Alaska starts updating the 2005 math behind hospital and clinic expansion approvals

The Alaska Department of Health on Thursday began asking hospitals, clinics and nursing homes how to update the 20-year-old standards it uses to decide whether their building and expansion projects are needed.

Those standards decide a lot. Under the state's Certificate of Need program, health care projects generally need state approval first if they cost $1.5 million or more, change a facility's bed count or add a new kind of service.

In September, Health Commissioner Heidi Hedberg denied Alaska Regional Hospital's proposed South Anchorage emergency room. Part of the reason was that the program's formula projected Anchorage would need 64 emergency treatment rooms by 2030, and the city already has 65. The hospital argued that 13 of Providence's rooms are sometimes closed or reserved for particular patients. Alaska Regional has appealed.

The current review standards date to 2005. "A lot has changed in how healthcare is delivered since then," Certificate of Need Program Manager Mattie Dawson said at an online kickoff meeting.

"The number of beds a facility has doesn't necessarily tell us how many patients it can care for," she said. Staffing and operating capacity matter too, she said, and the current formulas have limited ways to account for them.

The project will update those formulas and the application materials. Changes to the law itself, or wholesale rewrites of the regulations, are outside its scope, said Nicole Lebo, executive director of the department's Office of Rate Review.

The consulting firm Myers and Stauffer is running the review. It will look at how other states handle these decisions and survey providers through Nov. 13. Candice McDaniel, a senior manager with the firm, said the team wants to know whether the requirements led providers to delay, shrink or drop projects, where the process could be less burdensome and what's working well enough to keep.

Jared Kosin, president and CEO of the Alaska Hospital & Healthcare Association, passed along a question someone had asked him: why do this at the tail end of an administration? Lebo said "rush" didn't describe the work, since no regulation changes are expected before the 2028 state fiscal year. "This one is long overdue," she said.