Hospital process was in need of CPR

January 22, 2006|By TAMELA BAKER


The diagnosis was an outdated system, and it was time for radical treatment.

Before a health-care facility can be established, moved or expanded in Maryland, the state Health Care Commission must review the project and issue a Certificate of Need approving it.

But as can be the case in many government processes, getting that certificate can be a slow and cumbersome ordeal.

A case in point was when the Washington County Health System attempted to secure approval for a new hospital.

When objections were raised to the hospital's pay-as-you-go plan to phase in rate increases during construction rather than charging a larger rate increase when construction was completed, the hospital had to start over - and go to the back of the line of projects awaiting review by the Health Care Commission.

And the local hospital wasn't the only project caught in bureaucratic limbo.

Because any significant change to an application required a facility to "re-docket," or get back in line, the process led to delays and added expenses for a lot of projects.


"A lot of these issues just keep coming back and coming back," said Del. John P. Donoghue, D-Washington, chairman of the House Health and Government Operations Committee's subcommittee on health facilities.

"Everyone was complaining that the (Certificate of Need) process was outdated," he said.

"There were a number of converging factors," said Pegeen Townsend, senior vice president for legislative policy of the Maryland Hospital Association.

"There was a growing frustration with the system and there are a large number of hospitals seeking major projects," she said, because many of the state's health-care facilities are in aging buildings "that need updating."

And a change of leadership in the Health Care Commission helped usher in a desire to take a fresh look at the process, Townsend said.

So last year, the certificate review process got a review of its own from a task force trying to make it a little less painful.

Last week, the task force presented its findings to Donoghue's subcommittee, along with recommendations for more efficient reviews.

A few of those changes would require legislation to change - such as raising the limit of capital expenses a facility could spend without going through the process and removing a requirement for a public hearing before a facility closes.

But the recommendations that would have affected the Washington County Health System can be made internally, Townsend said.

Those include developing a "fast track" review process for hospital renovation and new construction projects, and changing the re-docketing rules. Two conferences with the applicant - one for commission members to raise questions about the application and another for facilities to provide the answers - would be scheduled for each review. Another recommendation is to require electronic files of application papers.

Implementing them would require changes in the Code of Maryland Regulations, and such changes go through a series of internal approvals, are published for public comment, then usually become effective 90 days after publication, Townsend said.

As she noted, the delays to the Washington County Hospital project weren't confined to the Certificate of Need process - other parties, including the City of Hagerstown, sought further consideration of the project. The health system also had to get zoning variances, which now have been appealed.

But Hamill said that if the Certificate of Need changes had been implemented earlier, "it would have cut a year, a year and a half out of the process.

One area not addressed by the task force, however, is the commission's "batching" system, which allows facilities in various regions in the state to apply only at certain times of the year.

That system, Townsend said, has led some facilities to submit applications before they were really ready and resulted in further delays when changes in the applications had to be made.

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