Heart services needed at Metro Health, doctor says

April 23, 2010
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Providing cardiac catheterization and open heart surgery at Metro Health Hospital would end transfers to Spectrum Health’s Meijer Heart Center for patients and doctors, an osteopathic heart specialist said last week.

Metro Health last week took the first step toward seeking state permission to establish those services at its hospital in Wyoming. The nonprofit filed a letter of intent with the Michigan Department of Community Health, indicating that it is interested in seeking a Certificate of Need for the program.

Currently patients who may undergo emergency or diagnostic heart procedures at Metro Health or Saint Mary’s Health Care must be transferred to the Meijer Heart Center if further treatment is needed, said Dr. John Key, a member of Metro Heart and Vascular. MHV doctors then perform the interventional cardiology or surgical procedures at Spectrum, Key said.

“When some patients have their diagnostic angiogram done at either Saint Mary’s or Metro Health Hospital, sometimes we do have to sit on those patients either due to bed availability problems at Spectrum or due to cath lab openings at Spectrum,” he said.

“There’s not an insignificant cost as well associated with having to transfer patients, having to duplicate staff and supplies at the other hospital. We already have the patient on a table in the cath lab room with supplies open and all that kind of stuff and then we transfer them. Then all those supplies and stuff have to be reopened at Spectrum. It’s an all new set of staff. There’s not an insignificant cost to the patient and providers.”

Demand for heart services at Metro Health has increased since the hospital moved from Grand Rapids to Wyoming in 2007, Key said. The hospital has the leeway to allow MHV physicians to perform many types of cardiac procedures, he said.

But coronary artery bypass surgery, valve replacement surgery, elective angioplasty and stenting and catheter ablation cannot be performed at Metro Health. MHV doctors do those procedures, but must send those patients to the Meijer Heart Center for them, Key said.

“We support their (Spectrum Health’s) numbers,” he said.

State regulations require that hospitals offering certain interventional cardiology procedures also have open heart surgery capabilities in case of complications. They require that a hospital perform a minimum of 300 procedures annually.

“The way the state has the guidelines set up, we can take care of a critical patient in the throes of having a myocardial infarction and who may be unstable. We can take care of that patient, stent them and keep them in our hospital,” Key said.

“But a patient that has a diagnostic catheterization done and is stable, and we find a significant coronary lesion, we cannot stent it. That patient has to be transported. So we can take care of the sickest of the sick, but we can’t take care of the stable patient.”

Metro Health, supported by hospitals from across the state, requested that the Certificate of Need Commission appoint a committee this year to study regulations for catheterization and open heart surgery, 12 months ahead of a scheduled review. The CON Commission agreed to create a catheterization committee this fall but leave open heart surgery for next year.

Key said he would like changes in regulations that ask for statistics based on a hospital’s number of discharges for diagnoses related to heart conditions.

“Nowadays a significant amount of those patients are cared for in an outpatient setting,” he said. “So it’s sometimes very difficult to show the numbers as far as inpatient discharge.”

Spectrum Health Strategic Program Manager Bob Meeker spoke against the move at a commission meeting earlier this year, arguing that the services are readily available and that higher volume has a positive impact on quality.

“Volume and quality have been linked by repeated studies,” Meeker added. “The more you do, the better you are, and by providing additional sites it’s only going to dilute the volume and therefore the quality of the existing sites, and create more small volume services.”

In 2008, Spectrum Health performed 972 open heart surgeries and more than 13,000 catheterization procedures on adults, according to its application for the heart and lung transplant program which was approved in February.

Last year, the area’s largest group of heart doctors, West Michigan Health, became a subsidiary of Spectrum Health. However, before that occurred, a group of WMH’s osteopathic doctors split off to associate with Metro Health as Metro Heart and Vascular.

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