8-40

RULES AND REGULATIONS FOR HOSPITALS

SYNOPSIS OF PROPOSED RULE CHANGES

STATEMENT OF PURPOSE: The Department of Community Health proposes to revise the Rules and Regulations for Hospitals, Chapter 111-8-40, to identify and define rural free standing emergency departments. Changes have been made to identify the services that a rural free standing emergency department may provide. In addition, changes have been made to identify special requirements applicable to rural free standing emergency departments. These changes are being proposed pursuant to the authority granted the Department of Community Health in O.C.G.A. §§ 31-2-5 and 31-2-7.

A note of thanks to Commissioner Clyde Reese for taking the lead on the development of the standalone ED language as initiated by House Appropriations Chairman Terry England. There is a clear need for a plan to help create what will be the alternative health care delivery model in rural Georgiaespecially as rural hospitals close.

This language certainly begins to address the issue of necessary access to health care in rural Georgia by starting the conversation on what the needed model should look like.

The language as prepared has been done so in the light of a potential bill that was designed to cover similar models but was killed due to concern over CON implications. As a result, this language was prepared in an effort to achieve similar results but through licensure and regulations.

For having done so the language has inherent to it some serious drawbacks that may need to be addressed including:

  1. Access rule (7-day, 24-hours). This may be overkill and economically not feasible, especially if there is an urgent care center in the area. The mandatory ER hours may be should be limited to “after hours.”
  2. Ability to pay rule. This may be unfair as the transferee hospital most often objects if the patient is a no-pay thus keeping the patient in the ED beyond licensure capability.
  3. The ER should only have to do a screening to determine, in the opinion of the attending doc, if the patient is facing a life-threatening emergency. If not, ability to pay should not be a limiting factor.
  4. Required written transfer agreement. The transferee hospital will take transfers fromthe SAER if in the opinion of the SAER doc the patient needs a transfer.
  5. There appears to be no definition of payment methodology. There needs to be payment methodology spelled out as to how Medicaid, Medicare, and Commercial can be paid as in hospital payments in order to make the unit financially viable.
  6. There needs to be some form of language granting access to block grants or local subsidies in addition to standard hospital payments to finance the operation.
  7. There needs to be some kind of relief from EMTALA in conjunction with payment methodology. The force of EMTALA with no commensurate reimbursement makes it a non viable entity as written.
  8. There needs to be some language to allow this to operate as a hybrid between a voluntary free clinic with liability exemptions for practitioners volunteering and a reduces size hospital – standalone entity

While there probably are many other comments to be offered, these are a few of the prominent features needing addressing. As written the language probably would be very limited in its application if at all. It needs much more fine tuning before passage with major input for the rural user community.

Respectfully submitted,

Jimmy Lewis

CEO HomeTown Health, LLC

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