New law of­fers chance to de­fine health care

Record Observer - - Opinion - By GENE M. RAN­SOM III

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.

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