Specialist Coverage of Emergency Departments and Related Reporting Requirements

1
Specialist Coverage of Emergency Departments and
Related Reporting Requirements

• Dr. Kelly Gray-Eurom, MD, MMM, FACEP
• President, Florida College
• of Emergency Physicians

March 15, 2013
2
Florida College of Emergency Physicians

• The Florida College of Emergency Physicians
  exists to promote high quality emergency medical
  care.
• FCEP supports and promotes the health and safety
  of the public by ensuring patient access to
  quality emergency care.
• 1,400 members statewide.

3
Floridas Emergency Physicians

• Treat/See Over 7,000,000 Patients Each Year in
  Florida
• Working in Academic Setting, Community Hospitals,
  Urban-Tertiary Care
• Diverse ED Environment
• Diverse Specialty

4
FCEP and ACHA

• FCEP values a working relationship with AHCA as
  well as with hospitals to ensure patients have
  access to quality care
• FCEP supports the AHCA initiative to create
  transparency and further defining the Hospital
  Emergency Services Inventory

5
Statute 395.1041

• Access to Emergency Services and Care

6
Access to Emergency Services and Care

• Legislative Intent
• The Legislature finds and declares it to be of
  vital importance that emergency services and care
  be provided by hospitals and physicians to every
  person in need of such care.

7
Access to Emergency Services and Care

• It is further the intent of the Legislature that
  hospitals, emergency medical services providers,
  and other health care providers work together in
  their local communities to enter into agreements
  or arrangements to ensure access to emergency
  services and care.

8
Access to Emergency Services and Care

• The agency shall establish and maintain an
  inventory of hospitals with emergency services -
  
• All services within the service capability of the
  hospital
• Each hospital having emergency services shall
  notify the agency of its service capability
• Assist emergency medical services providers and
  others in locating appropriate emergency medical
  care
• Available to the general public

9
Emergency Services Inventory

• If the hospital provides the service (i.e.
  neurosurgery), then the hospital must provide
  that service to its Emergency Department patients
• If the hospital is unable to provide that service
• Have a transfer arrangement relating to service
• Obtain a waiver/exemption from AHCA

10
Goal (ACHA)

• Enforce the ability of persons to receive all
  necessary and appropriate emergency services and
  care
• The agency act in a thorough and timely manner
  against hospitals and physicians which deny
  persons emergency services and care

11
FCEPs Perspective

• What will make the current system
• Useful for patient care?
• Transparent to our providers?
• Available to the public?
• Better service the intended goals?

12
Access to Emergency Services and Care

• Inventory of hospitals with emergency services
• All services within the service capability of the
  hospital (list)
• Each hospital having emergency services shall
  notify the agency of its service capability
• Assist emergency medical services providers and
  others in locating appropriate emergency medical
  care
• Available to the general public

13
Emergency Services Inventory

• Anesthesia
• Burn
• Cardiology
• Cardiovascular Surgery
• Colon/Rectal Surgery
• Emergency Medicine
• Endocrinology
• Gastroenterology
• General Surgery
• Hematology
• Hyperbaric Medicine
• Internal Medicine
• Nephrology
• Neurology

• Neurosurgery
• Obstetrics
• Ophthalmology
• Oral/ Max Facial Surgery
• Orthopedics
• Otolaryngology
• Plastic Surgery
• Podiatry
• Psychiatry
• Pulmonary Medicine
• Radiology
• Thoracic Surgery
• Urology
• Vascular Surgery

• Trauma

14
Emergency Services Inventory

• Anesthesia
• Burn
• Cardiology
• Cardiovascular Surgery
• Colon/Rectal Surgery
• Emergency Medicine
• Endocrinology
• Gastroenterology
• General Surgery
• Hematology
• Hyperbaric Medicine
• Internal Medicine
• Nephrology
• Neurology

• Neurosurgery
• Obstetrics
• Ophthalmology
• Oral/ Max Facial Surgery
• Orthopedics
• Otolaryngology
• Plastic Surgery
• Podiatry
• Psychiatry
• Pulmonary Medicine
• Radiology
• Thoracic Surgery
• Urology
• Vascular Surgery

• Trauma

15
Cardiology

• General Cardiology
• Interventional Cardiology

16
Internal Medicine

• Internal Medicine is becoming an out patient
  specialty
• Hospitalist or Primary Care Admissions

17
Neurology

• General Neurology
• Stroke (thrombolytic agents)

18
Neurosurgery

• Cranial
• Spine

19
Orthopedics

• Hand
• General
• Micro-vascular

20
Emergency Services Inventory

• Anesthesia
• Burn
• Cardiology
• Cardiovascular Surgery
• Colon/Rectal Surgery
• Emergency Medicine
• Endocrinology
• Gastroenterology
• General Surgery
• Hematology
• Hyperbaric Medicine
• Internal Medicine
• Nephrology
• Neurology

• Neurosurgery
• Obstetrics
• Ophthalmology
• Oral/ Max Facial Surgery
• Orthopedics
• Otolaryngology
• Plastic Surgery
• Podiatry
• Psychiatry
• Pulmonary Medicine
• Radiology
• Thoracic Surgery
• Urology
• Vascular Surgery

• Trauma

• PEDIATRICS

21
Pediatrics

• Emergency Medicine evaluates and treats all age
  groups
• Most adult providers will only see patients gt17
  years old
• Consultations
• Admissions
• Procedures
• Pediatrics must be required on the emergency
  services inventory

22
Pediatrics

• Pediatric surgical subspecialties should be added
• General surgery
• Gastroenterology
• Neurosurgery
• Critical Care / Pulmonary Medicine

23
Access to Emergency Services and Care

• Inventory of hospitals with emergency services
• All services within the service capability of the
  hospital
• Each hospital having emergency services shall
  notify the agency of its service capability
• Assist emergency medical services providers and
  others in locating appropriate emergency medical
  care
• Available to the general public

24
Notify Assist

• Currently the AHCA website has 16 hospitals
  listed that are approved for exemptions
• PDF
• Static
• Hospital Licensure
• ACHA needs to do an assessment of the statewide
  inventory of emergency services

25
Notify Assist

• Provide medical oversight to assist with approval
  of exemptions formerly State EMS Medical
  Director/DOH provided.
• Create a non-punitive reporting structure if
  possible to promote honesty and transparency

26
Notify Assist categories of service

• Clarify the categories of service
• Do not provide
• Provide on a limited basis by exemption
• Provide through a transfer agreement with another
  hospital
• Provide through a combination of in-house and
  transfer agreement
• Provide in-house 24 hours, 7 days a week

27
Notify Assist Reporting of Services

• Interactive list of services denoting changes
• Updated regularly by designated personnel
• Removes any doubt of services provided by
  hospitals

28
Access to Emergency Services and Care

• Inventory of hospitals with emergency services
• All services within the service capability of the
  hospital
• Each hospital having emergency services shall
  notify the agency of its service capability
• Assist emergency medical services providers and
  others in locating appropriate emergency medical
  care
• Available to the general public

29
(No Transcript)
30
Summary

• FCEP will continue to work with AHCA and other
  partners to improve and ensure our patients have
  access to quality emergency services and care
• Questions?