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GETAC
Recap (February 12/13, 2004)
The Governor's EMS and
Trauma Advisory Council (GETAC) met on February 12/13in Austin. The
February 12th meeting was a workgroup with stakeholders to discuss the
current re-organization of the Texas Department of Health into the State
Department of Health Services and the potential impact on the EMS
Regulation and EMS/Trauma Systems in Texas. GETAC heard reports from
TDH staff on the current status and had a lengthy open discussion
between members and with stakeholders in attendance about what action,
if any, GETAC should take at this time. A plan was proposed, but no
specific actions were taken and the meeting was adjourned.
At the February 13th
meeting, GETAC approved the minutes from their November 23rd meeting and
heard reports from the chair, staff, and committee/task force/work group
chairs. Chair, Dr. Ed Racht, recognized the recent death of the Capital
Area Trauma Regional Advisory Council Chair and Director of North Blanco
County EMS, Bill Watson, with a moment of silence. He then introduced
TSA "B" RAC Chair, Cathy McMahon, who related the story of her recent
serious car crash and experiences with the Texas EMS/Trauma System on
her trip home after the August GETAC meetings. Dr. Racht noted that
there were now four positions on GETAC that were up for appointment or
reappointment and told the council that he was putting on hold any
changes to the Standing Committees and update work on the Strategic Plan
until after the results of the re-organization are known.
GETAC discussed the
reports. Much time was spent on draft rule 157.131 Designated Trauma
Facility and Emergency Medical Services Account that will implement
HB-3588 as well as if/how GETAC should respond to the re-organization of
TDH. GETAC heard public comment on the reports and other general
issues.
Action Items
A motion was made by Dr.
Ronny Stewart and seconded by John Simms that GETAC adopt the revised
GETAC procedural rules based on last meeting's discussion (draft
included in the GETAC handouts for this meeting). The motion passed
unanimously.
A motion was made by
Pete Wolf and seconded by Gary Cheek that GETAC recommend the Texas
Board of Health propose draft rule 157.25 Out-of-Hospital
Do-Not-Resuscitate Order (draft included in the GETAC handouts for this
meeting) for public comment. The motion passed unanimously.
A motion was made by Dr.
Stewart and seconded by Mario Segura that GETAC recommend the Texas
Board of Health propose draft rule 157.130 Emergency Medical Services
and Trauma Care System Account and Emergency Medical Services, Trauma
Facilities, and Trauma Care System Fund (draft included in the GETAC
handouts for this meeting) for public comment. The motion passed
unanimously.
A motion was made by Mr.
Simms and seconded by Mr. Cheek that GETAC recommend the Texas Board of
Health propose draft 157.131 Designated Trauma Facility and EMS Account
(draft included in the GETAC handouts for this meeting) for public
comment with the revisions recommended by the Texas Hospital Association
regarding definitions and the formulae for distribution (handed out by
THA at the meeting) and recommended by TDH regarding an annual
application, and with the removal of the section stating that "hospitals
should have" an agreed upon physician incentive program ..." The motion
failed on a vote of 3 for and 7 against.
A motion was made by Mr.
Simms that was the same as the above motion but without the removal of
the section regarding a physician incentive plan, but changing "should"
to "may". The motion failed for lack of a second.
A motion was made by Mr.
Simms and seconded by Maxie Bishop that GETAC recommend the Texas Board
of Health propose draft 157.131 Designated Trauma Facility and EMS
Account (draft included in the GETAC handouts for this meeting) for
public comment with the revisions recommended by the Texas Hospital
Association regarding definitions and the formulae for distribution
(handed out by THA at the meeting) and recommended by TDH regarding an
annual application, and leaving the section regarding a physician
incentive plan, but removing the phrase "agreed upon". The motion
passed unanimously.
A motion was made by Mr.
Simms and seconded by Mr. Wolf that GETAC accept the "GETAC Position
Statement" (see document at the end of this recap) developed over the
past two days, with attachment of the meeting sign-in sheets to indicate
participation of stakeholders, for delivery to the Health and Human
Services Commission. The motion passed unanimously.
The next meeting date
for GETAC is May 7th in Austin. Standing Committees and Task Forces will
meet the preceding days.
Staff, Committee, Task Force, and
Workgroup Reports:
Issues addressed by
staff included changes in regulatory processes that are continuing
(centralization of provider licensing application receipt and
processing; centralized test scheduling; and transfer to Texas On-Line
for web-based re-certification/re-licensure which has an implementation
date of May 31st); status of rule revisions, including the current rule
packet, which is open for public comment through 2/27 and staff
recommendations on draft 157.25, 157.130, and 157.131 (drafts included
in the GETAC handouts for this meeting); update on NREMT testing,
including the implementation of new Basic tests and the planned 2007
implementation of computer adaptive testing; current balance in the
Designated Trauma Facility and Emergency Medical Services Account
(HB-3588) of ~$3.5 million dollars; EMS/Trauma
Registry workgroups on
"Errors and Flags" and "Regional Registries"; staff action plan to
address identified registry issues; and extension of the planned 2003
database closure date to 7/1/2004 because of the current closure due to
maintenance. Questions about these staff reports may be directed to BEM
(512/834-6700) or the Bureau of Epidemiology (512/458-7266).
Wayne Morris, Co-Chair
of the Medical Transport Provider Task Force, reported on their 2/6/2004
meeting. The Task Force heard reports from the FBI and the federal
inspector general office on Medicare/Medicaid fraud and heard their
charge from Dr. Racht (see below). The members broke into workgroups to
address sections of the charge. Their next meeting is scheduled for
March 3rd in Austin (M-739, 1100 West 49th Street).
Charge for the Medical
Transport Provider Task Force
2/6/2004
Review all pertinent
statutes/regulations regarding the provision of emergency medical
services (EMS) in Texas.
Identify issues; pro
and con, related to the state's current practice of licensing entities
as EMS providers whose scope of business does not include emergency/911
response or emergency interfacility transport.
Identify issues; pro
and con, related to the current non-regulation of entities that provide
non-emergency interfacility transport services only.
Propose solutions,
including risks and benefits, regarding the issues identified in #2 and
#3 above to the Governor's EMS and Trauma Advisory Council.
Ernie Rodriquez reported
that the Emergency Medical Dispatch Resource Center Pilot Workgroup has
continued its work using email. They have been reviewing the Request
for Proposals and are almost ready to provide recommendations TDH. Work
has also been done on a transfer protocol and a training website. A
conference call is set for February 18th.
Jorie Klein reported
that the major topic of discussion at the January 21st and
22nd Trauma Systems Committee meetings was draft rule 157.131 Designated
Trauma Fund and Emergency Medical Services Account. The Committee voted
to recommend the draft to GETAC for consideration for proposal by the
Texas Board of Health. The Committee also continued work on the trauma
facility designation criteria and rule.
GETAC Position Statement
The Governor's EMS and
Trauma Advisory Council (GETAC) has reviewed the recent proposed
structures of the Department of State Health Services and strongly
recommends the EMS and Trauma System functions remain intact. These
functions are critical to public health and safety, are inter-related,
and require consistent oversight and coordination. We believe that HB
3588, a mandate from the Texas Legislature, supports this system
approach to EMS and Trauma care. Such an approach to the EMS and Trauma
System is a hallmark component of the EMS Agenda for the Future
published by the National Highway Traffic Safety Administration and well
documented throughout industry publications. Integration and
collaboration between stakeholders and TDH has allowed the Texas EMS and
Trauma System to show dramatic decreases in trauma deaths - 20% since
1989.
Despite this, trauma
remains the leading cause of death for children and young adults.
Maintaining the integrated approach to EMS and Trauma will promote the
goals of reorganization - cost savings as well as efficient and
effective management while improving quality of service to our patients.
Fragmentation of the system will limit coordination of the inter-related
components; increase costs to tax payers and local governments, and
inhibit the efforts to further reduce mortality and morbidity rates in
Texas. A coordinated functional approach to EMS and Trauma Systems
(including Healthcare Systems, EMS Licensing and Credentialing, Trauma
Systems, and Injury Prevention) will:
* Focus on service
delivery
* Foster direct
management accountability
* Reorganize around
common service delivery
* Promote integration
and consistency
* Establish appropriate
span of control
To this end, GETAC
recommends EMS and Trauma Systems remain functionally intact in one of
the two following scenarios in order of preference:
1. As an integrated unit
reporting to an Assistant Commissioner for EMS and Trauma.
2. As an integrated unit
reporting through the Healthcare Systems branch to the Assistant
Commissioner of Regulatory Services (as proposed).
Through continued EMS
and Trauma System integration, we will produce cost savings for the
taxpayers, improved care for the consumers, and a process that meets the
stakeholders' needs.
Ed Racht, MD
Chair, Governor's EMS & Trauma Advisory Council
February 13, 2004 |
