Archive for the ‘General’ category

The Certificate of Necessity (CON) “Pipeline”

December 16th, 2014

EAmerican Medical Response’s (AMR) isn’t the only application in the pipeline.  A number of fire departments along with private groups are applying for CONs right now.  Some are farther along in the application process than others.

Why all the interest in running an ambulance company?  Rural Metro’s bankruptcy has probably played a role along with the Affordable Care Act.  Also, hospitals are now beginning to contract with Emergency Medical Services (EMS) agencies to help reduce the number of patients being re-admitted to the hospital for chronic disease management – a new revenue source for EMS agencies.

Administrative Judge Recommends Approving New Ambulance Service Application

December 9th, 2014

Emergency VehiclesLate Monday, an Administrative Law Judge issued an Order recommending that I approve American Medical Response of Maricopa’s (AMR) application to operate ambulances (certificate of necessity or CON) in all of Maricopa County.

We regulate ambulance services differently than most states.  In order to operate an ambulance here the applicant needs to meet a number of requirements including demonstrating that:  1) there’s “public necessity” for the services they want to provide; 2) they have the finances and operational skills necessary to operate the service; and that 3) they can provide high quality clinical care and evaluate their service with a performance improvement plan.

An application for a CON triggers a process that starts in our Bureau of EMS and Trauma System where we  evaluate the application to see if it’s complete.  Once that’s done, we notify folks in the area about the proposed CON.  If the application is uncontested, then it comes directly to me for a decision.  If the application is contested (as this one was), it goes to a hearing before a judge at the Office of Administrative Hearings.

The Administrative Law judge evaluates the application and the evidence presented during the hearing and issues a recommendation.  The Judge sends the recommendation (called an Order) to me, and I have 30 days to make a decision.  I can:  1) deny the application; 2) accept it as-is; 3) accept the application with amendments; or 4) allow the recommendation to take effect without acting.

The Judge reviewed several criterion in AMR’s application (public necessity, billing rate, fiscal and operational experience, clinical excellence, negative financial impact on the current provider).  The Order concludes that: “In view of the foregoing, it is recommended that the Director approve the proposed Application, directing BEMSTS to issue a CON to American Medical Response of Maricopa, LLC (“AMR”) upon AMR’s confirmation that it is ready to immediately assume all rights and responsibilities under that CON.”

Before I make a decision, I’ll review the hearing record, the application and the judge’s decision and Order.  I’ll be paying particular attention to how the Judge came to her conclusion.  Stay tuned.

Community Paramedicine Legal Analysis Report

December 9th, 2014

ECommunity Integrated Paramedicine programs are coming together in two primary business models in Arizona.  The first one has EMS (emergency medical services) agencies partnering with hospitals to reduce the frequency that patients are re-admitted to hospitals.  In the second, EMS agencies are cultivating social service referrals to reduce the frequency that folks use emergency departments for non-emergency events.

Community Integrated Paramedicine programs are on the rise because federal law provides hospitals a financial incentive to reduce the number of readmissions among patients discharged within 30 days.  There’s also been a national focus on conducting community health needs assessments, which have exposed gaps in the availability of preventative health care services needed to improve the health and well-being of residents.  Community paramedicine is increasingly being recognized as a cost-effective way to fill those gaps.

A new piece of the community paramedicine puzzle became available a couple of weeks ago with the publication of a document called  Expanding the Roles of Emergency Medical Services Providers: A Legal Analysis. The document examines the legal perspective and provides guidance on several topics including scope of practice, emergency calls, payment, liability and medical direction for community integrated paramedicine programs.

Community Integrated Paramedicine touches our Bureau of EMS and Trauma System, the Bureau of Tobacco and Chronic Disease and the Health Care Institution Licensing Branch. Our job over the coming months is to help Community Integrated Paramedicine Programs to navigate regulatory waters and manage the risks associated with a new business model for EMS providers – our Team is finalizing work on a guidance document right now.

2013 Arizona Health Status and Vital Statistics Report

December 5th, 2014

2013 reportLast week we published our Agency’s most popular annual report.  It’s called the 2013 Arizona Health Status and Vital Statistics Report.  Last year’s version got 2,000,000 hits!

It gives our most granular public health information of the year including refined health statistics on pregnancies, births, reportable diseases, deaths, inpatient hospitalizations, emergency room visits, marriages, divorces and population for Arizona.  The report provides critical data for health policy formulation, interventions and resource allocation.  All of AZ’s Universities use our Arizona-specific health status reports in classroom teaching.

The published works include the Arizona Health Status and Vital Statistics E-book 2013, which includes an Introduction and sections that focus on State, County, and Community data as well as selected vital statistics comparing 2003, 2008, and 2013.  You can download and print each of the 10 chapters of the report, as well as the summaries or tables.

Our public health statistics team also went live with our new Community Profile Dashboard that brings key data elements from the Big Book to a Primary Care Area.  In addition, our 2012 AZ Hospital Compare website provides an online searchable database to help Arizonans make educated decisions about their healthcare.

Thanks for Volunteering

November 28th, 2014

teens highschoolA couple months back, I sent a note to staff letting you know about an opportunity to help out kids in our hood…students at Capitol Elementary School.  Several of you volunteered and will be tutoring the kids a couple days a week in math and reading.

As Winston Churchill said:, “We make a living by what we get, but we make a life by what we give.”  Volunteering’s a great thing to do.  Thanks to Kelli Donley, Joann Hatton, Gerilene Tsosie, Sherri Moncayo, Sherry Haskins, Jeff Jones, Ryan Fulmer, Jacqueline Luckey-Eaton, Sabrina Canela, Libby Puccio, Diane Flanagan, Della Maneese, Debra Kunkle, Jane Thompson for volunteering and thanks go out to their supervisors for making it possible.

Have a Happy & Healthy Thanksgiving

November 26th, 2014

turkeyThe holiday season can be challenging if you’re trying to eat healthy and limit sodium.  Fortunately, you don’t have to give up all of your favorite dishes in the name of heart health.  Be sure to check out these six tips for a healthier Thanksgiving. Also, click here to visit the Million Hearts Healthy Eating & Lifestyle Resource Center to find practical recipes, nutritional facts, and lower-sodium versions of classic dishes that you can add to the menu throughout the holiday season.

Take the Title V Needs Assessment Survey

November 25th, 2014

MOur Women’s and Children’s Health Team is working on the 5-year Needs Assessment for the Maternal and Child Health Title V Block Grant.  The needs assessment helps us tailor how we spend the federal funding to improve the health and well-being of Arizona’s women, children, and adolescents.

You can help narrow down the 10 health priorities by taking the online survey.  We’ll use the data from the survey to focus our public health programs for women’s and children’s health based on the needs of the people who are the most affected.  It’s also a chance for the community to give us feedback on what we are doing well and where we can use some improvement.

The survey is for everyone:  partners, moms, dads, grandmothers, neighbors…anyone living in Arizona who is interested in maternal and child health.  So far more than 600 people from around the state have completed the survey.  If you want to fill out the short, 10 minute survey, or if you know someone who should take it, please do it by the end of the month.  The survey closes at 5 p.m. on November 30…so you still have time to have your voice heard.  After we compile the data from the survey, we’ll present the priorities to the community.

This is a great opportunity to have your voice heard and to help us set priorities that will be of the greatest help to the women and children of Arizona.  To learn more about the survey, you can watch this short video blog or visit the Bureau of Women’s and Children’s Health online.

Developmental Disabilities Planning Council Refresh

November 24th, 2014

FArizona’s Developmental Disabilities Planning Council got some good news this week after learning that Governor Brewer extended the Executive Order that created the Council in 2009.  Signed on November 4th, the Executive Order authorizes the Council to continue its work through 2019 in supporting persons with developmental disabilities and their families by funding important projects related to employment, self-advocacy and educational opportunities.

Operating on an annual budget funded through a federal grant, the Council funds innovative projects that help persons with developmental disabilities become more included in their communities either by achieving systems change or increasing capacity.  To learn more about the Council, stop by their office located at 1740 West Adams Street, Suite 410, Phoenix, or visit their Website,  Facebook or Twitter sites.

CDC National Health Report

November 21st, 2014

HLast Thursday, the CDC published the CDC National Health Report which provides a snapshot of recent trends in key areas of the nation’s health.  The report finds Americans are living longer, healthier lives, but  indicates that progress has been slow or stagnating in some areas, including several leading causes of death and their risk factors.

The new report will help guide national policy and programmatic efforts for the improvement of health and quality of life.  It includes: 1) a scientific paper (CDC National Health Report: Leading Causes of Morbidity and Mortality and Associated Behavior Risk and Protective Factors — United States, 2005-2013); 2) Report Highlights; 3) a three-minute video called “The Road to Health and Longevity;” and 4) at-a-glance dashboards.

The CDC National Health Report website offers quick access to resources to advance public health work.  Many of these tools relate directly to CDC Winnable Battles focus areas, including food safety, healthcare-associated infections, HIV, motor vehicle injuries, teen pregnancy, tobacco, and nutrition, physical activity and obesity.   To learn more and gain access to the CDC National Health Report resources go to

Navajo Nation Establishes the Navajo Department of Health

November 20th, 2014

navajonationAfter many years of planning and conducting of public forums throughout the Navajo Nation, the Navajo Tribal Council recently approved legislation establishing the Navajo Department of Health.  Navajo Nation President Ben Shelly  signed the legislation into law.

The new law establishes the Navajo Department of Health as the lead agency delegated to ensure that quality comprehensive and culturally relevant health care and public health services are provided on the Navajo Nation.  The new Department will also be authorized to continue planning for the establishment of a Navajo Nation Medicaid Agency.