Spectrum Metro Health heart program may hike costs

October 4, 2010
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Losing more than 100 patients to a proposed Metro Health Hospital open heart surgery program would be enough to hamper quality and raise prices for heart procedures now done at the Meijer Heart Center, Spectrum Health officials said last week.

“The cost per patient will actually go up and cause an increase in the cost of care. At the same time the quality of care in the city, because it’s being diluted by a startup program, will go down,” said Dr. John Byrnes, senior vice president of system quality for Spectrum Health.

The Alliance for Health, the nonprofit health planning agency that serves 13 counties in West Michigan, has set a public hearing to take comments on Metro Health’s application to launch an open heart surgery program at its Wyoming hospital.

The hearing is scheduled for 10:30 a.m. Tuesday at the Alliance for Health conference room, 1345 Monroe Ave. NW in Grand Rapids. The issue then will move to the organization’s Evaluation Board for a decision on whether to endorse the plan, and from there to Michigan Department of Community Health Certificate of Need staff for a decision.

Both Metro Health and Spectrum Health made presentations at the Grand Rapids Area Chamber of Commerce’s health policy and human resources committee meeting last week, Legislative Affairs Director Andy Johnston said.

“The business community is going to bear the cost of this, so it’s a reasonable discussion for the community to have,” Byrnes added.

In CON filings on the issue, Metro Health contends that Spectrum Health has a monopoly in open heart services in Kent County and that patients would be better served with choice.

“The incumbent sole provider operates the highest volume open heart program in the state of Michigan at nearly 1,000 procedures annually while in complete control of one of the state’s few growing local markets,” Metro Health’s CON application states.

“Cost clarity in the market is clouded by the fact that the existing OHSP facility also wholly owns a robust local health insurer which covers a growing group of over 500,000 members. Competition would provide all payers and patients with a comparable service in the market which is necessary to quantify and control costs.”

Spectrum Health spokesman Bruce Rossman said his health system is trying to steer the debate away from cost and access to issues of patient safety and quality. Studies have shown that in heart procedures, volume is closely correlated with better outcomes.

“Metro came out early and they were publicly trying to frame this whole discussion as being a question of cost and access, which we don’t feel are really true issues,” Rossman said. “They divert attention away from what we feel is the real focus, and so that’s why we publicly came out and said if we’re going to have this discussion, we need to focus on patient safety and quality.”

John B. Mosley, Spectrum’s senior vice president for strategy and business development, argued that the Meijer Heart Center received high marks in cost and quality.

“The Meijer Heart Center is at the lowest quartile of cost and the highest quartile of quality in the country. With the exception of Muskegon, which is comparable to us, we are lower in cost than any of the surrounding heart programs,” Mosley said.

Metro Health has the support of University of Michigan Health Systems, Saint Mary’s Health Care owner Trinity Health, St. Joseph Mercy Health System in Ann Arbor and Ascension Health’s Borgess Medical Center in Kalamazoo in launching the program. It also has received the backing of Physicians Organization of West Michigan Executive Director David Silliven.

A group of doctors formerly associated with West Michigan Heart, part of Spectrum Health, broke off in 2008 and established a cardiac practice at Metro Health. Currently, no open heart surgery is performed at Metro Health, and cardiac catheterization is performed in heart attack emergencies. For other procedures, Metro Health doctors must schedule their patients at the Meijer Heart Center, sometimes turning them over to other doctors. Metro Health also is seeking permission to perform therapeutic cardiac catheterization.

The five-doctor Metro Heart and Vascular practice funnels about 250 heart procedures to the Meijer Heart Center annually, Dr. John Key told the Business Journal earlier this year. That’s because state rules require that a hospital have an open heart surgery program to perform angioplasties on a non-emergency basis.

Two Metro Heart and Vascular doctors who are interventional cardiologists perform non-emergency angioplasty and stent procedures at Spectrum, Key said. Some Metro patients are referred to cardiothoracic surgeons for open heart surgery, which must be performed at Spectrum, as well.

According to Metro Health’s application to the Michigan Department of Community Health, the hospital expects it would handle at least 126 heart procedures based on the expectation of referrals from Saint Mary’s Health Care, Mercy Health Partners and Sheridan Community Hospital, or as many as 507 as the years progress.

However, Suzette Jaskie, executive director of cardiovascular strategies at Spectrum, noted that the number of open heart procedures has been going down in recent years, replaced by stents and medication. She said the loss of patients to a Metro Health program could hamper funding for the research and education function at Spectrum Health’s new heart institute.

The hospital expects about $4 million in capital expenses and a similar amount in personnel costs, adding 14 full-time equivalent jobs.

Alliance for Health President Lody Zwarensteyn said CON standards are the rule for deciding whether Metro Health’s proposal moves forward.

“When a proposal comes in, it is considered almost in the same light as an open-book test is taken,” he said. “There are adopted standards that are well known to everybody in advance. If the applicant is able to meet the standard, the application can be approved. If the applicant does not meet the standard, the application cannot be approved.”

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