Hospitals choose sides in cardiology debate

June 14, 2009
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Metro Health Hospital intends to continue to pursue an open-heart surgery program, despite being turned away last week in its bid to open the state standards regulating cardiology services.

“We see this as a process … the beginning of dialogue about it,” Metro Health spokeswoman Ellen Bristol said.

Metro Health officials last week made their case before the state Certificate of Need Commission to open a review of standards governing cardiology programs. Commissioners listened to and discussed Metro Health’s request, but took no action. Commissioners said they may reconsider if Metro Health returns with data that provides a compelling basis to review the rules.

The hospital’s request comes at a time when West Michigan Heart, the area’s largest cardiologists’ practice with 34 physicians, is negotiating to become a unit of Spectrum Health.

West Michigan Heart’s roster includes six osteopathic doctors, five of whom see patients at an office at Metro Health, which is traditionally an osteopathic hospital, according to the organization’s Web site. Several West Michigan Heart allopathic doctors also are listed on the Web as working out of the Metro Health office in Wyoming.

Representatives of West Michigan Heart did not return phone calls seeking comment.

The battle before the CON Commission provided a rare public peek at the intense competition among Grand Rapids area hospitals. Cardiology is one of several areas, such as cancer and gastro-intestinal bypass surgery, where hospitals in general are competing for profit margins in a health care environment with little margin to be found in other areas of care.

Metro Health’s proposal drew support from Trinity Health, owner of Saint Mary’s Health Care in Grand Rapids, and Mercy Health Partners in Muskegon, while Spectrum Health vigorously opposed it.

Privately, sources say that some West Michigan Heart doctors are unwilling to join Spectrum Health and also have approached Saint Mary’s about establishing an open-heart surgical program there.

Saint Mary’s Vice President Micki Benz wouldn’t comment on whether those plans exist.

“One step at time,” Benz said. “We are always strong supporters of Certificate of Need, and that if things have changed enough that the commission feels standards should be reviewed, we would support that, as well.”

She said Metro requested support from Saint Mary’s, which provided a letter from Trinity Health President & CEO Joseph Swedish.

“The issue is really Metro’s. Spectrum is doing a fine job,” Benz said, noting that West Michigan Heart physicians presented the CON Commission with comments both for and against Metro’s request.

Saint Mary’s and Metro Health both are limited to performing emergency angioplasties, while Spectrum Health offers all cardiac interventions short of transplants. Spectrum is seeking to establish a transplant program.

Spectrum Health will continue to argue against re-opening the standards prior to its next scheduled review in 2011, said John Mosley, senior vice president.

“Unless there is a substantial reason to open those standards again, they should not be reopened based on somebody’s request,” Mosley said, noting that the CON Commission heard no comment from Metro Health during a regular standards review in 2008. “That’s all we are saying. We are trying to do everything we can to support those standards.”

Spectrum, which hosts between 900 and 1,000 cardiology procedures annually, mostly at the Meijer Heart Center, opposes the establishment of a cardiac surgery program at Metro Health, Mosley said.

“We have quality with access,” and Spectrum is below comparable programs in cost, Mosley said.

Heart programs with the best outcomes are those that do a lot of procedures, he added. “If you put another program here in town, it’s going to take away from quality outcomes. … You not only decrease quality and increase cost, it has little to do with access. There’s no value in starting a new program in this area.”

He noted that of the state’s 33 programs, 17 did not meet the CON threshold of doing 300 procedures annually.

Bristol said that Metro Health would like the CON Commission to look at the methodology used to determine the number of cases a hospital would see, based on commitments from doctors. “We would like to look at how they count the cases so we could capture physician commitments,” she said.

“I haven’t heard any formal next steps. The commission meets again in September, and we might be talking beforehand. I don’t know for sure what discussion will happen,” Bristol added.

“We think it was helpful to hear the questions that were asked and even the discussion between some of the commissioners. We know their top three concerns are access, quality and cost.”

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