Specialist coverage of Emergency D epartments 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. Florida’s 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; • and that the agency act in a thorough and timely manner against hospitals and physicians which deny persons emergency services and care

11. FCEPs Perspective • Where are the gaps? • What needs to change to make this access more available to our patients? • What needs to change to make the system more transparent to our providers? • How can this information be more readily available to the public? • What resources does AHCA need?

12. 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

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 >17 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 • ACHA needs to do an assessment of the statewide inventory of emergency services. • Provide medical oversight to assist with approval of exemptions – formerly State EMS Medical Director/DOH provided. • Currently the AHCA website has 16 hospitals listed that are approved for exemptions • PDF • Static • Hospital Licensure

25. Notify • Create a non-punative reporting structure if possible to promote honesty and transparency

26. Clarify the categories for the 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. 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

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?