The committee met to review stakeholder input regarding levels of care designations and to receive presentations regarding levels of care.
Members and stakeholders discussed the levels of care document and issues that were brought up at the recent stakeholder meeting.
According to Council chair Dr. Eugene Toy, the rules need to be released by mid-late December and still have to be finalized by the Department of State Health Services. Once DSHS has the finalized levels of care designation document they will draft the rules to the best of their ability based on comments and suggestions made by members.
Discussion
Jeff Turner, CEO, Moore County Hospital District
- Upset about the decentralization of oversight
- Decentralization will ultimately lead to an unmanageable system
- Expects that Level I facilities with the least resources will be required to fund the agency surveys as well as being required to fund a medical director
- The medical director will likely have to be a family practitioner in rural areas with few candidates to choose from; the director will need to learn about neonatology
- Eventually this system could lead to every department in a hospital requiring a medical director
- The council must be sensitive to rural issues
THA Representative
- Have not discussed the current draft with the Association yet but will provide comments at a later date
Rural Hospital Administrator
- If these regulations force departments to close or to downgrade care will be impacted for rural residents
- Many times there aren’t multiple hospitals to choose from for rural residents and transferring patients long distances can be a poor decision
Ivar Gjolberg, CEO, Cuero Community Hospital
- Talked to Rep. Kolkhorst about the intent of her legislation, HB 15 (83R); she was apologetic and noted the law was only intended to impact NICUs, not neonatal units as a whole
Dr. George Saade, Council Member
- The council probably needs to adjust the number of births requirement for each level to ensure rural hospitals continue to practice obstetrics
Dr. Michael Stanley, Council Member
- The council needs to promote the idea that high-risk mothers need to be transported to higher level units
- The one factor that affects mortality above all others is location of delivery
Pediatrician, Level I Unit, Alpine
- Because of the low number of births that occur at Level I units, they are the ones who get the least amount of practice and likely need the most oversight
Baylor Scott & White Representative
- Wants to ensure telemedicine is left as a possibility to meet some of the requirements; this would make it much easier to meet specialist requirements for mid-level units
Bill Blanchard, CEO, DeTar Healthcare System
- Unit has been a Level IIIA for 15 years
- If the unit is not permitted to remain a level III it will cut business by 27%
- Do not have a volume of births that would make it feasible to employ a neonatal nurse practitioner or a neonatologist in-house 24/7
- Many hospitals are in a large enough population center but far enough away from another major metropolitan area that they are the only place to receive high levels of care; must be able to maintain the levels of care that are currently being provided
Transfer Transportation Provider
- Early birth babies are at a high-risk for head bleeding
- Transferring these babies long distances from rural areas can be dangerous because of the condition of many rural roads; helicopter transport from rural areas can be dangerous as well because of wind factors
March of Dimes Representative
- The council should follow very closely with AAP guidelines
- Understands the rural issue but the AAP guidelines should not be deviated from
Dr. Toy noted there has been enough support for the council to be able to explore an additional designation level for rural hospitals. The council discussed a Level II-Rural designation with the following preliminary guidelines:
- 75 miles from a Level III or IV unit
- Maximum time on mechanical ventilation – 24 hours
- Gestational age – 30 weeks or more
- Must have a close consultative relationship with a Level III unit
- Must have a neonatologist as the medical director
- ROP and Echo – same as a Level III
- Nurse program manager must be a RN preferably with a BSN
Dr. Michael Speer, Ex-Officio Council Member
- The council may want to create a Level III-Rural designation with the same capabilities as a Level III aside from having a neonatologist in-house 24/7
- Should also be a certain distance from a Level III
Dr. Toy
- The council feels very strongly that for Level IV units, social services should be provided at a higher level within the hospital
The following presentations were delivered to the council – Slides Attached Below
- A Plea to Follow the Intent of HB 15 – Alex Kenton, MD
- Comments on Levels of Care to PAC – Brenda Morris, MD