Report recommends structural change to Health Resources Board
DOVER — Delaware legislators are exploring major structural changes to the Health Resources Board (HRB), as a new report proposed turning the state’s top health care regulator into an advisory board backed by the state government.
The Joint Legislative Oversight & Sunset Committee report, issued last week as part of continuing work that was halted due to the COVID-19 pandemic, recommends reducing the number of board members from 15 to five to serve in a review capacity, while a state-appointed director would make the final decisions.
Other suggestions include appointing a health care economist to the advisory board, adding a full-time employee to independently research applications and maintaining a statewide database on health care statistics.
“The process is important to have, especially in a small state and smaller infrastructure. It just needs some structure changes,” Sunset Committee analyst Amanda McAtee said on March 18. “These issues can be resolved by moving that capacity to advisory and really creating a department and administrative staff to adequately and thoroughly research the applications.”
The HRB is designed to control health care costs by regulating the number of beds in hospitals and nursing homes and major equipment purchases. But the report shows that the board has routinely struggled with attendance, which slows down the application process.
From filing the notice of intent to an application’s final decision, the entire process can take an average of 117 days. McAtee noted that of the seven board members surveyed, three made 57% of meetings in 2019, either because of absences or to avoid conflict of interest. The board spent $7,000 on meeting room reservations in 2019.
In the past seven years, the HRB has approved 30 applications and denied two. But McAtee noted that these decisions largely hinge on the applicant’s own research, and the board currently is not set up to evaluate the market with its own research. Furthermore, the HRB’s largest line-item expenses in 2019 was to contract for outside research on nursing home bed use statistics. That is the only database maintained by the HRB.
If the HRB went to an advisory capacity, McAtee said that it would likely see staff issue reports on applications and hold a public hearing before making a recommendation to the director. That director would have the final say in the application.
“With a restructure, it would mean there is more staff doing the research to adequately and thoroughly review applications,” McAtee said. “It would streamline the process and make it transparent. With the board no longer making decisions and just advising, it would eliminate conflict of interest issues.”
Notably, the lack of independent data became a larger issue when Bayhealth and Beebe both sought to expand in Sussex County. Two years ago, the health care systems filed applications to build emergency rooms within 10 miles of each other. The HRB ultimately denied Beebe’s application while Bayhealth withdrew its bid before a vote.
A year later, Bayhealth was approved to open a $35 million hybrid emergency room and walk-in care center in Milton. Beebe has since filed a notice of intent for a similar facility near Georgetown, although that has not gone through the process yet.
Sen. Brian Pettyjohn (R-Georgetown) raised concerns about that process, noting health care access in central Sussex County was an ongoing issue for people who had to drive long distances for comprehensive care.
“When minutes count, in terms of getting a patient to critical care, the decision to deny something in the center of the county really struck a lot of people. It’s not in the best interest for the residents in central Sussex County,” Pettyjohn said. “I don’t want to throw the baby out with the bathwater and disband the board, but I do think there’s some serious structural problems with how decisions are done.”
Rep. Krista Griffith (D-Hockessin) said that she was alarmed at the lack of transparency with meeting minutes, missed opportunities to independently review the board members’ conflict of interests and how delaying decisions can have serious ramifications on consumers.
“Anecdotally, an A.I DuPont pediatric surgeon told me he had to clear his schedule, he wouldn’t see children in desperate need for heart surgeries, to be told that the HRB meeting didn’t have enough members. That was a waste of a day,” Griffith said.
But Rep. Lyndon Yearick (R-Camden/Wyoming) was not “sold on the idea of not terminating the board” completely, arguing more in favor of a free market. He argued that ChristianaCare has 70% market share in New Castle County alone, and the state should be more welcoming to allow a health care provider that did their due diligence to compete.
“I can’t remember any scenario where you ever increase the quantity of a product or service, and the price goes up,” he said. “We should be welcoming as much competition in resource acute care, emergency room, long term care facilities, not deterring it.”
Among other recommendations included in the report:
- Requiring health care companies to report more frequently how services are used.
- Raising the public review fee, which has not been changed in decades. The fees currently max out at $300,000 for a $10 million project.
- Clarifying stance on free-standing emergency departments, inpatient rehabilitation facilities and acquisition of health care facilities.
The Sunset Committee is set to vote on recommendations on the HRB on March 25.