Cardiac rules review sought

December 14, 2009
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Metro Health Hospital and Saint Mary’s Health Care parent Trinity Health were among 10 health systems that asked the state last week to consider dropping a requirement that hospitals performing therapeutic cardiac catheterization have the capability to perform open heart surgery.

The coalition of health systems asked the Michigan Department of Community Health’s Certificate of Need Commission to move its review of standards for open heart surgery and cardiac catheterization from 2011 to 2010. The commission is expected to decide in January which standards it will consider during 2010.

The coalition included Botsford Hospital, Detroit Medical Center, Garden City Hospital, Henry Ford Health System, Hurley Medical Center, as well as Metro Health, Trinity Health and individual Trinity Health hospitals, including Saint Mary’s, Mercy Health Partners in Muskegon and St. Mary Mercy Livonia.

Changes in reimbursement patterns to reflect quality and outcomes, the move toward patient-center medical homes, standardization and new technology are combining to make Michigan’s current standards obsolete, Trinity Health Director of Health Networks Cheryl Miller told the CON Commission.

Even as open heart surgery is giving way to medication and interventional cardiology, some hospitals maintain open heart surgery programs that barely meet minimum volume requirements in order to meet the standard required to perform cardiac catheterization, Miller contended in her presentation.

In addition, Dr. Mike Jaggi, CMO and director of emergency medicine for Hurley Medical Center, told commissioners that improvements in technology and experience in techniques have eliminated the usefulness of having open heart surgery assets available to back up catheterization.

If open heart surgery were no longer required for a hospital to provide therapeutic catheterization, some might close open heart programs, thereby increasing volumes at remaining programs while still providing access for other heart procedures, Miller stated.

Also at the commission meeting, Susan Heck, a senior vice president at cardiac program consultant Corazon Inc., contended that it is more expensive for patients to be transferred to open-heart-capable hospitals for procedures requiring catheterization.

In June, Metro Health asked the commission to look at the standards ahead of their scheduled review. The standards were reviewed in 2007 and 2008, and a regularly scheduled review is expected in 2011.

At that time, the commission declined to take action, telling Metro Health to return with compelling data, ask for an early review in 2010 or wait another year.

At that time, Metro Health COO Brian Jepson said that a key hurdle for the hospital was to show that it would perform at least 300 open heart procedures annually.

In October, six cardiologists left West Michigan Heart to form Metro Heart & Vascular, a new practice with three locations.

Currently catheterization is performed at Metro Health in emergency cases only. In Grand Rapids, open heart surgery is limited to Spectrum Health’s 164-bed Meijer Heart Center.

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