New law offers chance to define health care
This year the General Assembly passed legislation aimed at regulating actions taken by hospitals with the effect of closing or altering services. Maryland hospitals contend that the new Maryland Hospital Medicare Waiver requires hospitals to adjust their level of services to account for declining hospital inpatient stays. However, individuals (both patients and physicians) in the affected communities have expressed concern that reductions in service would harm patient safety and affect access to care. While the bills have statewide impact, the issues were highlighted this legislative session when the University of Maryland Shore Health System and Laurel Regional Hospital signaled consideration of plans to reduce inpatient services.
The legislation championed by Senators Steve Hershey and Mac Middleton gives the affected communities, and health systems serving them, particularly Shore Health System, an opportunity to hit the restart button and develop a mutual plan for the future of health care delivery. Senate Bill 707 (Freestanding Medical Facilities – Certificate of Need, Rates, and Definition) and Senate Bill 352 (Maryland Health Care Commission – Certificate of Need Review – Interested Party) passed the Maryland General Assembly this session. Both bills will change the process that hospitals follow to adjust levels of service.
Senate Bill 707 (Freestanding Medical Facilities – Certificate of Need, Rates, and Definition), introduced by Senators Middleton, Hershey and Mathias exempts the conversion of a licensed general hospital to a freestanding medical facility (and any related capital expenditure), from the requirement to obtain a certificate of need (CON) and establishes the procedures for obtaining the exemption from the Maryland Health Care Commission. In direct response to rumored changes/proposed changes by Shore Health System to Chester River Hospital, the bill prohibits a licensed general hospital located in Kent County from converting before July 1, 2020, and creates a workgroup on rural health care delivery.
Senate bill 707 also adds due process to the procedure to downgrade a hospital in Maryland. A hospital requesting permission to reduce services must hold a public informational hearing in the county where the hospital is located. Within 10 working days after that hearing, the hospital must provide a written summary of the hearing to the Governor, the Secretary of Health and Mental Hygiene, the governing body of the county in which the hospital is located, the local health department and local board of health, the Maryland Health Care Commission, and specified committees and members of the General Assembly.
Hershey also sponsored Senate Bill 352 (Maryland Health Care Commission – Certificate of Need Review – Interested Party), which passed this session, and which provides additional protections to communities where hospital changes are proposed. Under this bill, if a hospital system serving multiple contiguous jurisdictions (i.e., three or more adjoining counties) is proposing an amendment to its certificate of need that would result in a county losing its in-county acute hospital, the county would be granted “interested party” status and would be eligible to participate in the decision by the Maryland Health Care Commission as to whether to allow an amendment and under what terms. This would guarantee that affected jurisdictions would have a seat at the table when major changes are being made to health care delivery for their citizens.
These new measures and the rural task force allow additional protections to patients and physicians in affected communities. MedChi applauds the work of the legislature on these issues, and will continue to be a partner as reasonable people work to shape the future of healthcare in Maryland. The protections, specifically the hold on the closure of Chester River, provide an unique opportunity for all affected parties in the mid-shore to sit down in a calm and deliberative fashion and determine together where and how health care is delivered in the Mid-Shore area. I, for one, hope Shore Health System takes advantage of this opportunity.
Gene Ransom is a former Queen Anne’s County Commissioner (2002-10) and the current CEO MedChi, The Maryland State Medical Society email gransom@ medchi.org.