WAC 246-310-745
Need forecasting methodology. For the
purposes of the need forecasting method in this section, the
following terms have the following specific meanings:
(1) "Base year" means the most recent calendar year for
which December 31 data is available as of the first day of the
application submission period from the department's CHARS
reports or successor reports.
(2) "Current capacity" means the sum of all PCIs
performed on people (aged fifteen years of age and older) by
all CON approved adult elective PCI programs, or department
grandfathered programs within the planning area. To determine
the current capacity for those planning areas where a new
program has operated less than three years, the department
will measure the volume of that hospital as the greater of:
(a) The actual volume; or
(b) The minimum volume standard for an elective PCI
program established in WAC 246-310-720.
(3) "Forecast year" means the fifth year after the base
year.
(4) "Percutaneous coronary interventions" means cases as
defined by diagnosis related groups (DRGs) as developed under
the Centers for Medicare and Medicaid Services (CMS) contract
that describe catheter-based interventions involving the
coronary arteries and great arteries of the chest. The
department will exclude all pediatric catheter-based
therapeutic and diagnostic interventions performed on persons
fourteen years of age and younger are excluded. The
department will update the list of DRGs administratively to
reflect future revisions made by CMS to the DRG to be
considered in certificate of need definitions, analyses, and
decisions. The DRGs for calendar year 2008 applications will
be DRGs reported in 2007, which include DRGs 518, 555, 556,
557 and 558.
(5) "Use rate" or "PCI use rate," equals the number of
PCIs performed on the residents of a planning area (aged
fifteen years of age and older), per one thousand persons.
(6) "Grandfathered programs" means those hospitals
operating a certificate of need approved interventional
cardiac catheterization program or heart surgery program prior
to the effective date of these rules, that continue to operate
a heart surgery program. For hospitals with jointly operated
programs, only the hospital where the program's procedures
were approved to be performed may be grandfathered.
(7) The data sources for adult elective PCI case volumes
include:
(a) The CHARS data from the department, office of
hospital and patient data;
(b) The department's office of certificate of need survey
data as compiled, by planning area, from hospital providers of
PCIs to state residents (including patient origin information,
i.e., patients' zip codes and a delineation of whether the PCI
was performed on an inpatient or outpatient basis); and
(c) Clinical outcomes assessment program (COAP) data from
the foundation for health care quality, as provided by the
department.
(8) The data source for population estimates and
forecasts is the office of financial management medium growth
series population trend reports or if not available for the
planning area, other population data published by
well-recognized demographic firms.
(9) The data used for evaluating applications submitted
during the concurrent review cycle must be the most recent
year end data as reported by CHARS or the most recent survey
data available through the department or COAP data for the
appropriate application year. The forecasts for demand and
supply will be for five years following the base year. The
base year is the latest year that full calendar year data is
available from CHARS. In recognition that CHARS does not
currently provide outpatient volume statistics but is patient
origin-specific and COAP does provide outpatient PCI case
volumes by hospitals but is not currently patient
origin-specific, the department will make available PCI
statistics from its hospital survey data, as necessary, to
bridge the current outpatient patient origin-specific data
shortfall with CHARS and COAP.
(10) Numeric methodology:
Step 1. Compute each planning area's PCI use rate
calculated for persons fifteen years of age and older,
including inpatient and outpatient PCI case counts.
(a) Take the total planning area's base year population
residents fifteen years of age and older and divide by one
thousand.
(b) Divide the total number of PCIs performed on the
planning area residents over fifteen years of age by the
result of Step 1 (a). This number represents the base year
PCI use rate per thousand.
Step 2. Forecasting the demand for PCIs to be performed
on the residents of the planning area.
(a) Take the planning area's use rate calculated in Step
1 (b) and multiply by the planning area's corresponding
forecast year population of residents over fifteen years of
age.
Step 3. Compute the planning area's current capacity.
(a) Identify all inpatient procedures at CON approved
hospitals within the planning area using CHARS data;
(b) Identify all outpatient procedures at CON approved
hospitals within the planning area using department survey
data; or
(c) Calculate the difference between total PCI procedures
by CON approved hospitals within the planning area reported to
COAP and CHARS. The difference represents outpatient
procedures.
(d) Sum the results of (a) and (b) or sum the results of
(a) and (c). This total is the planning area's current
capacity which is assumed to remain constant over the forecast
period.
Step 4. Calculate the net need for additional adult
elective PCI procedures by subtracting the calculated capacity
in Step 3 from the forecasted demand in Step 2. If the net
need for procedures is less than three hundred, the department
will not approve a new program.
Step 5. If Step 4 is greater than three hundred,
calculate the need for additional programs.
(a) Divide the number of projected procedures from Step 4
by three hundred.
(b) Round the results down to identify the number of
needed programs. (For example: 575/300 = 1.916 or 1 program)
[Statutory Authority: RCW 70.38.128. 09-01-113, §
246-310-745, filed 12/19/08, effective 12/19/08.]