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From YouTube: Certificate of Need Task Force (7/17-23)
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A
We
do
have
a
quorum
and
our
duly
constituted
to
conduct
business
today.
At
this
time,
I
would
like
a
motion
to
approve
the
June
19th
meeting
minutes,
Senator
schickel
and
representative
Senator
Meredith.
It
was
the
second
all
those
in
favor
say
aye.
Any
opposed
minutes
are
adopted
at
this
time.
We
are
going
to
begin
moving
into
our
presentation
today
before
we
do
that.
I
do
have
a
couple
of
items.
I
want
to
address
to
follow
up
with
Senator
Douglas's
chairing
the
last
meeting
I'm
going
to
ask
those
that
are
testifying
not
to
use
acronyms.
A
A
E
E
I
will
go
first,
since
we
do
have
a
presentation
today
and
also
you
should
have
a
one-pager
in
your
packet.
Hopefully
you
did
receive
that
if
you
didn't
I'll
be
happy
to
afford
it.
Thank
you,
chair,
Weber
and
chair
Douglas,
for
inviting
us
to
testify
today,
I'm
here,
to
discuss
our
association's
position
on
certificate
of
need
and
our
rationale
for
keeping
certificate
need
for
for
long-term
care.
E
Hopefully
what
you
hear
from
me
today
is
that,
hopefully,
what
you
hear
from
me
today
is
that
we
won
I,
always
appreciate
legislave
committees,
task
force
and
individual
legislators
asking
our
association's
position
on
a
matter.
We
believe
open
and
honest
dialogue
is
the
best
way
to
achieve
positive
policy
decisions
in
long-term
care
to
our
Association
members.
E
Do
not
have
a
quote
head
in
the
sand
approach
to
certificate
of
need
in
Kentucky
we
understand
the
interest
interests
and
the
subject
matter,
and
our
association
has
been
instrumental
in
adding
language
to
the
state
health
plan
to
modernize
con
certificate
of
Need
for
long-term
care
in
recent
years.
Three.
Finally,
as
many
of
you
have
heard
from
us
the
past
few
years,
skilled
nursing
facilities
and
other
long-term
care
providers
are
still
recovering
from
the
covid-19
pandemic
and
unfortunately,
some
may
not
ever
recover.
E
We
are
still
experiencing
significant
Workforce
shortages.
Staff
Agency
costs
are
still
way
too
high.
We
are
also
facing
a
federal
Staffing
ratio
mandate
from
the
federal
government
that
our
National
Association
estimates
will
cost
11.3
billion
to
hire
as
many
as
191
000
additional
staff
Nationwide.
E
Hopefully,
that
provides
some
context
of
where
we
are
in
long-term
care.
Today.
I
know
you
all
have
been
given
information
about
how
con
works
for
long-term
care,
but
this
slide
gives
a
very
brief
overview.
Skilled
nursing
facilities
do
have
criteria
in
the
State
Health
Plan
Personal
Care
Homes
do
not
so
they
receive
non-substantive
review
after
Senate
Bill
11
was
passed
in
2022
they're,
going
to
be
fewer
personal
care
provider
licensed
personal
care
providers,
because
many
of
them
will
move
to
the
assisted
living
community
category.
E
E
On
this
slide,
we
highlight
two
states
I.
Think
that'll
show
a
good
example
about
why
con
is
important
for
skilled
nursing
facilities
in
preparation
for
my
testimony
today,
I
did
text
my
former
colleague
from
Indiana,
who
was
the
Indiana
Health
Care
association's
executive
director
when
con
was
reinstated
for
nursing
facilities
in
2018..
E
Again
this
was
a
brief
text
message
exchange
and,
of
course,
we
all
know
that
this
is
much
more
complicated
than
that.
He
said
that
there
were
many
reasons,
but
one
that
really
stuck
out
to
him
was
rural
providers
were
being
significantly
hurt,
with
the
lack
of
certificate
need
in
Indiana,
without
certificate
of
need,
a
new
construction,
we're
limiting
their
admissions
to
Medicare,
only
or
private
pay,
and
this
hurt
this.
This
not
only
hurt
the
rural
providers
in
Indiana,
but
also
our
elders
in
need
of
Medicaid
services
in
their
community.
E
E
In
2017.
There
was
an
attempt
to
repeal
certain
Kentucky
Skilled
Nursing
Facility
certificate
of
need
requirements
by
a
company
based
out
of
Indiana.
The
company
wanted
to
focus
on
Medicare
or
private
pay.
Only
our
association
opposed
those
changes.
I
looked
back
at
the
testimony
that
was
given
during
the
in
August
2017
Committee
hearing
and
I
would
like
to
summarize
it
for
you
today,
Terry
Fork,
who
is
an
owner
of
nines,
go
nursing
facilities
in
Eastern,
Kentucky
and
Mary.
Haynes
CEO
of
the
non-profit,
Nazareth
home
in
Louisville,
spoke
in
opposition
to
the
changes
at
that
hearing.
E
Mr
four
referenced,
the
30
million
in
recent
Investments
that
he
had
made
to
facilities
in
East
Kentucky
to
ensure
Eastern
Kentucky
residents
can
receive
short-term
rehabilitation
services
in
their
home.
County
Mary
Haynes
spoke
about
the
duplication
of
services.
She
stated
quote.
Basically,
this
company
of
Indiana
is
duplicating
what
we
already
are
doing,
but
in
a
more
limited
way,
with
no
means
to
serve
the
underserved
or
challenging
lifestyle
diseases
which
Kentucky
is
grappling
with
at
this
time,
both
Mr,
forks
and
Mary
haynes's
testimony
was
compelling
and
the
changes
did
not
go
forward
again.
E
A
lot
of,
what's
on
the
slide,
is
in
your
on
your
one
pager
that,
hopefully,
is
in
your
packet
and
and
our
one
pager
outlines
these
arguments
as
well
simply
put
skilled
nursing
facilities
do
not
set
their
own
prices.
We
are
very
dependent
on
government
payers
such
as
Medicaid
and
Medicare,
and
so
it's
not
like
we
can
adjust
our
pricing
structure
based
on
competition
or
lack
thereof.
E
D
D
My
comments
today
are
going
to
be
brief.
I
know
you
have
a
full
agenda
today
and
you
want
to
have
time
to
get
through
the
testimony
and
get
through
any
questions
that
you
might
have
with.
The
Advent
of
Medicare
federal
government
became
a
substantial
payer
for
health
care
services
in
the
United
States
because
of
the
substantial
tax
dollars
going
in
to
reimburse
providers
for
care.
Con
was
one
tool
developed
to
protect
the
taxpayer
interest
in
order
to
provide
ample
Access
to
Health
Care
Services.
D
The
federal
government
makes
substantial
Capital
Investments
to
ensure
citizens
have
access
most,
if
not
all,
federal
health
care
reimbursement
systems
make
an
allowance
to
cover
a
portion
of
the
capital.
Cost
certificate
of
need
is
an
important
tool
to
control
over
duplication
of
health
facilities
and
Health
Services
overduplication
of
Health
Services
can
have
multiple
negative
effects.
D
This
situation
can
most
definitely
put
a
financial
strain
on
Health
Care
entities
in
a
particular
geographical
area
and
may
result
in
closure.
Con
is
a
far
cry
from
being
perfect.
I
think
everybody
here
would
agree
with
that.
For
instance,
just
this
year
the
general
assembly
recognized
that
individuals
with
intellectual
and
developmental
disabilities
were
not
getting
access
to
care
and
unanimously
it
passed.
House
Bill
334
to
address
these
seven
to
ten
year
long
waiting
lists
for
services.
D
Conversely,
nursing
facilities
providing
skilled
nursing
services
to
the
to
the
elderly,
as
Betsy
mentioned,
are
nearly
33
000
beds
over
bed
according
to
chfs
Zone
data.
Because
of
this
imbalance
in
demand
versus
available
beds,
Leading
Age
Kentucky
would
ask
that
the
current
con
process
be
retained
for
nursing
facilities.
D
Considerable
regulatory
relaxation
has
occurred
over
the
last
several
years.
As
Betsy
mentioned,
nursing
facilities
can
now
move
beds
from
an
area
of
low
utilization
to
high
utilization.
If
it's
within
the
same
area,
development
District
entities
like
rehab
agencies
were
removed
from
both
co-n
and
licensure.
Many
of
our
members
have
outpatient
rehab
agency
services,
along
with
skilled
nursing
services
and
a
licensure
category
for
a
new
Medicaid
Program
that
provides
all
inclusive
care
to
the
elderly,
has
just
been
Greece
recently
granted
non-substantive
reviews
so
that
those
new
entities
May
establish
their
constituent
services.
D
Private
duty,
nursing,
is
one
as
well
that
those
standards
have
been
relaxed
were
previously
folks
were
not
able
to
obtain
any
new
services
and
we've
seen
an
explosion
in
home
care
and
requests
for
in-home
Nursing
Care
I.
Those
are
just
a
few
examples
that
I
wanted
to
touch
on
I.
Think
it's
important
that
you
all
consider
these
factors.
D
A
F
F
Follow-Up,
sir,
if
I
may
you
know
my
ex
my
experience
so
far
with
with
skilled
nursing
homes
has
been
fairly
extensive
and
if
you
are
paying
out
of
pocket,
you
can
definitely
find
a
bed.
If
you
have
Medicare,
you
can
almost
definitely
find
a
bed
where
you
want
it.
Medicaid
patients
are
having
terrible
times
finding
beds
close
to
their
families.
F
D
F
G
H
A
H
Well,
thank
you
again
this
morning
for
the
opportunity
to
be
with
you
and
share
some
information
on
Home
Health,
again
I'm
at
the
executive
director
for
the
Kentucky
Home
Care
Association,
representing
Home,
Health,
Providers
and
personal
care
providers.
So
a
little
bit
about
home
health.
Specifically,
these
are
intermittent.
Skilled
Services,
provided
in
the
home,
tends
to
be
nursing,
skilled,
nursing
therapy
and
aid
services.
H
H
Kentucky
also
requires
you
to
participate
in
Medicare
as
a
home
health
agency,
so
to
distinguish
us
from
other
Healthcare
Providers.
This
is
not
your
traditional
brick
and
mortar
scenario.
You
certainly
have
an
office,
but
that
office
is
for
administrative
purposes.
You
know
from
an
accounting
perspective,
there
are
no
real
quote-unquote
assets
to
to
speak
of.
H
So
here
in
Kentucky
we
have
97
licensed
agencies
of
all
different
types.
We
have
hospital-based
agencies,
we
have
nationwide
organizations
that
have
a
license
here
in
Kentucky.
We
also
have
health
departments
that
operate
Home,
Health
agencies,
and
we
have
Standalone
non-profits
that
are
local
operators
of
Home
Health
agencies.
H
So,
just
briefly
on
the
the
process
of
methodology,
we
have
an
overall
need
determination
for
con.
This
is
on
a
county
by
county
basis,
applying
Target
rates
at
estimating
a
number
of
individuals
per
1000
that
are
expected
to
require
home
health,
and
you
would
need
at
least
250
patients
in
having
a
need
for
these
services,
with
a
new
con
license
for
125,
for
an
existing
to
be
consistent
with
the
state
health
plan,
and
we
use
five
factors
for
approval.
Consistency
with
the
state
health
plan
is
obviously
mandatory.
H
So
further
discussion
on
CNN,
specifically,
we
would
Echo
what
you
heard
from
the
the
nursing
homes
earlier.
That
Home
Health
in
particular,
is
also
not
a
free
market.
Our
rates
are
determined
by
the
department
of
Medicaid
services
Medicaid
here
in
Kentucky,
as
well
as
the
centers
for
Medicare
and
Medicaid
services
at
the
national
level
through
the
Medicare
program.
H
Commercial
Insurance
is
a
payer,
but
there
is
limited
penetration
and
there's
no
negotiation
with
Medicare
or
Medicaid.
Those
rates
are
handed
to
the
agencies
and,
for
example,
Medicaid
rates
for
home
health
here
in
Kentucky,
haven't
changed
for
well
over
15
years
or
excuse
me.
Medicaid
rates
and
Medicare
rates
are
coincidentally
posed
to
be
cut
for
by
10
percent
in
2024.
If
we
don't
have
a
change
to
the
law
prior
to
that.
H
So
that's
all
to
say
that
the
Home
Health
industry
is
is
what
we
would
term
unstable.
Staff
turnover
ranges
from
40
to
70
percent
mergers
and
Acquisitions
are
frequent
and
tend
to
increase
that
instability
and
Home
Health
agencies
continue
to
decrease
other
offerings
because
of
these
Staffing
and
Workforce
challenges.
Employees
are
scarcer
than
ever,
and
competition
from
our
nursing,
home
and
hospitals
counterparts
continues
to
erode.
Home
Health
Access
rates
directly
impact
both
of
those
factors,
access
and
Workforce.
H
H
So
I
want
to
also
touch
on
the
differences
between
Kentucky
and
Indiana
I
also
serve
as
the
India.
The
executive
director
of
the
Indiana
Association
for
home
and
hospice
care,
so
I
did
want
to
you
know,
draw
a
few
parallels
between
the
two
states.
Indiana
currently
does
not
have
con
for
Home
Health
Services.
H
We
do
pay
a
little
bit
different
for
both
of
the
the
states,
so
there
are
some
differences
in
that
respect.
There
are
currently
around
350
agencies
in
Indiana
versus
98,
in
Kentucky,
from
a
Fraud
and
Abuse
perspective.
Both
the
Indiana
Department
of
Health
and
Medicaid
go
to
extra
efforts
to
control
Fraud
and
Abuse
in
Indiana,
whereas
we
would
argue
the
con
process
allows
that
vetting
to
happen
on
the
front
end.
H
In
Indiana
we
do
a
little
bit
more
of
what
they
call
pay
and
Chase
where
we
have
to
go
after
the
Bad
actors
on
the
back
end,
which
in
that
case,
we've
already
paid
for
whatever
Services
have
been
provided.
Likewise,
reimbursement
rates,
Indiana
just
invested
in-home
health
to
the
tune
of
a
30
increase,
showing
both
the
the
dire
circumstances
of
the
workforce
and
the
need
for
investing
in
Home
and
community-based
Services.
H
So
Solutions
we
would
propose
that
con
be
maintained,
as
is
it
serves
as
a
formal
and
detailed
vetting
process
and
ensures
agencies.
New
entrants
of
the
market
are
accountable
and
Fraud
and
Abuse
is
minimized,
and
likewise
we
would.
We
would
propose
that
reimbursement
be
increased
for
home
health
to
help
stabilize
the
market
and
allow
kentuckians
to
be
served
where
they
want
to
be
in
their
homes.
H
The
in
particular
this
industry,
both
from
a
a
an
ability
to
pay
for
staff-
that's
that's
one
of
the
highest
factors,
especially
we're
competing
with
the
likes
of
of
Amazon
Target.
Any
other
operation.
In
that
respect
that
you
know
those
those
wages
have
gone
from
being
being
similar
in
range
to
us
to
now
twenty
dollars
an
hour,
twenty
five
dollars
an
hour.
We
can't
quite
compete
with
that
in
terms
of
what
were
reimbursed.
H
So
our
our
ability
to
pay
staff
is
is
in
that
kind
of
15,
maybe
dollar
an
hour
range,
so
that's
one,
one
huge
factor
is
just
being
competitive
in
the
market.
Likewise,
this
is
a
unique
industry
in
that
you're
going
into
a
person's
home.
There's
a
very
you
know,
kind
of
interpersonal
aspect
and
I
think
that's
that's
another
difficulty
in
terms
of
attracting
and
retaining
staff.
It
takes
a
special
person
to
be
able
to
go
out
and
and
do
that
in
a
person's
home.
H
A
As
I
look
at
your
slides
here
on
the
the
section
labeled
certificate
of
need
discussion,
the
second
point
there
says
this
is
an
unstable
industry
and
some
of
the
things
you've
just
cited,
really
have
more
to
do
with
with
an
adjustment
in
the
in
the
rates
that
are
paid
really,
as
opposed
to
certificate
of
need,
as
I'm
as
I'm
trying
to
process
this.
So
can
can
you
kind
of
explain
to
me
how
the
certificate
of
need
process
is
supposed
to
help
with
an
unstable
industry.
I
H
So
and
I'm
not
an
expert
on
con
and
and
that
particular
item,
so
I'm
I'm
happy
to
come
back
with
information
on
that.
But
just
from
a
general
perspective
you
know,
agencies
do
have
quality
metrics
that
they're
measured
by
whether
it's
you
know,
number
of
visits
that
are
fulfilled
or
other
performance
from
a
clinical
perspective,
so
I'm
happy
to
provide
more
information
but
specific
to
the
con
process.
I'm,
not
that
familiar
with
the
in-depth
piece
of
that.
J
H
So,
in
particularly
in
in
our
industry,
those
costs
to
deliver
services
are
sort
of
fixed
in
a
way
and
in
particular
to
the
the
way
we
deliver.
Services
I
mean
this
is
a
person
going
out
to
the
home,
so
you
have
their
transportation
costs
and
then
their
costs.
You
know
to
deliver
the
service,
which
is
you
know,
x,
amount
per
hour.
H
So
from
that
perspective,
delivering
that
that
service,
you
know,
unless
we're
we're
going
to
take
a
holistic
approach
to
understanding
how,
to
you
know,
make
that
service
more
efficient,
which
we
even
see
on
the
Medicare
side.
There's
some
value-based
purchasing
Pilots
that
haven't
been
expanded
just
yet,
but
from
from
that
perspective,
home
health
is,
is
sort
of
just
the
cost.
Is
you
know,
X
to
deliver
those
services,
so
I
can't
more
efficiently
pay
for
someone
to
drive
for
your
home
right?
H
That's
that's
something
that
the
cost
is
going
to
be
similar
between
agencies
so
than
likewise
for
the
nursing.
You
know
we're
going
to
pay
x
amount
per
hour
for
that
nurse
to
come
into
your
home.
So
it's
it's
very
direct
in
that
sense
that
you
know
that
cost
is
not
going
to
change
whether
we
have
agency
X,
providing
the
Care
Agency.
Why?
It's
simply
the
cost
to
deliver
that
service.
G
H
Absolutely
and
we're
already
seeing
that
in
in
terms
of
the
Dynamics
in
the
market,
so
it's
not
just
about
which
payer
is
better,
it's
which
patient
is
easier
to
deliver
the
service
right.
So
if
I
have
a
more
acute
patient,
that's
going
to
require
more
visits.
That's
potentially
going
to
eat
away
at
what
I'm
getting
reimbursed
by
delivering
more
more
visits.
H
You
know
and
I'm
going
to
select
the
easier
patient.
There's
an
agency
out
there,
that's
going
to
have
to
take
that
other
more
difficult
patient,
and
in
that
regard
we
already
see
that
that
happening.
So
some
agencies
out
there
tend
to
operate
more
on
a
safety
net
model
and
they
have
to
take
those
more
acute
patients
and
provide
the
care
for
them
at
potential
Financial
consequence.
Whereas
other
agencies,
you
know,
use
the
term
or
cherry
picking
patients,
so
we're
already
seeing
that
out
in
the
industry.
Currently.
G
Mr
chair
one
other.
Thank
you.
Obviously,
one
of
the
reasons
that
we're
here
today
may
be
the
primary
reason
is
cost
of
Health
Care.
It's
phenomenally
High
I
think
we're
spending
thirteen
thousand
dollars
per
capita
in
the
United
States.
The
next
industrialized
nation
is
Germany
at
seven
thousand,
which
means
this
is
crushing
for
most
Working
Families.
They
can't
afford
health
care
any
longer,
so
we've
got
to
address
this
in
some
form
or
fashion.
So
again,
in
your
opinion,
how
do
we
reduce
the
cost
of
Health
Care
in
the
United
States.
H
Well,
I,
I,
think,
and-
and
one
example-
that's
already
been
mentioned
here
today
is-
is
Indiana
as
well.
You
know
Indiana's
taking
a
a
shift
to
focusing
on
home
and
community-based
services,
so
delivering
the
services
in
the
Home
and
Community
as
much
as
possible,
and
we've
seen
that
shift
happen
nationally.
The
average
now
is
tends
to
be
70
of
services
are
delivered
in
the
Homing
Community
versus
in
a
facility
or
in
in
a
brick
and
mortar
and
I.
That
shift
hasn't
happened
yet
it
didn't
happen
yet
for
Indiana
We're.
H
You
know
kind
of
in
the
process
of
working
on
that.
Likewise
for
Kentucky,
that's
our
belief
about
how
to
bend.
That
curve
is,
to
you
know,
invest
in
home
and
community-based
services
and
really
deliver
those
Services.
As
you
know,
an
effort
to
prevent
someone
being
put
into
a
facility,
so
I
think
that's
our
suggestion
about
a
solution
for
bending
the
cost
curve.
A
Any
member
that
is
not
a
member
of
this
task
force
is
asked
to
get
with
a
member
and
and
have
asked
that
individual
to
submit
a
question
on
their
behalf,
and
so
that
is
the
policy.
Center
Douglas
and
I
have
discussed
that
and
that's
what
we're
going
to
do
moving
forward
at
this
time,
Senator
Douglas,
you
have
a
question.
K
H
You
know
that
where,
where
we've
had
an
example
of
a
you
know,
even
multiple
mile
radius
in
terms
of
access
for
a
patient
and
likewise
some
of
the
discussions
we've
had
for
some
of
the
proposed
changes
to
the
State
Health
Plan,
you
know
our
our
members
reaction
is
typically.
Where
are
these
patients?
Let
us
know
where
they
are
and
we'd
love
to
provide
service
for
them,
even
going
above
and
beyond
that
and
providing
services
that
aren't
reimbursed
to
make
sure
that
access
is
there
and
quality
of
life
is
there.
H
K
K
H
F
H
So
from
the
information
that
the
office
of
An
Inspector
General
puts
out,
there
are
a
handful
of
counties
that
show
needs,
but
one
example
is
Fayette
County,
where
there's
a
proliferation
of
of
Home
Health
agencies.
So
we
would
really
want
to
get
more
granular
in
terms
of
you
know
what
what
the
need
is,
because
there
are
plenty
of
agencies
in
Fayette
County.
So
from
our
perspective,
you
know
there
should
be
access
in
each
County
and
to
the
extent
that
there
is
a
struggle
to
access
Services,
it's
going
to
be
related
to
Workforce.
H
F
F
Yes,
if
we
took
away
the
con
when,
when
I
think
of
taking
away
a
con,
what
I
think
happens
is
the
people
that
can
pay
out
of
prop
out
of
pocket
the
wealthy,
wealthy
sort
of
separate
off
in
the
market
and
they
pay
whatever
you
need
to
pay
for
it,
and
then
the
rest
of
the
people
are
sort
of
left.
Sharing
that
same
pie
dividing
it
up.
Does
it
work
that
way
for
home
health
care
or
not?
Does
it
siphon
off
a
substantial
amount
of
the
workforce?
H
H
This
is
going
to
be
an
individual
who,
typically
is,
is
aging
and
either
accesses
through
Medicare
or
Medicaid.
So
in
in
that
there
is
private
pay
in
this
industry,
but
it's
similar
to
Commercial
Insurance.
That's
not
typically
the
the
majority
of
the
census
that
we
see
from
a
Services
provision
perspective,
so
we're
providing
services
to
the
majority
of
our
patients,
our
Medicare
and
Medicaid,
and
any
private
pay
is
going
to
be.
You
know
a
handful
of
patients
here
or
there
it's
not
going
to
be
the
Lion's
Share
of
the
services
that
are
provided.
F
H
We
don't
have
any
of
those
resources
available
to
us.
We,
you
know
we
can
use
them
in
small
examples
to
help
subsidize.
You
know
the
Medicare
or
Medicaid,
but
it's
so
small
that
it
doesn't
create
a
situation
where
we
can
rely
on
it.
It's
Medicare
and
Medicaid
is
where
we
spend.
You
know:
I
I,
we
don't
have
specific
numbers,
but
you
know
I'd
I'd
be
willing
to
Hazard
to
Guess
that
we're
well
above
80
85
percent
close
to
90
in
terms
of
the
mix.
Thank.
A
L
Mr
chair,
this
might
have
been
answered
with
Senator
Berg's
question,
but
with
a
skilled
nursing,
they
talked
about
the
large
excess
of
beds
that
they
have
did
I
miss.
Did
you?
Can
you
quantify
any
any
numbers,
whether
you
have
a
shortage
or
do
you
think
that
that
there's
a
correlation
between
and
excessive
beds
in
one
versus
what
what
the
Home
Health.
H
So
we
don't
have
any
data
to
speak
to,
but
I
think
our
situation
is
much
different.
I
mean
we
have
folks
that
are
ready
and
willing
to
access
the
service.
We
just
don't
have
staff
to
send
this
them
out
to
perform
the
and
deliver
the
service.
That's
that's
our
shortcoming
and
we
can't
necessarily
track.
You
know
where
that
patient
goes
where
they
end
up.
You
know
our
time
is
spent.
You
know
typically
trying
to
hire
folks
to
go
out
to
deliver
the
service,
so
we
don't
have
data
on
that.
H
But
that's
our
that's
our
challenge
right
now
is
you
know
we
we're
interested
in
finding
patients
and
matching
them
up
and
trying
to
hire
staff,
and
you
know
really
coordinate
that
as
best
we
can
so
that
we
don't
lose
staff
if
they're
not
working,
because
you
know
we
can't
necessarily
afford
to
pay
them
unless
they're
out
delivering
the
service.
So
from
that
perspective,
it's
really
Workforce
is
our
our
biggest
shortcoming
right
now.
C
H
So
those
really
govern
two
different
processes
so,
from
a
licensure
perspective,
we're
trying
to
understand
if
an
agency
is
compliant
with
what
we
call
the
conditions
of
participation,
so
these
these
really
dictate
to
the
agency.
Their
specific
delivery
of
the
service,
very
different
from
you
know
are:
are
we
identifying
a
need,
and
is
there
a
need
for
an
agency
in
a
particular
area,
a
license
in
our
space
governs
how
that
agency
operates,
that's
a
standard
for
their
delivery
of
of
Clinical
Services
and
is
really
an
ongoing.
C
J
C
K
K
K
H
So
and
I
think
we
discussed
this
just
a
little
bit
earlier
from
an
economic
perspective,
I
mean
what
we
can
afford
to
pay.
Staff
is
is
fixed,
so
any
new
entrance
to
the
market
would
would
really
just
be
fighting
over
those
same
resources.
They
wouldn't
have
any
new
or
unique
ability,
and
likewise
you
know,
Senator
Meredith
asks
about
the
cost
of
delivering
the
service.
You
know
new
entry
into
the
market
can't
change
gas
prices,
can't
change.
You
know
they're
going
to
pay.
Similarly
what
they
pay
for
a
nurse
so.
K
My
apologies,
I,
don't
I
don't
want
to
interrupt.
You
you've
already
gone
over
that
so
I
apologize
for
interrupting
you,
but
I
we
we
are.
We
are
kind
of
strange
on
time
here,
but
may
I
have
one
one
last
question:
why
is
why
are
your
agencies
required
to
go
through
a
formal
review
process,
even
though
the
care
is
provided
in
the
patient's
home?
K
H
So
so
again,
that's
looking
at.
Is
there
already
enough
saturation
in
that
market,
similar
to
what
we
talked
about
with
the
nursing
homes?
Earlier
you
know,
is
there
a
need
for
Home
Health
Services,
or
is
there
not
and
and
that's
really
what
the
process
is
looking
at
again,
you
know
it's
everything's
sort
of
fixed
in
terms
of
the
industry
itself,
so
adding
new
insurance
to
the
market.
You
know
really
really
doesn't
add
additional
resources
they
would.
They
would
have
to
take
staff
from
you
know
an
already
existing
agency.
H
K
Thank
you.
Thank
you
very
much
we're
you
know
we're
not
just
educating
those
of
us
sitting
up
here,
we're
also
educating
those
who
are
who
are
either
listening.
You
know
with
the
auditory
Media
or
watching
on
the
visual
media
and
I,
just
I
just
wanted
to
get
some
of
those
out
there.
Thank
you,
Mr
chair.
Thank
you.
Last.
M
I'm
thinking
about
the
information
you
shared
with
us
about
Indiana,
because
that's
perhaps
the
best
example,
we
can
use
to
see
what
our
future
could
be
if
we
make
substantial
changes
to
the
certificate
of
need
program,
so
I'm
wondering
if
you
can
tell
me
part
A
how
the
consumer
or
patients
experience
has
changed
since
the
number
of
Home
Health
agencies
has
gone
up
to
350
in
Indiana
and
then
similarly
Part
B,
what
the
effect
has
been
on
other
health
care
agencies.
So
how
has
this
changed
for
home
health
affected
hospitals?
M
H
Nursing
homes
in
Indiana
are
about
a
three
billion
dollar
industry,
so
our
ability,
even
if
we
went
up
you
know
in
in
terms
of
10
in
term,
you
know,
as
far
as
our
number
of
patients
served,
that
still
wouldn't
be,
even
just
a
small
blip
on
the
radar.
So
this
is
about
substantial
paradigm
shift
and
systems
change
to
focusing
on
home
and
community-based
services,
and
we
haven't
seen
it
yet
we're
hopeful
to
see
it.
But
one
easy
example
is
in
Indiana
a
patient
can
access
a
nursing
home
typically
within
about
48
hours.
H
It
takes
sometimes
weeks,
sometimes
months
to
access,
Home
and
community-based
Services.
One
of
the
goals
of
our
recent
changes
is
to
allow
access
to
either
within
48
Hours
very
lofty
goal,
but
that's
where
we're
attempting
ahead
and
we
haven't
really
moved
the
needle
on
that
yet
but
I
think
some
of
the
changes,
including
Investments
and
reimbursement,
are
going
to
really.
You
know
start
to
have
an
impact
on
that
front.
H
Apologize
so
specific
to
the
consumer,
their
ability
to
access
the
services
is
really
what's
being
focused
on
and
I
think
we're
we're
seeing
a
little
bit
more
of
an
opening
up
of
you
know,
whereas
we
would
see
patients
calling
an
agency
or
calling
multiple
agencies
unable
to
find
anyone
that
would
would
take
them
because
they
simply
don't
have
staff
and
that
person
might
end
up.
You
know
elsewhere
in
the
system
or
in
a
nursing,
home
or
hospital,
and
now
we're
we're
hearing
that
those
patients
are
able
to
access.
Services
may
take
some
time.
H
It
was
capped
to
use
you
know
just
a
phrase,
and,
and
so
that's
changing
a
little
bit,
but
you
know
it's
not
something
that
we're
going
to
be
able
to
see
a
huge
shift
in
the
consumers
experience
until
those
changes
are
made,
and
we
we
start
to
hit
that
48-hour
window
where
they
can
access
the
services.
I.
Think
one
other
piece
of
this
is
about
education.
Folks,
don't
often
know
about
what
home
health
is
or
what
Home
Care
is.
H
You
know
and
and
be
able
to,
you
know
be
in
the
community
as
long
as
I
can
so
I
think
that
element
is
changing
a
little
bit,
but
before
it
was
really,
you
know,
the
nursing
home
was
the
the
easiest
and
quickest
place
to
get
to,
and
now
the
patient,
maybe
is,
is
a
little
bit
more
knowledgeable
about.
What's
there
and
and
can
stay
home
if
they
so
choose,
Thank.
A
O
A
N
N
Chairman
Weber
and
chairman
Douglas
I'm
Liz
Fowler,
the
president
and
CEO
of
Bluegrass
care,
Navigators
and
I'm
here
today
to
represent
the
Kentucky
Association
of
hospice
and
palliative
care.
Bluegrass
care
Navigators
is
a
hospice
provider
in
Central,
kentucky
Northern
Kentucky
and
throughout
rural
Eastern
Kentucky.
A
O
O
N
It's
so
important
for
hospice
care
in
Kentucky,
first
similar
to
Home
Health.
The
majority
of
our
care
is
provided
by
clinicians
going
to
patients
homes
and
it
doesn't
take
a
lot
of
capital
to
start
a
hospice
agency
and
the
fixed
daily
payment
makes
it
really
a
target
for
companies,
specifically
private
Equity
firms
and
others
that
want
to
skimp
on
services
and
profiteer.
N
The
less
you
spend
on
a
day
of
care,
the
more
profit
you
make
for
companies,
owners
and
stakeholders
and
I'll
give
you
one
example.
This
winter
we
had
a
resident
of
Kentucky
that
was
a
snowbird
in
a
warm
Southern
state,
was
admitted
to
a
hospice
there
and
coming
back
to
Kentucky
and
I
got
a
call
on
the
phone
and
said
hey
in
Florida.
I
have
to
pay
for
these
medications
because
my
hospice
doesn't
cover
it.
I
need
to
plan
to
come
home.
N
N
So
that's
an
example
of
how
profiteering
can
occur
in
our
industry
states
without
a
certificate
of
need
process
for
hospice
providers
have
experienced
a
flood
of
new
hospice
providers
and
serve
as
a
cautionary
tale.
By
way
of
example,
the
centers
for
Medicare
and
Medicaid
services
is
placing
new
States
in
four
states
under
enhanced
oversight.
Due
to
the
number
of
new
hospices
and
growing
reports
of
Fraud
and
Abuse,
another
state
recently
imposed
a
moratorium
on
new
hospice
providers
because
poor
quality
providers
flood
the
market.
N
Other
states
without
a
con
process
for
hospice
care
are
considering
similar,
moratoriums,
open
markets
for
hospice
care
of
without
thousands
of
poor
quality
hospice
providers
to
operate,
and
this
development
continues
to
worry
elected
officials,
regulators
and
Health
Care
advisory
boards.
You'll
see
on
the
slide
that
we
have.
Four
of
our
national
associations
are
crying
out
for
increased
oversight
for
hospices,
foreign.
O
So
I
want
to
talk
a
little
bit
about
the
com
process
and
how
it
ensures
terminal
kentuckians,
receive
high
quality
care.
So,
thankfully,
because
of
the
certificate
of
need
process
in
Kentucky,
we
have
high
quality
providers
that
ensure
patients
and
families
receive
the
full
benefit,
including
bereavement
Services.
After
the
patient's
death,
at
a
glance
on
the
presentation
displayed
red
being
bad
and
white,
or
a
light
color
being
good,
we
visualized
that
Kentucky
is
not
plagued
by
program.
O
There
is
access
to
all
who
need
and
want
services
to
our
knowledge.
No
one
wants
no
one
that
wants
Hospice
Services
and
two
is
eligible
for
Hospice.
Services
have
been
denied
care
because
of
a
lack
of
a
hospice's
capacity
to
serve
them,
unlike
hospitals
or
nursing
homes,
where
there
is
a
limited
number
of
beds,
there
is
no
limit
to
the
number
of
patients.
A
hospice
agency
can
serve
because
the
care
is
predominantly
provided
in
a
patient's
home.
O
The
com
process
effectively
keeps
cost
low,
while
maintaining
a
high
standard
of
quality
and
Hospice
Services.
Removing
con
cannot
lower
cost
daily
rates
are
set
by
the
federal
government.
However,
with
increased
fraud
and
a
greater
challenge
for
a
state
to
oversee
care
providers,
data
shows
that
costs
go
up
when
certificate
of
need
laws
are
removed.
O
Preliminary
studies
demonstrated
that
quality
of
care
is
lower
in
states
without
certificate
of
need
laws.
The
hospice
providers
in
Kentucky
have
proven
over
the
years
that
the
priority
is
patience
over
profits.
Our
Kentucky
hospices
have
a
track
record
of
working
together
to
ensure
high
quality
Hospice
Services
are
provided
in
every
County
across
the
state.
We
have
supported
each
other
during
tornadoes,
floods
and
recently
the
pandemic
Kentucky
Kentucky
hospice
organizations
have
a
reputation
for
providing
distinguished
and
compassionate
end
of
Life
Care.
O
There
are
numerous
examples
of
investing
in
initi,
innovative
solutions
that
are
responsive
to
un
responsive
to
unmet
community
needs,
Kentucky
hospice
leaders
and
their
programs
are
sought
out
to
participate
on
national
boards
technical
expert
panels
and
to
test
center
for
Medicare
and
Medicaid
Innovation
demonstrations
currently
Liz
serves
on
the
board
of
the
national
hospice
and
palliative
care.
Association
and
I
serve
on
the
board
of
the
National
Partnership
for
hospice
and
Healthcare
innovation.
O
Kentucky's
hospice
providers
are
the
safety
net
providers
in
their
communities.
There's
no
cherry
picking
of
urban
versus
rural
patients
where
the
cost
may
be
higher,
while
Kentucky
may
be
close
to
the
bottom
nationally.
On
some
health
indicators,
it
is
a
national
leader
in
the
delivery
of
hospice
and
palliative
care.
O
Kentucky
not
only
stands
out
in
terms
of
quality
of
end-of-life
care,
but
Kentucky
is
devoid
of
hospice,
Fraud
and
Abuse
that
characterizes
providers.
In
far
too
many
states
Additionally
the
medicare
payment
advisory
commission
medpac,
an
independent
organization,
a
congressional
agency
established
by
the
balanced
budget
Act
of
1997,
to
advise
the
U.S
Congress
on
issues
affecting
the
Medicare
program
has
analyzed
the
correlation
between
the
number
of
hospice
providers
and
access
to
Hospice
Services
multiple
times
over
the
years.
O
N
N
Competition
in
the
hospice
Market
has
not
improved
made
improvements
in
quality
or
innovation.
Rather,
it
has
produced
a
proliferation
of
disreputable
providers,
exasperated
hospice,
Fraud
and
Abuse
increased
hospice
expenditures
and
created
numerous
program.
Integrity
concerns
from
the
Department
of
Justice
Office
of
the
Inspector
General
and
the
center
for
program
Integrity.
Additionally,
the
growth
of
Bad
actors
in
Hospice
Care
has
garnered
much
attention
in
the
public
domain
and
several
investigated
stories,
demonstrating
how
a
lack
of
safeguards
leads
to
maleficence
and
end-of-life
Care
put
succinctly.
N
A
F
You
Mr
chairman,
one
of
my
biggest
recent
concerns
with
Healthcare
delivery
is
the
proliferation
of
private
equity
companies
that
are
buying
up
medical
practices
and
basically
looking
at
the
margins
and
encouraging
their
providers
to
provide
services
that
have
better
margins
and
discouraging
their
providers
to
provide
services
with
smaller
margins,
which
is
antithetical
to
the
delivery
of
health
care,
because
you're
supposed
to
be
delivering
Health
Care,
based
on
the
need
not
on
the
reimbursement.
Is
this
a
problem
that
you're
seeing
in
other
states
in
hospice
care.
N
Senator
Berg,
it's
a
huge
problem,
I
like
to
say
in
hospice
care.
We
all
get
to
be
plus
by
knocking
on
the
door
and
offering
Hospice
Services
to
individuals,
because
besides
Home
Health
we're
the
only
ones
that
go
to
people's
homes
and
you
can
profiteer
in
hospice
by
skimping
on
Services.
We
are
required
to
provide
for
all
the
medical
needs
that
someone
has
related
to
their
terminal
prognosis,
so
by
not,
and
we're
paid
a
fixed
daily
rate
to
do
that.
N
So
we
might
not
send
a
nurse
as
frequently
we
might
not
send
AIDS
in
the
home
and
the
family
has
to
prep
bathe
and
care
for
their
bed
bound
loved
one
without
the
support
of
nursing
AIDS.
We
provide
medical
equipment.
In
most
cases
in
our
organization,
an
individual
gets
a
hospital
bed
an
over
the
bed
table
a
bedside,
commode
wheelchair
walk
or
oxygen
patients.
Don't
know
they
can
have
all
of
that
and
a
provider
that
wants
to
skimp
or
profiteer
says
here.
O
I
would
just
say
that
there
are
many
services
that
individuals
in
Kentucky
who
have
utilized
Hospice
Services,
think
are
part
of
the
benefit.
But
what
you
see
in
Kentucky
is
a
more
robust
and
I
think
what
was
intentionally
meant
to
be
part
of
the
benefit,
but
weren't,
maybe
coded
in
a
way
that
support
that,
for
example,
after
the
loss
of
a
loved
one,
we're
required
to
provide
12
months
of
services.
Now
Kentucky
hospices
provide
13
months
of
bereavement
services
to
that
family
member.
O
We
do
13
months
because
we
know
well.
The
12th
month
is
the
anniversary
that
individual
is
going
to
need
support.
At
that
anniversary.
We
also
provide
individual
counseling.
We
provide
group
counseling.
We
provide
different
groups
and
camps
for
children.
I
don't
have
to
provide
those
from
a
regulatory
standpoint.
I
can
do
what
many
for-profit
companies
who
are
focused
on
profiteering
and
skinnying
down
their
cost
of
care
and
send
people
a
letter,
and
that's
just
one
example
of
the
concerns
that
we
see
in
other
states
and
what's
happening
nationally
in
the
hospice
industry.
O
F
I
N
So
there's
a
number
of
actually
nationally
required
things,
we're
supposed
to
report
for
Medicare
or
do
report.
One
is
all
our
families,
after
their
loved
one
passes,
receives
a
caps
which
is
consumer
assessment
of
hospice.
It's
a
satisfaction
survey,
and
so
we
are
then
benchmarked
against
our
state
region
and
nationally,
and
you
can
frequently
see
that
Kentucky's
hospices,
always
our
state
outperforms,
the
national,
and
we
can
get
you
some
samples
of
that
type
of
data.
N
O
I
may
add,
I
think
you
know
Liz
mentioned
earlier
that
when
someone's
in
crisis
and
hospice
shows
up
at
the
door,
you
get
to
be
plus
for
just
being
there.
What
happens?
Is
people
don't
know
what
support
they
should
get?
So
any
support
seems
positive.
It's
the
same
with
a
lot
of
the
quality
measures.
It's
proven
very
difficult.
O
G
Thank
you
Mr
chair,
and
thank
you
for
your
presentation.
But,
more
importantly,
thank
you
for
the
service
you
provide
to
patients
in
Kentucky
and
I've
always
been
a
big
fan
of
hospice
kind
of
reminds
me
of
where
Healthcare
used
to
be
and
I
started
in
the
in
the
mid
70s
and
back
in
those
days.
Your
primary
motivation
was
to
heal
the
sick
and
help
relieve
pain
and
suffering
and
improve
the
quality
of
life
of
the
people.
We
serve
and
provide
Comfort
to
the
dying.
G
But
since
then,
we've
added
a
new
element,
that's
to
make
a
profit
and
we
all
have
to
make
a
profit.
Even
you
folks
have
to
do
it,
but
it's
not
right
to
make
a
fortune
off
The
Misfortune
of
others,
and
that's
the
thing
we're
struggling
with
you
mentioned
that
hospice
is
a
cost-effective
means,
providing
care
or
certainly
is,
but
even
hospice
costs
are
too
high
today,
through
no
fault
of
your
folks.
N
So
the
one
graph
in
the
lower
right
hand,
is
the
percentages
of
hospices
in
the
top
decile
of
Medicare
spending
prevent
beneficiary
by
state,
and
you
can
see,
Kentucky
is
lightly
colored
there
and
the
one
thing
strong
con
does.
Is
it
encourages
hospices
to
re,
admit
patients
at
the
right
time,
because
in
when
you
have
an
organization
that
comes
in
and
is
really
focused
on
profits
and
profiteering,
the
incentive
is
is
to
met,
admit
folks
that
might
not
be
eligible.
N
Yet
in
the
last
two
years
of
life
and
Bill
that
daily
rate
to
Medicare
or
Medicaid
versus
our
hospices
really
are
focused.
Is
the
prognosis
of
this
individual
six
months
or
less,
and
those
of
you
in
the
medical
field
know
how
difficult
prognostication
is,
but
that
increases
spending
when
you're
admitting
patients
too
early
longer
than
that
six
months,
and
sometimes
we
have
folks
with
a
longer
length
of
stay.
N
But
that
is
something
again
that
Medicare
monitors
and
we
get
what's
called
a
payment
report
of
payment
patterns
that
compares
us
and
you
can
see
that
Kentucky
routinely
is
below
the
national
averages
on
spending
and
that
just
shows
you
that
we
are
managing
health
care
costs
at
the
end
of
life.
The
other
thing
that
we
are
measured
on
is
readmissions
to
the
hospital,
and
that,
of
course,
helps
to
maintain,
lower
and
live
discharges,
patients
that
discharge,
because
they're,
expensive
or
they're
no
longer
terminally
ill
Kentucky
has
lower
rates
of
that
again.
G
A
J
P
It's
important
to
understand
the
context,
a
certificate
of
need
why
it
exists
and
why
it's
important
to
Health
Care
access
and
safety,
there's
a
misperception
that
there's
a
free
market
in
health
care
or
one
would
spring
into
existence
if
certificate
of
need
were
eliminated.
So,
let's
be
very
clear.
P
P
A
small
contingent
has
employer
provided
or
private
insurance.
The
health
care
delivery
system
and
particularly
hospitals,
are
heavily
regulated
and
financed
by
the
federal
government
on
any
given
day.
Our
patient
census
in
our
hospitals
is
70
to
80
percent
government
paid
patients
and
that
is
10
to
20
percent
higher
than
the
national
average.
P
The
federal
emergency,
medical
treatment
and
Labor
Act
requires
hospitals
to
evaluate
and
treat
any
person
who
comes
to
the
facility,
regardless
of
their
ability
to
pay.
No
other
facility,
physician,
Surgery,
Center,
Imaging,
Center
or
any
other
provider
is
required
to
treat
Medicaid
Medicare
or
the
uninsured.
P
In
a
free
market,
price
increases
are
passed
on
to
the
consumer,
but
payment
rates
set
by
the
federal
government
are
fixed
and
non-negotiable.
Hospital
financing
is
complex
and
complicated.
It
requires
cost
shifting
to
cover
programs
that
hospitals
offer
as
a
community
benefit.
Despite
the
financial
loss
to
the
hospital.
P
This
is
how
hospitals
pay
for
services
such
as
Behavioral,
Health,
obstetrics,
Emergency,
Care,
trauma
care
and
oncology,
just
to
name
a
few,
so
you
might
ask:
where
does
certificate
of
need
fit
into
all
of
this?
Like
35
other
states,
Kentucky
maintains
a
certificate
of
need
program
to
ensure
access
to
care
and
safety,
and,
unlike
many
of
those
other
states,
Kentucky
maintains
certificate
of
Need
for
relatively
few
services.
P
For
example,
certificate
of
need
ensures
the
procedures
like
open
heart
surgery
are
safe.
The
certificate
of
need
program
requires
applicants
to
show
that
a
certain
minimum
number
of
procedures
will
be
performed
in
accordance
with
the
highest
medical
standards,
so
the
patients
can
be
sure
the
hospital
where
the
surgery
is
performed
has
the
appropriate
level
of
experience
and
expertise.
P
Linear
accelerators,
are
extremely
expensive
and
highly
technical
pieces
of
equipment
that
require
both
an
investment
of
capital
in
the
equipment
and
the
skilled
operators
to
deliver
the
most
up-to-date
treatment.
So
much
like
with
open
heart
surgery,
a
certain
number
must
be
performed
annually
to
ensure
the
proper
skill
level
for
the
best
patient
outcome.
P
Another
example
is
the
need
for
certificate
of
Need
for
neonatal
intensive
care
units.
These
units
are
expensive
to
maintain
and
require
highly
trained
Personnel
to
operate
them.
Certificate
of
need,
ensures,
The,
crucial,
Investments
can
be
made
and
specialized
staff
are
not
cherry-picked,
which
ultimately
would
cause
a
neonatal
Intensive
Care
Unit.
To
close
the
experience
in
other
states
where
certificate
of
need
has
been
partially
or
fully
repealed
indicates
that
freestanding
cert,
Ambulatory,
Surgery,
centers
and
imaging
centers
would
be
developed
in
nearly
every
Kentucky
county
at
the
expense
of
struggling
rural
hospitals.
P
All
Imaging
is
not
alike
in
states
without
certificate
of
need.
We
have
heard
Mobile
Imaging
Services,
which
have
older,
cheaper
and
less
medically
helpful
devices
being
offered
where
image
quality
is
poor
and
often
must
be
repeated.
In
contrast,
hospitals
have
the
most
modern
equipment
and
imaging
services
are
integrated
into
the
patient's
care.
P
The
Kentucky
certificate
of
need
program
focuses
primarily
on
a
core
set
of
facilities
and
services
that
are
high
cost
and
where
sufficient
utilization
is
tied
to
Quality
outcomes,
the
state
has
established
criteria
to
assure
sufficient
need
exists
for
these
facilities
and
services,
which
is
important.
Given
the
taxpayer-funded
government
programs
are
the
primary
payer
for
this
care
without
certificate
of
need.
Out-Of-State
entities
would
quickly
swoop
in
to
cherry
pick,
the
few
commercially
insured
patients
away
from
hospitals
for
the
most
profitable
Services
hospitals
provide
meanwhile
Medicare
Medicaid
and
the
uninsured
would
be
left
to
the
hospitals.
P
There
are
two
levels
within
certificate
of
need.
The
very
fewest
number
of
services
are
covered
by
the
formal
review
process
in
which
an
applicant
has
to
produce
evidence
of
the
need
for
the
facility
or
service.
They
have
to
demonstrate
coordination
of
care
with
other
providers
in
the
area
through
established
liquid
linkages.
P
P
P
According
to
the
Kaiser
Family
Foundation
Kentucky
has
the
27th
lowest
total
per
capita
Health
costs,
the
35th
lowest
net
inpatient
price
per
day
and
both
are
lower
than
Indiana
and
Ohio
that
have
repealed
certificate
of
need.
The
Rand
Corporation
has
consistently
ran
Kentucky
in
the
bottom
of
states
in
commercial
prices
for
hospital
care.
P
The
certificate
of
need
program
has
been
in
place
for
decades,
and
it's
worked
well
to
ensure
access
to
care
and
safety
for
patients.
Hospitals
have
planned
expansions
and
added
Services
based
on
the
law
and
have
relied
on
the
certainty
that
certificate
of
need
provides
to
deliver
services
to
their
communities.
P
Our
hospitals
and
Health
Systems
recommend
the
following
common
sense.
Proposals
for
change
first
is
reforming
the
application
and
appeals
process.
Our
membership
supports
improving
the
certificate
of
need
process
to
reduce
administrative
burden,
time
and
bureaucracy,
so
the
Kentucky
Health
Providers
can
meet
Community
needs
in
a
timely
manner.
P
We
also
support
cutting
red
tape
and
providing
flexibility
for
existing
Kentucky
hospitals
to
improve
Patient
Service,
so
as
models
of
care
change
and
the
practice
of
medicine
and
Technology
change.
Certificate
of
need
should
allow
for
some
reasonable
adjustments
so
that
exist
in
Kentucky.
Hospitals
can
better
serve
their
communities
and
we
specifically
recommend
allowing
existing
acute
care
hospitals
to
qualify
for
expedited
review
to
add
20
percent
or
25
Adult
Psychiatric
beds
through
bed
conversion.
P
P
Hospitals
that
operate
emergency
departments
and
treat
all
patients,
regardless
of
ability
to
pay,
must
have
ready
access
to
Advanced
Imaging.
To
support
that
service.
These
hospitals
should
qualify
for
expedited
review
to
acquire
magnetic
resonance
imaging
and
existing
Kentucky
hospital
should
also
be
allowed
to
replace
worn
out
equipment
that
they
already
have
without
a
new
certificate
of
need.
P
Finally,
there
are
a
few
services
that
should
continue
under
the
formal
review
process
as
they
are.
Currently,
these
services
are
subject
to
cherry
picking
that
could
leave
many
patients
without
access
to
care,
or
they
require
certain
numbers
of
procedures
to
ensure
competence
and
quality
in
the
delivery
of
service.
These
include:
building
new
hospitals
or
adding
new
hospital
beds,
neonatal
intensive
care
units,
Ambulatory
Surgery,
centers,
open
heart
surgery
and
cardiac
catheterization
organ
transplants,
megavolt
radiation
therapy
and
positron
emission
tomography
equipment
and
magnetic
resonance
imaging.
P
So
we
hope
that
these
recommendations,
which
are
the
result
of
consultations
with
more
than
75
hospitals
and
systems
throughout
the
state
and
have
been
approved
by
the
Kentucky
Hospital
Association
board,
will
provide
useful
to
the
task.
Force's
work,
We,
Stand,
ready
to
work
with
the
general
assembly
and
the
cabinet
to
produce
positive
results
for
our
patients.
P
A
G
P
G
P
Well,
there
was
just
a
study
that
came
out
and
I
thought
I
might
be
asked
that
question
Kentucky
actually
has
one
of
the
highest
numbers
of
hospital
beds
per
thousand
population.
This
is
frauda
Becker's
States,
ranked
we
rank
11th
highest
and
we're
ahead
of
both
Ohio
and
Indiana.
We
have
plenty
of
licensed
hospital
beds.
What
happened?
G
P
Well,
certainly,
reducing
bureaucracy
and
administrative
costs
is
huge.
That's
only
increased
over
the
years
that
I've
worked
in
this
industry.
What
our
hospitals
have
to
go
through
every
day,
just
to
get
their
care
approved
by
all
the
variety
of
insurance
companies,
commercial
companies,
Medicare
Advantage
companies,
Medicaid
mcos,
what
they
have
to
do,
the
staff
number
of
Staff
they
have
to
hire
just
to
get
care
approved
just
to
get
their
claims
paid
correctly.
The
documentation
requirements
that
are
contributing
to
the
burnout
of
our
Workforce
is
enormous.
I
P
Well,
Northern
Kentucky
is
part
of
the
Cincinnati
Metropolitan
statistical
area,
so
there
may
be
and
I
think
there's
several
hospitals
up
there,
but
there's
plenty
of
access
because,
from
the
federal
government's
perspective,
that's
considered,
you
know
a
Health
Care
system
within
that,
so
it
doesn't
stop
within
Northern
Kentucky.
You
know,
we
know
that
there's
a
lot
of
population
that
goes
in
and
out
in
and
out
migration
from
from
our
border
areas,
and
so
you
can't
just
look
at
access
within
our
state.
You
have
to
look
at
the
health
care
area.
P
Just
like
Louisville
include
Southern
Indiana
northern
Kentucky
include
Cincinnati,
so
you
know
we're
bordered
by
seven
states,
and
so
we
have
to
consider
that
some
of
our
population
is
going
out
in
other
states
in
in
the
case
of
the
Louisville
area,
if
they're
coming
into
Louisville.
So
there's
that
Dynamic
going
on.
I
What
about
for
the
people
that
the
insurance
does
not
cross
state
lines?
So,
yes,
Cincinnati
has
many
hospitals
where
Northern
Kentucky
has
one
hospital
system
that
dominates
17
counties
in
Northern,
Kentucky
and
Southeast
Indiana,
so
do
every
other
major
metropolitan
area
here
in
the
Commonwealth
has
multiple
hospitals?
Do
you
think
Northern
Kentucky
is
better
service
because
they
only
have
one
hospital
system.
P
K
Thank
you
very
much.
Mr
chair
I
have
two
short
questions.
My
first
one
because
I
want
to
switch
gears
just
a
little
bit
because
we're
looking
at
providers
and
being
able
to
provide
health
care
across
the
Commonwealth
is
there
an
increased
reimbursement
rate
again.
This
is
education
of
those
people
who
are
watching
or
listening.
Is
there
an
increased
reimbursement
rate
to
those
facilities
who
have
a
certificate
of
need
versus
those
non-con
facility
facilities.
P
Try
to
answer
so
hospitals
are
regulated
by
certificate
of
need.
There's
not
a
higher.
You
know,
70
to
80
percent.
90
percent
is
government
fixed
payment
rates
and
we're
one
of
the
lowest
paid
states
by
the
Medicare
program.
Most
people
don't
realize
that
they
think
everybody's
paid
the
same.
We
are
one
of
the
lowest
we're
the
43rd
lowest
reimbursed
State
under
Medicare,
so
giving
us
a
certificate
of
need
is
not
giving
us
higher
reimbursement.
So
that's
that's
number
one
outpatient
facilities.
K
K
Other
than
those
which
are
not
hospital-based,
we
have
a,
we
have
a
decreasing
number
of
of
Physicians
or
health
care
providers
in
private
practice,
more
going
to
the
hospitals
or
or
otherwise
employed
and-
and
my
question
is-
and
you
may
not
thought
about
this
much,
but
how
is
it
affecting
our
our
otherwise
physicians
in
private
practice?
When
we
look
at
cons
well,.
P
First
of
all,
C1
doesn't
cover
physicians
at
all,
so
there's
no
barrier
to
having
you
know
more
physicians
in
Kentucky.
Certificate
of
need
is
not
impacting
that
whatsoever.
I
think
there's
other
things
that
are
driving
Physicians
to
join
hospitals,
and
that
is
the
burden
of
regulation
on
the
Physicians
from
the
federal
government
that
you
know
it's
just
so
difficult
for
Physicians
to
be
in
private
practice,
with
all
the
federal
regulations
that
are
on
these
Physicians
today.
Thank.
F
Thank
you,
sir
and
I
think
this
is
a
pretty
much
a
follow-up
question
from
Senator
Douglas
in
my
understanding
at
this
point
is
approximately
80
percent
of
Physicians
are
now
work
for
somebody.
They
no
longer
work
for
themselves,
so
they
work
for
hospitals.
They
work
for
private
Equity
companies.
They
work,
you
know,
does
the
c-o-n
in
any
way
impact
our
ability
to
keep
or
attract
Physicians
to
the
state?
You
know
a
couple
weeks
ago
we
heard
that
we've
lost
590,
Physicians
Statewide.
Does
this
in
any
way
impact
those
numbers
I.
P
Think
it's
positive
Senator
Berg!
You
know
when
you
think
about
our
rural
hospitals.
Our
rural
hospitals
have
to
be
financially
sound
to
be
able
to
attract
Physicians,
to
go
into
rural
areas
and
when
I
meet
with
rural
Hospital
CEOs.
You
know
people
think
it's
cheaper
to
provide
care
in
the
rural
areas.
It's
not
cheaper
to
pay
your
staff,
it's
not
cheaper
to
recruit
Physicians,
and
so
the
stability
that
certificate
of
need
provides
to
our
hospitals
is
very
key
for
them
to
be
able
to
recruit
and
retain
staff
as
well
as
Physicians.
A
We
have
no
other
questions.
Thank
you
all
for
your
presentation
today.
Thank
you
for
all
the
presenters
today
for
for
providing
information
to
the
committee.
Just
a
few
items
I'd
like
to
address
before
we
adjourn
for
the
day
under
the
meeting
materials
section
on
the
lrc
website
legislative
research
commission
website
there
there
is
an
opportunity
there
for
those
that
will
not
be
presenting
before
this
task
force
to
submit
materials
to
the
task
force
that
will
be
included
in
our
official
final
report.
A
What
we're
running
into
is,
we
have
so
many
folks
that
are
affected
by
this.
We
have
so
few
meeting
times
and
so
few
months
to
be
prepared
for
the
2024
session
and
to
finalize
this
report
by
the
end
of
the
year,
those
organizations
can,
as
I
said,
submit
written
materials
to
the
task
force
that
we
will
incorporate
and
make
available
to
members
of
the
task
force.
I'd
like
to
also
point
out
to
members
there's
information
in
your
folder
today.
A
That
was
regarding
questions
that
were
asked
at
the
previous
meeting,
and
those
answers
were
provided
by
the
Cabinet
for
Health
and
Family
Services.
So
those
are
there
for
your
purview
also
like
to
announce
that
the
next
meeting
of
the
certificate
of
need
task
force
will
be
Monday,
August
the
21st
and
we
will
meet
at
10
30
a.m.
If
there
are
no
questions
at
this
time,
I'd
entertain
a
motion
to
adjourn
motion.
We
have
a
motion.
Second,
second,
we
are
adjourned.
Thank
you.