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CPR Review Considerations DHRB Discussion July 25, 2013

CPR Review Considerations DHRB Discussion July 25, 2013. 16 Del. C ., Chapter 93 of the Delaware Code relating to Health Planning and Resources Management § 9303. Delaware Health Resources Board § 9306 Review Considerations. § 9306. Review Considerations AKA Criteria upon which CPR is decided.

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CPR Review Considerations DHRB Discussion July 25, 2013

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  1. CPR Review ConsiderationsDHRB DiscussionJuly 25, 2013 16 Del. C., Chapter 93 of the Delaware Code relating to Health Planning and Resources Management § 9303. Delaware Health Resources Board § 9306 Review Considerations

  2. § 9306. Review ConsiderationsAKA Criteria upon which CPR is decided “In conducting reviews under this chapter, the Board shall consider as appropriate at least the following: (1) The relationship of the proposal to the Health Resources Management Plan adopted pursuant to § 9303 of this title. Prior to adoption of a Health Resources Management Plan by the Board, the State health plan last in use by the Health Resources Management Council shall comprise such plan;”

  3. Criterion #1: Notes, Variables & Context • DE Health Resources Mgmt Plan adopted 10/26/95 & last updated 3/6/10 • Note resource documents listed; are different or additional resources available in July 2013? • 7 General principles of Mgmt Plan: • HRB challenge: balance access, cost & quality of care issues • Complexity of medical indigency • Support managed, coordinated approach • Proximity to referral centers/out-of-state resources • Financial restraint • Enhancement of meaningful markets: balance quality & cost • Preventive activities – progress toward Healthy Delaware

  4. Criterion #1: Notes, Variables & Context, continued • Bed need formulas & projections (M/S-acute, OB, NH) • 1990-95 Population change calculated • 2005 Occupancy rates • 2010 projected bed needs • What or how have details or context changed? Beds added/deleted since 2010? Population? Occupancy? Demographics? • Guidelines within each subcategory (M/S, OB, NH) • Medical Technology: New & emerging re: use in DE • Devices (major medical equipment) & procedures (health services) • Balance access, cost, quality of innovative technology • What or how have details or context changed?

  5. Criterion #1: Notes, Variables & Context, continued • Charity Care Policy & Implementation Requirements • Appendix A. 2009 Federal Poverty Guidelines & 2005-07 DE 3-year average median household income • Appendix B. Charity care write-off for free standing surgery centers • Appendix C. CHAP/VIPII programs for uninsured • What has changed in July 2013? What do we know today that we did not know in 2009? What contextual changes have altered the economic/cost, access & quality climate?

  6. Criterion #2: “(2) The need of the population for the proposed project;” Notes, Variables & Context • Variables that determine need? What do we know? What don’t we know? • Contributing, antecedents/precipitating factors • Detracting, antecedents/resulting outcomes • Confounding • What in healthcare environment is changing? • Context that helps, hinders defining/describing need? Formula? Definitions of 3 types of beds?

  7. Criterion #3: “(3) The availability of less costly and/or more effective alternatives to the proposal, including alternatives involving the use of resources located outside the State;” Notes, Variables & Context • Less costly than what? What is measure or standard against which cost is evaluated? Indirect? Direct? Cost to whom? Cost impact on whom? • More effective that what? What is measure or standard against which effectiveness is evaluated? • Would outside state resource as alternative cost more because of indirect cost to family? Client? Loss to State?

  8. Criterion #4 “(4) The relationship of the proposal to the existing health care delivery system;” Notes, Variables & Context • What is the state of the current health care delivery system? Nationally? Within Delaware? Static? Dynamic? • What outcomes or changes are proposed, hypothesized or predicted about the health care delivery system?

  9. Criterion #5 “(5) The immediate and long-term viability of the proposal in terms of the applicant’s access to financial, management and other necessary resources;” Notes, Variables & Context • What are the time parameters for immediate? For long-term? What variables & context are important? • How is viability determined? What variables & context are important?

  10. Criterion #6: “(6) The anticipated effect of the proposal on the costs of and charges for health care;” Notes, Variables & Context • Parameters used to determine or compare costs, charges for health care? • Local or national cost variables? • How are costs & charges accounted for, determined, retrieved, and analyzed?

  11. Criterion #7 “(7) The anticipated effect of the proposal on the quality of health care;” Notes, Variables & Context • What is “quality”? What measures and standards are used to determine quality? Good quality? Poor quality? Standardized scales? National, regional, state or setting-determined standards? • Nature of the data used to define quality? Qualitative or quantitative? Derivation of data?

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