Surgery program sought

Measure would permit medical center to perform open-heart procedures


Arundel residents will no longer need to leave the county for open-heart surgery if legislation is passed allowing Anne Arundel Medical Center to bypass existing state regulations that prevent the creation of new open-heart programs.

State health officials said they plan to oppose the bill, warning that safety should not be sacrificed for convenience. They cautioned that adding more open-heart programs, which would decrease patient volume at existing programs, is dangerous because patients suffer more complications at hospitals that perform fewer surgeries.

The House of Delegates Health and Government Operations Committee has scheduled a hearing March 20 on the proposal - House Bill 1440 - which would require the Maryland Health Care Commission to grant one new open-heart program to a hospital that meets specified criteria. The proposed legislation does not explicitly name a hospital, but AAMC is the only medical center that meets the requirements enumerated in the bill, said Martin L. "Chip" Doordan, president of the hospital.

If passed, the bill would free the hospital from constraints set by the Maryland Health Care Commission. Open-heart facilities for Baltimore City and five counties, including Anne Arundel, are currently limited to five hospitals in Baltimore and its northern suburbs.

The county's growing population demands an open-heart facility, said Doordan. It refers about 400 open-heart candidates a year to other hospitals, including 50 patients flown by helicopter, Doordan said. Although the hospital offers angioplasty and other minor cardiac procedures, county residents must travel more than 20 miles for open-heart surgery. Doordan said open-heart facilities at AAMC also would draw patients from Southern Maryland and the Eastern Shore.

If the bill is passed, AAMC would coordinate the creation of new cardiac facilities with a $200 million expansion that is scheduled to begin in the fall, Doordan said. The hospital is slated to add eight operating rooms, which could accommodate open-heart patients, he said.

"AAMC has the facilities and the doctors, and people have the need," said Del. Herbert H. McMillan, a Republican who supports the bill, as does the entire county delegation. "The certificate of need requirements are flawed," said McMillan, referring to the guidelines by which some states, including Maryland, evaluate and approve new medical facilities.

Bill's critics

State guidelines ensure patient safety, said Pamela Barclay, deputy director of the Maryland Health Care Commission, which sets certificate of need requirements for the state. Patients at hospitals that perform fewer than 200 open-heart operations a year are more likely to suffer complications from surgery, Barclay said.

"You have to be sure that there's sufficient volume, and that you're not taking away volume from other programs," Barclay said. Commission representatives will testify in opposition to the bill, she said.

Since most open-heart surgeries are elective, patients can make arrangements to have the procedure performed in Baltimore, Barclay said, noting that many Anne Arundel residents commute to jobs in Baltimore.

"The more a procedure like open-heart you do, the better you get at doing it," said Gerard F. Anderson, director of the Johns Hopkins Center for Hospital Finance and Management.

"If you have too many facilities in Maryland doing the procedure, then you won't have any of them doing it really well," said Anderson, citing numerous studies that correlate low patient volume and increased risk of readmission, infection and death. Anderson noted that the number of open-heart surgeries performed is decreasing nationwide because of technological improvements.

Prince George's Hospital Center, the closest open-heart facility to AAMC, performed 565 of the procedures last year, according to data released by Nduka Udom, a director of the state's Health Services Cost Review Commission.

In contrast, each of the approved hospitals in the Baltimore area - Johns Hopkins Hospital, Sinai Hospital, St. Joseph Medical Center, Union Memorial Hospital and University of Maryland Medical Center - operated on more than 1,000 open-heart patients. At St. Joseph, doctors performed 4,503 open-heart surgeries last year - more than any other hospital in the central Maryland region, according to Udom's data.

Attracting the best

Hospitals with open-heart facilities attract the best surgeons and bring in considerable revenue from the surgery and associated procedures, Anderson said. St. Joseph derives more than 30 percent of its inpatient revenue from cardiac care, according to Udom.

Since managed-care groups and insurance companies prefer to send patients to full-service hospitals, small community hospitals are losing patients, Anderson said.

AAMC is ranked sixth in the state for patient admissions and has performed 320 cardiac catheterization procedures in the past three years, Doordan said.

If the bill does not pass, AAMC could still be awarded a certificate of need when the Maryland Health Care Commission updates Maryland's health plan early next year. The commission updates the plan every three years after analyzing changes in technology and shifts in demographics, Barclay said. The state is currently guided by a plan drafted in 2004.

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