WV HEALTH CARE AUTHORITY
AMBULATORY CARE CENTERS
CON STANDARDS MEETING
10/28/2008 – 1PM ET
Conference ID 137202
Ms. Sonia Chambers: All right, why
don’t we, it’s 10 after, why don’t we go ahead and get started, my name is
Sonia Chambers, and I’m chair of the West Virginia Health Care Authority. I believe on the phone is Marilyn White, one
of the other board members.
Ms. Marilyn White: I’m here.
Ms. Sonia Chambers: And Sam
Kapourales, who will be arriving here momentarily. He’s running a little bit late. For those of you who have not participated in
one of these prior meetings, we are going through a process agreed to by the
legislature, getting input from the various, I guess, stakeholders, interested
parties, around whether we ought to continue to subject certificate of needs,
certain services, that are currently regulated by certificate of need. The legislature is looking at that issue more
generally, and has asked us to convene groups and get input around each of the
specific types of services. We will be
providing the comments from today’s meeting, which I’d like to remind you, we
are getting transcripts, we are recording these calls and meetings, and we are
getting transcripts, those will be available on the website. I would also welcome you to submit any
written comments you would like to about this set of issues today. Please direct those to Dayle Stepp, our
director of Certificate of Need, and have those in within 30 days. We will provide all of that to the
legislature. With that as background,
I’d like to first go around the room here, see who’s on the phone, and then,
Dayle will briefly go over the standards and any other material we might have,
and then we’ll just open it up for comments and discussion. So, again, I’m Sonia Chambers. We’ll go around the room here, and then we’ll
see who’s on the phone.
Mr. David Jarrett: I’m David
Jarrett, with CAMC.
Ms. Jill McDaniel: Jill McDaniel,
Hospital Association.
Mr.
Ms. Lindsay Darling: Lindsay
Darling, Jackson & Kelly.
Ms. Nora McQuain: Nora McQuain,
I’m with the Bureau for Medical Services, Medicaid
Ms. Raymona Kinneberg: Raymona
Kinneberg, Bill J. Crouch Associates
Ms. Sheila Kelly: Shelia Kelly,
CON division.
Mr. Tim Adkins: Tim Adkins,
Health Care Authority, CON division.
Ms. Martha Morris: Martha Morris,
with the Insurance Commission and consumer etiquette division.
Ms. Marianne Kapinos: Marianne
Kapinos, General Counsel.
Ms. Cindy Dellinger: Cindy
Dellinger, the Health Care Authority.
Ms. Kay Myers: Kay Myers,
Health Care Authority.
Ms. Sonia Chambers: Okay, and on
the phone?
Mr. Phil Wright: Phil Wright,
over at The Health Plan.
Mr. Gary Murdock: Gary Murdock,
Ms. Angela Swagger: Angela
Swagger,
Mr.
Unidentified Female:
[unintelligible],
Mr. Bob Coffield: Bob Coffield, Flaherty,
Sensabaugh & Bonasso
Ms. Sonia Chambers: Anybody
else? Okay. Dayle, why don’t you go through the standards
briefly?
Mr. Dayle Stepp: The ambulatory
care center, starting with the definitions, the first definition is Private
Office of Health Professionals. This
kind of outlines what a private practice of a health professional is, and it
says private office practice is exempt from certificate of need review. It says the facility which meets any part of
the definitions of ambulatory care centers is not a private office practice for
purpose of this standard and is subject to review as an ambulatory care
center. Then defined ambulatory care
centers as freestanding facilities staffed with one or more health care
professionals, that serve on an outpatient basis, an ambulatory care center, if
they require medical equipment over the threshold value, or they fall under one
of the categories: community based primary care center, urgent care center,
diagnostic center, ambulatory surgery center, which we already had a meeting
on, or an outpatient behavioral health center.
Need methodology is generally what we see as, what’s called the general,
or general need methodology, wherein the applicants have to show a specificity
that there’s an unmet need, does one have a negative impact on the community at
the most cost effective. They have to
define their service area, document expected utilization for the service to be
provided for the population, this can be expressed as a number of providers
typically required service in a given population, a number of persons that’s
typically served by a single provider.
Then they have to estimate the number of existing providers in the
service area and the extent to which the demand is being met. It says where expected, utilization, expected
utilization is expressed as a number, providers typically serve in a given
population, shall be sufficient to share the ratio providers to the population
in the area is below the expected number.
It goes into the quality standard, they have to meet all the licensing
certification, their accreditation standards, they have to have a suitable
plant, physical plant, adequate staff, effective treatment protocols,
administrative evaluation process, they have to develop referral relationships,
cost, they have to show that it’s financially feasible, that the charges are
comparable to other services in the area, and that all interested persons
needing the service or procedures can be served without jeopardizing the
financial viability of the project as far as accessibility [unintelligible] it
is accessible to the disabled, and preference be given to applicants who
demonstrate intent to provide service to all patients without regard to ability
to pay. They have to show that this is
the best alternative for the project.
Then it goes into some facility specific community, standards for
community based primary care centers, which we won’t go through. Each of those have their own quality
standards in addition to the quality standards for the general application. That’s basically a quick overview of it. Also, we have, we don’t have a comprehensive
listing of every ambulatory care center, because there’s so many different
variations of it, but we printed out from the licensure website all federally
qualified health centers, all real health clinics, there’s 121 at QHCs, and
we’ve found 54 real health clinics.
Ms. Sonia Chambers: And all of
those documents Dayle referenced will be available on our website. All right.
We just jump right into comments.
Raymona looks like she had something she’d like to say.
Ms. Raymona Kinneberg: Well, I think
that there could be some changes to this standard, you know, for example, the diagnostic center definition is inconsistent
with the regulations. Behavioral health
is no longer under this standard, it’s under a different standard. I think, in general, that [unintelligible]
continuation of ambulatory care centers.
We do have some recommendations that we’ll be putting in a letter in the
30 day comment period.
Ms. Sonia Chambers: Okay. Joe?
Mr.
Ms. Sonia Chambers: Dave?
Mr. David Jarrett: Yes, our
position is that they should remain on the review list as a reviewable service.
Ms. Sonia Chambers: Okay. Anybody, Lindsay? Just happy to be here, huh? Nora, you just continue to be happy to be
here, right?
Ms. Nora McQuain: Absolutely.
Ms. Sonia Chambers: All
right. Ed or Phil?
Mr. Phil Wright: Phil. Question: if, how many, well I guess, back
up, how many surgical centers are there?
Ambulatory centers?
Ms. Sonia Chambers: Ambulatory
surgery centers?
Mr. Phil Wright: In the
hospitals in
Ms. Sonia Chambers: We discussed
that last week, and there are –
Mr. Dayle Stepp: 11.
Ms. Sonia Chambers: 11 of them.
Mr. Phil Wright: And where are
they?
Ms. Sonia Chambers: They’re all
over the state. There’s a couple in
Mr. Phil Wright: As I
understand it, if a group of doctors wanted to put a surgery center in –
[unintelligible]
Mr. Phil Wright: I’m sorry, I’m saying the wrong thing here.
Ms. Sonia Chambers: Well, Phil, we
did, I think you participated, did you not participate in our meeting that we
had last week that we had specifically about ambulatory surgery?
Mr. Phil Wright: Yes, I’m
sorry, I’m thinking surgery and not ambulatory.
I’m sorry.
Ms. Sonia Chambers: It’s all right. The standards for ambulatory surgery are
embedded in these standards. But we did
try to have a separate meeting about that.
Ambulatory care is kind of a broad –
Mr. Phil Wright: Very broad –
Ms. Sonia Chambers: Yeah, somewhat
catch-all, I guess, definition.
Mr. Phil Wright: But these are
the standards that apply to the ambulatory surgery center.
Ms. Sonia Chambers: They are
embedded, yes, generally yes, and then there are some more specific ones in
here.
Mr. Phil Wright: Then I’ll go
back to my question. If an ambulatory
surgery center wanted to just get into the market to reduce the price, they
couldn’t because of the formula?
Ms. Sonia Chambers: Well, they
would have to show a need, and one of the largest, I guess, hurdles, is that
the operating rooms in the service area have to be operating at
Mr. Dayle Stepp: 40 hours?
Ms. Sonia Chambers: - 40, all of
them have to be operating at 40 hours a week to show that there’s an unmet need
for new operating rooms.
Mr. Phil Wright: I’m not one
for opening it up. We tried, at The
Health Plan, we try to keep our business within a hospital, but there’s nothing
competitively driving the cost. In the
ambulatory surgical centers, you are required to keep it in the hospital, and
required to keep the rates the way they are, with the increases the way they
are. So there’s no competition to try to
keep the rates in check. Hello?
Ms. Sonia Chambers: Yep.
Mr. Phil Wright: Yep.
Ms. Sonia Chambers: We’re just,
we’re absorbing your comment.
Mr. David Jarrett: This is David Jarrett, I don’t know about the rest of the hospitals that
are here represented, at our branch, they’re set by the Authority.
Mr. Phil Wright: The hospital
rates.
Mr. David Jarrett: Yes, they are.
Mr. Phil Wright: Yes, I know.
Ms. Sonia Chambers: The over, your
average is, but not the amount that you charge for a specific surgical
case. So you can really pretty much set
your surgical rate as you please.
Mr. David Jarrett: Right.
Mr. Ed Hamilton: And this is Ed
Hamilton. That’s one of the things that
I was kind of thinking of yesterday when I brought up the question of, why is
this provider not rate regulated? And
that’s something that we’re looking at here to see what the code says, vs. the
definitions that are in the code, vs. what’s apparently being applied in
practice. Beyond that, page 9 of this
certificate of need guideline talks about operating suites and surgical suites,
and I’m looking at item number 2A, and you know, in the past, sometimes the
term “treatment room” has been used, and when we look at claims for
quote-unquote “procedures,” we’re looking at, well, in the reimbursement genre
falls to the category of surgical procedures, which includes treatments,
operations, in a broad sense, but you know, we’re paying them based upon
surgical codes. So, you know, if
somebody pops up and says, “Oh, that’s not an operating room, it’s a treatment
room,” the question then becomes, that’s a treatment that’s probably being paid
by a surgical code, therefore it’s a surgical room to us, and under the
guideline, I don’t see where there really is a clear differentiation as to
whether there is a difference or whether there isn’t a difference. You know, is there such thing as a treatment
room vs. an operating room vs. a surgical suite?
Mr. Dayle Stepp: Ed, this is
Dayle, and I’m not sure this, what I think the difference is, operating suite
and surgical suite are probably the same, those are sterile environments. A treatment room doesn’t have to be a sterile
environment.
Ms. Sonia Chambers: But I don’t
think, I don’t think that we would necessarily, and it would be up to you as to
how you pay for different types of services.
Mr. Ed Hamilton: Well, I’m
wondering if, you know, calling something a treatment room, it being a
non-sterile environment, therefore, it makes it unregulated.
Ms. Sonia Chambers: Didn’t data on
the charge, Dayle, include treatment rooms as well as surgery rooms in the
count of rooms that were available in the ambulatory? I think they did.
Mr. Dayle Stepp: Ed, this is
Dayle, I’m still not sure whether it’s an operating room, a surgical room, or a
– how that affects what you determine to be the payment for that particular
service.
Mr. Ed Hamilton: Well, I’m not
concerned about our payment methodology.
My question is, if it’s, you know, a room where they do colonoscopy,
that’s not necessarily a sterile procedure, but does that fall under this
regulation?
Ms. Sonia Chambers: Yeah, Marianne
has taken care of. We, this question
does come up periodically, about endoscopies.
And Marianne, the answer is –
Ms. Marianne Kapinos: We have looked
at them in the past as surgical centers, because they administer anesthesia.
Ms. Sonia Chambers: Right. Did you hear the answer to that, Ed?
Mr. Ed Hamilton: Yeah.
Ms. Sonia Chambers: I’m sorry,
that was a yes, you heard it, or no you did not?
Mr. Phil Wright: Did not hear
it.
Mr. Ed Hamilton: I heard it, I
don’t think Phil did.
Ms. Sonia Chambers: Okay,
Marianne, why don’t you restate that a little louder.
Ms. Marianne Kapinos: We have looked
at endoscopy facilities or at ambulatory surgical facilities in the past,
because they administer anesthesia, and that’s one of the [unintelligible].
Ms. Sonia Chambers: So if a room
was used solely for endoscopies, it would still be considered an operating
room.
Ms. Marianne Kapinos: Right.
Ms. Sonia Chambers: Or surgical
room.
Mr. Ed Hamilton: Is that
something that maybe should be better defined as to, you know, help broaden
that where we’re working with?
Ms. Marianne Kapinos: Written in
1992. I’m sure there are a number of
[unintelligible]
Ms. Sonia Chambers: I think that
could probably be addressed in the standards, as opposed to in the statute.
Ms. Marianne Kapinos: Oh,
absolutely, yeah. That’s what I
meant. The standards were written in
1992.
Mr. Phil Wright: You have all
these standards. Who enforces these
standards?
Ms. Sonia Chambers: The Health
Care Authority does.
Mr. Phil Wright: Do you audit
or go into the hospital and do what?
Ms. Sonia Chambers: We require
them to submit compliance reports to us for a period of time, and if we, it
came to our attention that we thought somebody was not meeting the standards,
then we would certainly have the right to do that. We have periodically sent informational
requests to providers who we think are not meeting the standard.
Mr. Phil Wright: How many CONs
have you withdrawn?
Ms. Sonia Chambers: Have we
actually withdrawn for non-compliance with standard?
Mr. Phil Wright: For this
provision, yes. For ambulatory.
Ms. Sonia Chambers: Ambulatory
surgery, we haven’t done anything for ambulatory surgery. We can condition the CON compliance for three
years. And after that, Phil, we don’t
have as much legal authority.
Ms. Jill McDaniel: The hospital’s
license, or whatever’s license is in jeopardy if they’re found to be operating
a unit without a Certificate of Need, and any billings that are done within
that unit are void if they don’t, haven’t been approved by the Health Care Authority.
Ms. Raymona Kinneberg: Phil, this is
Raymona Kinneberg, and I’m not sure where you’re going with this. This standard sets requirements that are in
place before you get a CON. Once there’s
a CON, there’s no mandate that you operate at a certain level. All the ASCs in the state are certified
through OFLAC, every one that was on that list last week, and the operating
rooms and hospitals are under hospital licenses, so they’re all under oversight
in terms of quality, but there’s nothing in this CON that sets requirements as
there are in some other CON standards for utilization.
Mr. Phil Wright: I guess that’s
my point. Once you get the CON, then
there is no further compliance review other than what was just said. Once you’re protected, you’re protected. You don’t have to have the number of hours in
the operating room, you don’t have to have the, for renovation, replacement,
you don’t have to have the 36, you can be operating at 10 or 20, and nobody
would really care, would they?
Ms. Sonia Chambers: If you come in
for a renovation, a replacement, or for an additional, like if you wanted to
get an additional something, then there are standards.
Mr. Phil Wright: You get those,
but once you get those, and you drop below those numbers, there’s no further
review, is there?
Ms. Sonia Chambers: Well, there is
for three years.
Mr. Phil Wright: Okay, that’s
what I didn’t hear. I didn’t read that
anyplace.
Ms. Sonia Chambers: There is for
three years.
Mr. Phil Wright: Okay.
Ms. Sonia Chambers: Like, for
instance, we have, we have been going back and forth with some cardiac cath
providers recently, because they were not necessarily meeting the numbers they
needed to make in their original application.
So we have been taking some action.
We have taken action in some cases.
Gary and Nancy and Angela, I’m guessing I know your opinion, but if
you’d like to state it. I guess, still
on the phone?
Ms. Nancy [??]: This is
Ms. Sonia Chambers: Mr Coffield?
Mr. Bob Coffield: Yes, ma’am!
Ms. Sonia Chambers: Comments?
Mr. Bob Coffield: No
comments! I’m just listening in!
Ms. Sonia Chambers: Just listening
in, all right. Anybody else?
Ms. Marilyn White: Sonia, this is
Marilyn. I don’t know who to address
this to, but who could, I want someone to tell me that, okay, it sounds like
everyone that’s present on this call feels that we should definitely keep these
standards in place. And who can tell me
why? So, just so that I help, can
understand your logic better.
Mr. Phil Wright: Well, I don’t
know if I agree with that. I don’t know
if all of us think that, because nobody’s talking doesn’t mean they agree.
Ms. Marilyn White: Okay, okay.
Ms. Raymona Kinneberg: This is
Raymona, I want to be clear that we’re all talking about the same thing, which
is ambulatory care centers, not including ambulatory surgery centers, because
we dealt with those last week.
Mr. Phil Wright: Right. But in this is also urgent care centers.
Ms. Raymona Kinneberg: Yes, but only
urgent care centers that spend more than $2 million in capital expenditures
within a 2 year period. That’s the only
part of the definition that applies. It
says, “An urgent care center is subject to the criteria and standards set forth
below if it involves the acquisition over a period of two years of medical
equipment with a value in excess of [inaudible],” so any urgent care center
that spends less than that is not –
Mr. Phil Wright: My question, I
guess, on the urgent care centers, is how did the 60 hours get adopted?
Ms. Raymona Kinneberg: This is
Raymona Kinneberg. I want to make sure
that there’s another understanding.
There’s a catch-all definition at the bottom of this that says any other
ambulatory health care facility, as defined by
Ms. Jill McDaniel: And this is
Jill McDaniel, the Hospital Association.
One area of concern that we particularly have is the diagnostic centers
definition, and also, as I’ve mentioned before, in these proceedings, there
have been studies of national level about the surgeon spending due to
ambulatory surgical centers and also diagnostic centers. So we think that it’s very critical for
[unintelligible] to look at those facilities very carefully.
Ms. Raymona Kinneberg: And one of the
things, Marilyn, this is Ramona, in addition to what Jill said in terms of
diagnostic services, I think we do need
to look at the definition in here, is that once you develop a site, a
new site, so if ambulatory care facilities were not reviewable, once you
develop a new site, and that’s a health care facility, you can add anything to
that without a CON if it’s not a specific CON.
Ms. Marilyn White: Yeah, and I
appreciate all your thoughts. I guess I
was hoping that somebody would help me understand better. To me, when I look at it, I think, okay, it’s
either a quality issue, or it’s a financial issue. And I just wondered if that wasn’t what
people are looking at, what is it? And
what should it be?
Ms. Jill McDaniel: If I may jump
in again, this is Jill McDaniel. I think
it’s both.
Mr. Phil Wright: Me too.
Ms. Jill McDaniel: Some actual
studies have shown that there are some quality issues, perhaps, in some of
these ambulatory settings, that aren’t either licensed or accredited, or
subject to the same type of standards that hospitals, and also certified
ambulatory surgical centers may be subject to, for lack of oversight has been a
major concern, and also the financial aspect, as I mentioned. It’s both.
Ms. Sonia Chambers: Anybody else
want to take a crack at Marilyn’s question?
Mr. Phil Wright: I think it’s a
double edged sword, Marilyn. If you
don’t have a competition, you can’t drive the price. On the other hand, you don’t want to take the
volume out of a hospital, or you reduce the quality at the hospital. It’s a double edged sword.
Ms. Marilyn White: It really is.
Mr. Phil Wright: Sure.
Ms. Sonia Chambers: Phil’s got it
all figured out.
Mr. Phil Wright: I figured it
out, right!
Ms. Jill McDaniel: I’m sorry, I’m
having difficulty differentiating between Phil and Ed on the phone. You’re not saying who it is.
Ms. Sonia Chambers: That was
Phil. Anybody else?
Mr. Ed Hamilton: This is Ed
Hamilton again, at Mountain State Blue Cross Blue Shield. Is it the intent that the ambulatory surgical
center guidelines be separated from the ambulatory care center guidelines,
because, you know, we had a meeting last week on am-surge, so to speak, but
this guideline obviously encompasses that also. So is it the intent at some point that those
two guidelines be separated?
Ms. Sonia Chambers: Not
necessarily. I just thought, when we
were setting up these meetings, Ed, we tried to set them up so that discrete
groups of interested parties might be able to attend different meetings. Ambulatory surgery, while it is included in
this, has a bit of a different constituency than ambulatory care
generally. I don’t think there’s necessarily
any plan to do that, although I think once we get to the legislative session
and see what has finally been decided, then we’re going to need to go back and,
I think revisit a number of the sets of standards. So I wouldn’t rule it out, but I don’t think
there’s any preconceived notion about it.
Mr. Phil Wright: Under this
definition, Sonia, would a medical home be an ambulatory care center?
Ms. Sonia Chambers: It would
depend on how that ambulatory, how that medical home was structured. Now I’m practicing law, so I’m looking at my
lawyers and my CON director here. If the
medical home was a separate practice location started by a hospital with
employed physicians, and it was not on campus, then it would fall under this
definition. If a private physician, a
primary care physician, let’s say, I don’t know, up your way, if Dr.
Comercy[sp?] or somebody, that wanted to become a medical home and was going to
do all of that in his current office practice, then it would not be reviewable,
because that’s just a continuation of his private practice of medicine. If it were going to be done in an existing
urgent care center, then it would not be reviewable. If it were going to be done at an existing
primary care center, be it a rural health clinic or an FQHC, it would not be
reviewable.
Mr. Phil Wright: Take a double
standard.
Ms. Sonia Chambers: Well, because
the medical home is an extension of that private office practice. Unless you were going to, all of the sudden,
do other things, unless I don’t understand exactly what’s going to have to be
done in a medical home, I don’t know that it’s really that different than many
current primary care centers or private practitioner office practices.
Mr. Phil Wright: Didn’t you
say, though, if a hospital, the physicians off campus, it would be reviewable?
Ms. Sonia Chambers: That is
currently the case. Whether it’s a
medical home or not.
Mr. Phil Wright: The only
difference is ownership, from private to a hospital home.
Ms. Sonia Chambers: Yes, that is
true. And I think some of the, I think
the rationale for this, and I’m just going to key up my understanding of the
rationale, and I’m kinda looking at everybody in the room who’s looking at me,
saying, “Oh, let’s see how she explains this one!”
Mr. Phil Wright: I’m not trying
to put you on the spot, Sonia.
Ms. Sonia Chambers: Well, no, I
think that was originally designed to make sure that the playing field with
private practitioners was level. I think
the concern by physicians was that hospitals have a lot more financial
wherewithal to set up potentially competing practices right across the street
from a, perhaps, a single physician practice, and that if the hospital wanted
to do that, with all its financial backing, then they had to go through
certificate of need. And that is also no
longer on their campus, if they do it on their campus, that’s a different
matter, but if they want to go out, branch out, and get into traditional
physician office practice, then they have to go through review.
Mr. Phil Wright: Your offices?
Ms. Sonia Chambers: That’s setting
up a new location for that institutional facility. So that’s my understanding. Now obviously, all this predated me, but
that’s my understanding for the rationale.
Mr. Phil Wright: If you had ten
primaries wanted to set up an office outside the hospital, again, privately
owned, and you had a hospital wanted to have ten doctors in a practice across
the street from them, one is reviewable, and the other one isn’t.
Ms. Sonia Chambers: That’s
correct.
Ms. Marilyn White: And on that,
this is Marilyn again, but Phil, on that theory, I think, it just dawned on me,
these ten physicians could, quote, “have their office,” and they could stay
open 12, 18 hours a day, and they could do minor surgery, and they could really
run, be very competitive, couldn’t they, under this. I hadn’t thought about that.
Ms. Sonia Chambers: Well, I think
the other rationale, Phil, is, as long as you are getting into your traditional
line of business, then in your current location, then it’s not reviewable. If you wanted to get into somebody else’s
line of business, and it’s a regulated line of business, then you have to go
through review, and the argument kind of cuts both ways. If a hospital, that is really not
traditionally in the business of running private physician office practices,
wants to go set up somewhere, and compete with that, then it has to go through
review. The flip of that argument is
that, if physicians want to get into the traditionally regulated business of
imaging or ambulatory surgery, or ambulatory care, then they have to go through
review. It’s leveling the playing field
that cuts both ways.
Mr. Phil Wright: If you look at
it that way, yes.
Ms. Sonia Chambers: Unfortunately,
those who want things don’t often like to look at it both ways. They want to look at it only as their way.
Mr. Phil Wright: I’ll shut up.
Ms. Sonia Chambers: No, I think
that’s a good question. And it does seem
a bit odd and not fair unless you look at it the way I sort of outlined it.
Mr. Phil Wright: Yep.
Ms. Sonia Chambers: Other comments
or questions?
Ms. Jill McDaniel: I had a
question related to –
Ms. Sonia Chambers: And you’re
Jill McDaniel, right? [laughter]
Ms. Jill McDaniel: Question
related to community based primary care.
Although there are standards here that define, you know, what these
facilities are, is there a provision that allows new primary care clinics,
either FQHCs or CHCs to be exempt from the Certificate of Need review process?
Mr. Dayle Stepp: Separate
regulations, 65-23, that it’s an exemption process. For new primary care centers, they’re not
exempt from Certificate of Need review, but it’s a different process than going
through an expedited review.
Ms. Raymona Kinneberg: This is
Raymona. Actually, there’s a couple
routes that they can go. As Dayle said,
there’s a separate regulation, I do think it says exemption on it, but you
know, there’s a lot of things that could be similar to this that are in that,
and that’s one route they can go. That’s
the route that was taken before an additional change to the law, which allows
an exemption with the approval of the Office of Community Health Services, the
Health Care Authority, so at this point, most things that are done by primary
care centers are done through the law exemption, part of that, and I’m trying
to remember the last one I did which was a few years ago, a couple years ago
down in Summers County, there’s an exemption in the regulation. I’ve never seen anybody go use this through
the CON process, because you’ve got those other exemption avenues.
Mr. Dayle Stepp:
[unintelligible] 16-2D-5M is the one where they can request.
Ms. Jill McDaniel: I’m familiar
with the provision, I guess I’m asking kind of a hypothetical question, is
there a level playing field between these types of facilities and other
ambulatory health care facilities that may be providing similar services.
Ms. Sheila Kelly: This is Sheila
Kelly. The primary care centers are
still subject to review if they purchase major medical equipment in the amount
of two million dollars or more, so if they were going to do anything like
imaging, or at least on a large scale, I would imagine, though, it would still
be reviewable.
Ms. Raymona Kinneberg: This is
Raymona Kinneberg. In addition, those
two exemptions have to be approved from the authority, so if they were
proposing something that the authority doesn’t feel fell under either of those
exemptions, then they would be required to go under a CON standard.
Mr. Phil Wright: Sonia, is the
service area meaningful in this? We’re
talking about the application shall delineate the service area?
Ms. Sonia Chambers: I’m sorry,
Phil, your question is the application for what? For any ambulatory care center?
Mr. Phil Wright: Yes.
Ms. Sonia Chambers: Yeah, they
have to delineate a service area. They
can, in some cases, they can propose their own service area, is that
correct? And then, but then we have the
ability to decide whether we believe that service area is reasonable and
appropriate.
Ms. Raymona Kinneberg: They can
document where they currently get patients.
Ms. Sonia Chambers: Yeah, they can
come up, create one, say, you know, here are the counties from which we
currently get our patients, we would anticipate they would be the same, or if
we were going to offer these additional services, that it might grow by this,
and here’s our reason for that. They
have to present a service area, and we have to find it credible.
Mr. Phil Wright: Okay.
Ms. Raymona Kinneberg: This is
Raymona Kinneberg, if I can go back to what Jill was saying a minute ago, and I
think this is part of your question. I
don’t see anything in either of the two exemptions, or in this definition of
CON standard related to community based primary care center that would allow
them to have an exemption from review in providing diagnostic services. Is that –
Ms. Jill McDaniel: I was asking
more from the perspective that primaries in West Virginia, hospitals actually
provide outpatient primary care service as needed through their outpatient
department, or through rural health clinics.
And yet there’s a process that seems to exist to enable community health
centers to expand within the same service areas that are already being somewhat
served, but not making a statement whether they’re underserved or not, it’s just
an unlevel playing field, if you will.
Ms. Raymona Kinneberg: But I believe
that the Office of Community and Rural Health and the Health Care Authority
look at that. If there were a new
application to come through, and I can just sort of think of a few off the top
of my head where that has been somewhat of an issue. And the community and rural health and the
Health Care Authority have had those discussions and considered that in looking
at an application or proposal.
Ms. Sonia Chambers: Okay. If there’s nothing else, I thank everybody
for their time. The next meeting we have
is –
Mr. Dayle Stepp: October the 5th,
on Radiation.
Ms. Sonia Chambers: November the 5th.
Mr. Dayle Stepp: November the 5th.
Ms. Sonia Chambers: Next week,
radiation therapy, which is next Thursday, is that correct? The 5th? Wednesday.
Next Wednesday. Post
election. All right, thank you all.