The advisory bodies mentioned are established in the Public Health Care, including their representative
memberships. The members include the Michigan Hospital Association, Michigan College of Emergency
Physicians, Michigan Association of Ambulance Services, the Michigan Fire Chief’s Association, the Society of
Michigan Emergency Medical Services Instructor-Coordinators, the Michigan Association of Emergency Medical
Technicians, the Michigan Association of Air Medical Services, the Michigan Association of Emergency Medical
Services Systems, and labor organizations; each of these organizations has one representative from a county with a
population less that 100,000 in order to include rural populations. These rural areas are the most likely to have a
small hospital affected by this rule. In addition, the committee has a consumer and a municipal representative from a
government in a county with a population less than 100,000. The representation of the Statewide Trauma Advisory
Subcommittee consists of trauma surgeons that are currently trauma center directors; a trauma nurse coordinator; a
trauma registrar; an emergency physician; a hospital administrator from a Level I or Level II trauma center and a
hospital administrator from a non-Level I or non-Level II trauma center; a life support agency manager; a medical
control authority from a rural county and medical control authority from a non-rural county. The two broad-based
groups representing rural and non-rural businesses were involved in the development of these rules.
Cost-Benefit Analysis of Rules (independent of statutory impact)
28. Estimate the actual statewide compliance costs of the rule amendments on businesses or groups.
There are no actual statewide compliance costs to those small hospitals that choose not to participate with the
reporting. With the $3 million appropriated to DHHS, any actual compliance costs to businesses or groups would be
A. Identify the businesses or groups who will be directly affected by, bear the cost of, or directly benefit from the
Providing care for a Michigan resident who has a stroke, or a STEMI, is standard operating procedure. Hospitals that
volunteer to participate in the system will be affected by the rules. Conversely, they stand to directly benefit as the
rules will assist in smoothing out the standardization of care, provide a category of easily recognized resources,
contribute data to assist regional monitoring of the system, identify gaps, and address initiatives to manage them.
B. What additional costs will be imposed on businesses and other groups as a result of these proposed rules (i.e.
new equipment, supplies, labor, accounting, or recordkeeping)? Please identify the types and number of businesses
and groups. Be sure to quantify how each entity will be affected.
For participants, additional costs for Stroke/STEMI patient data entry may be incurred. Hospitals volunteering to be
designated as a Stroke/STEMI facility will incur other equipment and staffing costs based upon gaps between
existing resources and resources required for Stroke/STEMI center verification. These potential costs will also
depend upon the chosen level of Stroke/STEMI center designation pursued.
29. Estimate the actual statewide compliance costs of the proposed rules on individuals (regulated individuals or
the public). Include the costs of education, training, application fees, examination fees, license fees, new
equipment, supplies, labor, accounting, or recordkeeping.
There are no compliance costs for individuals in these rules.
A. How many and what category of individuals will be affected by the rules?
There are no individuals, only entities, regulated by the rules.
B. What qualitative and quantitative impact do the proposed changes in rules have on these individuals?
The public, as represented by Stroke/STEMI patients, will qualitatively and quantitatively benefit from being
transported by ambulance to the closest, most appropriate stroke/STEMI facility based on standardized physiological
and anatomical assessment of severity, as well as standardized transport protocols.
30. Quantify any cost reductions to businesses, individuals, groups of individuals, or governmental units as a result
of the proposed rules.
Although costs may not be reduced by the rule, compliance with the state Stroke/STEMI designation criteria,
improved adherence to care standards, protocols, and guidelines will improve patient care, including time to
treatment that will potentially lead to lower patient costs, lower inpatient mortality, and better outcomes.
31. Estimate the primary and direct benefits and any secondary or indirect benefits of the proposed rules. Please
provide both quantitative and qualitative information, as well as your assumptions.