Budget Amendment ID: FY2014-S3-595

EHS 595

Acute-care hospitals

Messrs. Montigny and Brownsberger moved that the proposed new text be amended by inserting at the end thereof the following new section:-

SECTION ___.  Chapter 111 of the General laws, as appearing in the 2010 official addition is hereby amending by inserting after Section 51H the following 2 sections

Section 51I.  Definitions for Section 51J

Consensus measures.  Standardized stroke metrics that including, but not limited to:

(a)Deep Vein Thrombosis (DVT) Prophylaxis

(b)Discharged on Antithrombotic Therapy

(c)Patients with Atrial Fibrillation Receiving Anticoagulation Therapy

(d)Thrombolytic Therapy Administered

(e)Antithrombotic Therapy By End of Hospital Day Two

(f)Discharged on Statin Medication

(g)Dysphagia Screening

(h)Stroke Education

(i)Smoking Cessation / Advice / Counseling

(j)Assessed for Rehabilitation

Primary Stroke Service. Emergency diagnostic and therapeutic services provided by a multidisciplinary team and available 24 hours per day, seven days per week to patients presenting with symptoms of acute stroke and have the ability to assess acute stroke patients and treat with IV-tPA in the 0-3 hour period and may sites could also treat up to 4.5 hours with IV tPA.

Primary Stroke Service Plus (PSS+):    In addition to service required in the definition of Primary stroke services, emergency diagnostic and therapeutic services that include

1)Participation in a national stroke QI program to be chosen by the department;

2)Mandatory data reporting to the department on an agreed upon expanded set of measures of stroke care quality, and annual evidence of compliance to standards;

3)Ongoing professional education requirements similar to Joint Commission-Primary Stroke Center requirements

4)Protocols for administering IV-tPA in the expanded time window (3 - 4.5 hours).  Patients with stroke symptom onset between 2.5 - 4 hours would be considered for direct triage/transport to these PSS+ sites when appropriate.

Comprehensive Stroke Center:  Facilities designated for patients with onset times of consensus measures greater than 4 hours

Undesignated Sites: Hospitals that do not seek or sustain a primary stroke service or higher designation that have pre-approved transfer agreements for walk-in or inpatient strokes

Section 5J.  Application to Provide Primary Stroke Service; Written Protocols

(1)  Each hospital seeking designation as a provider of a Primary Stroke Service shall submit an application to the Department, on forms prescribed by the Department, documenting how the hospital will meet the standards in 105 CMR 130.1400 through 130.1413.

(2)  The department shall base the certification Primary Stroke Centers based on Joint

Commission/ASA standards or similar standards.

(3)  The department shall include modifications to the hospital stroke designation and emergency medical service point of entry criteria to ensure sustainability of the program.

(4) The department shall create a sustainable three tiered system for hospital stroke designation that reflects the current tiered nature of care that shall include:

a)Primary Stroke Service;

b)Primary Stroke Service Plus;

c)Comprehensive Stroke Centers

(5) The department shall require undesignated hospitals to affiliate with a primary stroke services, primary stroke service plus or comprehensive stroke center.

(4)  The department shall establish a registry of infrastructure and mandatory participation by Primary Stroke Service Plus Hospital as defined by Hospital Licensure Regulations (105 CMR 130.000) 105 CMR 130.1400 Primary Stroke Service Licensure that shall include  but not be limited to reporting and collection of data on consensus measures.