Open-heart debate plays to houseful of doctors, executives

Regulators weighing wheher to OK more surgical programs

Issues: safety, cost, need

July 22, 2000|By M. William Salganik | M. William Salganik,SUN STAFF

Allowing more hospitals to perform open-heart surgery could benefit patients and drive down costs, representatives from half a dozen hospitals told state regulators yesterday.

Then, another group of hospitals - those that already do open-heart procedures - told the regulators that adding more programs could hurt patients and drive up costs.

The Maryland Health Care Commission will decide over the next few months whether more open-heart programs are needed. In a parallel but related process, the commission will also be deciding whether to recommend to the General Assembly that the state keep the current rules limiting open-heart programs, or that any hospital that meets quality standards be allowed to start a program.

An open-heart program means prestige and tens of millions of dollars in revenue, and hospital executives and doctors turned out in force for yesterday's commission meeting.

The hospitals that appeared to support more programs (and can be presumed to be interested in starting programs themselves) were Anne Arundel Medical Center in Annapolis, St. Agnes Health Care in Catonsville, Greater Baltimore Medical Center in Towson, Suburban Hospital in Bethesda, Holy Cross Hospital in Silver Spring and Southern Maryland Hospital Center in Clinton.

Dr. Donald E. Wilson, commission chairman, took pains to avoid the appearance of a conflict between the two groups of hospitals. "This is not going to appear in tomorrow's paper as the `haves' vs. `the have-nots,'" he said - although those designations are used frequently in the industry.

Wilson, who is dean of the University of Maryland Medical School (the hospital associated with the school does open-heart surgery), pledged a fair and nonpolitical process. He went as far as to note that the order of speaking at the meeting had been determined by a coin toss, "and it wasn't my coin."

Among the issues discussed:

Patient safety.

The hospitals without open-heart programs said the need to transport patients caused delays in treatment that could injure patients. "You have limited our capacity to give life-saving treatment," said Dr. John Woman, chief of emergency medicine at St. Agnes.

But Dr. Robert Lowery, a cardiac surgeon at the Washington Hospital Center, the largest open-heart program in the District of Columbia, said most emergency rooms could stabilize patients so the time required to transport them would not pose a danger.

The "haves" offered a counter- argument on patient safety: that studies generally show that high-volume open-heart programs have better results. Opening more programs, they maintained, would make the volume lower at each hospital, and could mean that some hospitals are not seeing enough patients to keep their skills sharp.

The "have-nots" agreed there is a relationship between volume and results, but said there is enough volume to support more programs.

Cost.

More competition can drive down prices, said Jack C. Tranter, a lawyer representing Suburban Hospital. He argued that the Baltimore region has sufficient competition, but that the Washington market is dominated by Washington Hospital Center, and more programs in the area would benefit consumers.

But John Green, executive vice president of MedStar Health in Columbia, which owns Washington Hospital Center and another "have" hospital in Baltimore, Union Memorial, said starting new programs was expensive. "Don't let free-market objectives compromise patient care," he warned.

Measuring need.

Kevin Sexton, chief executive officer of Holy Cross, said the commission was using "a flawed methodology" that overestimated the capacity of existing programs. He noted that some programs have low volume because patients don't choose to go to them.

But Keith Lindgren, director of cardiology at Washington Adventist Hospital in Takoma Park, said the commission was overestimating future volumes, as new treatments have been reducing the need for heart surgery.

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