Bid to shut endoscopy clinics denied

January 12, 1994|By Patricia Meisol | Patricia Meisol,Staff Writer

A plea by Baltimore hospitals to close down four outpatient centers competing for their business was rejected by a state planning commission yesterday, but the panel agreed to take up the larger issue of when and how to regulate the growing number of free-standing facilities.

At issue yesterday was a decision by state planners to allow four endoscopy centers to open in the past year and a half without being subject to a needs test. The centers provide certain nonsurgical endoscopy procedures at a lower cost than hospital-based outpatient centers.

In the most common form of endoscopy, doctors insert a tube with a tiny video camera through natural body openings to examine and treat organs of the digestive system.

The Greater Baltimore Medical Center and St. Joseph Hospital argued that the centers are surgical facilities and should have been subject to a needs assessment before being allowed to open and also that they would cause substantial economic harm to the hospitals.

The hospitals' argument was rejected, however, in a majority vote by the Maryland Health Resources Planning Commission. Commissioner Joan Y. Harris told the panel that the planning staff had appropriately exempted the facilities from a need determination because they do not conduct surgery and do not have operating rooms.

Moreover, she said the hospitals offered inconsistent and unproven data on the alleged economic harm, and thus failed to demonstrate any extraordinary circumstance that might allow them to intervene in the first place.

The hospitals had claimed they would lose up to 50 percent of their endoscopy business to the centers, citing figures of between $1 million and $2.7 million annually. But Commissioner Harris said that when she questioned the hospitals, they admitted these were "guesses."

Such potential losses are minute compared with the hospitals' total budgets. The larger issues being debated by state planners center on the impact of such centers on patient care and on hospitals, and on whether such centers are primarily diagnostic or surgical in nature. If they are shown to be primarily surgical in nature, they would be subjected to a stringent review to see if such services are needed in Maryland.

Right now they face no restrictions other than obtaining a letter to operate from the commission.

At least a half-dozen more applications to open new endoscopy centers are pending. Yesterday, the commission decided to examine as a whole the long-term impact of these and several dozen other pending applications to open outpatient facilities. They are the result of advances in technology and have the potential to shift business from established health care providers.

"The reason for the opposition is not the individual cases but the cumulative [impact]," said Walter Hall, a doctor who is chairing a commission subcommittee looking at health care delivery.

Roger Lipitz, a new member of the planning commission and chairman of Meridian Health Care, the state's largest nursing home company, agreed, and urged the planning commission to decide what role it wants to play in the marketplace, and guide the health care community accordingly.

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