Angioplasty To Remain Limited Among Hospitals

June 7, 2002
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GRAND RAPIDS — He has the talent to do it and, he believes, a safe place to do it.

So why shouldn’t Richard K. Foster, M.D., have the right to perform an angioplasty that could help heart attack patients at Saint Mary’s Mercy Medical Center?

The question is one that a state panel is about to take up as it weighs whether to revise standards that presently limit angioplasty procedures to a handful of hospitals in Michigan that perform cardiac surgery.

It’s an issue that’s likely to pit institutional health care haves vs. the have-nots. It also brings up questions of maintaining adequate quality and patient-safety safeguards.

Taking up the question is an ad-hoc committee of the Michigan Certificate of Need Commission that will examine whether, and under what circumstances, to allow hospitals with cardiac catheterization labs to perform angioplasty.

Angioplasty is a vascular procedure that — working from the interior — can widen some constricted arteries and unblock some occluded arteries.

Foster and many others argue that with advances in medical techniques and technology, and with research data showing the benefits of angioplasty as an alternative to bypass surgery, there’s no longer any rational reason to continue limiting angioplasty procedures to hospitals that have cardiac surgery programs.

The question may be whether there is an economic reason.

Saint Mary’s, Foster said, can perform the procedure in sufficient volumes needed to maintain proficiency and quality.

“In the interest of patient care, it makes sense to open up that procedure,” said Foster, a staff cardiologist at Saint Mary’s.

“It is going to improve the patient care and quality of care at those institutions,” he said. “It has become a procedure that can be done at more places and it has been done,” he added.

The ad-hoc committee of the CON Commission that consists of heath-care and medical professionals is preparing to tackle the subject and issue a recommendation.

Lody Zwarensteyn, president of the health-care planning organization Alliance for Heath in Grand Rapids, expects a contentious debate over the issue.

Cardiac procedures represent a lucrative revenue source for hospitals and those that presently do angioplasty around the state may be hard-pressed to give up part of their market share.

That’s why the Alliance for Health hopes to see a debate that focused solely on patient care and quality, without deference to hospital economics.

The organization’s general view is to open up the procedure, but do it with a standard that requires high enough volumes so to ensure quality.

“You’re not going to want to do this on every four corners in the state. There’s a skill level you want and an efficient level you want,” Zwarensteyn said. “We’re not saying don’t do it, and we’re not saying rush into it, either. What is best for the patients?

“What we would argue for is something that would not close the door, but to have the bar very high,” he said.

Under current CON standards, a cardiologist performing an angioplasty on a patient suffering from acute myocardial infarction, a heart attack, may only do it at a facility that performs cardiac surgery.

If that patient happens to be at Saint Mary’s, doing an angioplasty means transferring him or her to Spectrum Health, one of only two hospitals in the local market licensed to perform cardiac surgery.

The other is Mercy General Health Partners in Muskegon.

Proponents of changing present CON standards contend that angioplasty has advanced to the point where hospitals with catheterization labs can perform the procedure in high enough volumes and a level to maintain a high quality.

Those who question opening up the procedure to other hospitals say they worry about performing angioplasty without on-site cardiac surgical backup. They also question the assertion whether hospitals which don’t have cardiac surgery service would have a high enough volume of angioplasty procedures to assure quality.

Research data show that the higher volume a hospital performs of a cardiac procedure, the better the outcome.

“Our first and foremost concern is going to be quality,” said Bob Meeker, Spectrum Health’s strategic program manager.

Even with that concern, Spectrum Health is not against opening up the procedure for non-cardiac surgery hospitals. The Grand Rapids-based health system claims it simply wants to see quality and patient-safety safeguards maintained.

“We would accept something that convinces us that quality patient care is maintained,” Meeker said.

There’s also the question involved in the ad-hoc committee’s review about what if, for instance, complications arise as a patient is undergoing an angioplasty procedure and he or she requires immediate surgery.

In the case of Saint Mary’s, Foster cites examples where, in the low number of cases where complications have occurred, he’s been able to transfer such patients to Spectrum Health and have a surgical team in place within an adequate time period.

“In this community, it’s a non-issue,” he said.

But Saint Mary’s is close to Spectrum.

Holland Community Hospital — which also has an interest in performing angioplasty in its catheterization lab if allowed —  is not.

According to Dale Sowders, Holland Community would approach the issue from the perspective of formulating clinical protocols with its cardiologists that provide clear guidelines for deciding when to do the procedure locally, and when to transfer a patient to Grand Rapids.

Sowders is president and CEO of Holland Community .

He says the hospital has seen double-digit growth in the number of patients served at its catheterization lab in each of the last two years, and that the hospital doesn’t want to do angioplasty just to do it.

The hospital, with now performs nearly 500 catheterization procedures annually, is presently researching whether it can perform the procedure in sufficient volumes, he said.

The overriding issue is whether it makes sense for Holland Community Hospital to do angioplasty locally, he said.

“The bottom line is quality for us. If there is really any care that we can safely provide and we can do efficiently in a local setting, why have them transferred to Grand Rapids?” Sowders said.

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