Local board to mull Metro heart proposal next week

October 8, 2010
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Metro Health Hospital is prepared to push its request for new programs in heart surgery and cardiac catheterization as far as necessary to seek certificate of need approval, its consulting lawyer said last week.

“We would begin the certificate of need process with the understanding that we would be committed to seeing it through to the end,” said Brett H. Henderson, of Lansing law and government relations firm Kelley Cawthorne. “That’s simply the CON process.

“In this instance, we began the process of compiling a highly detailed application that we intended to advocate for within the CON process. But if that doesn’t yield the success the clients want, then we have to be committed to the next step.”

Metro Health is seeking permission from MDCH to perform cardiac surgeries and non-emergency catheterization at its Wyoming location. Currently, Metro Health is allowed to do only emergency catheterization. Spectrum Health is the only hospital in Kent County authorized to perform the full range of cardiac procedures.

An Alliance for Health public hearing last week featured verbal jabs between Henderson and Dr. John Byrnes, senior vice president of quality at Spectrum Health, which is fighting Metro Health’s proposal. Grand Rapids’ third hospital, Saint Mary’s Health Care, and its parent company, Trinity Health, support Metro’s bid.

Next week, the Alliance for Health’s Evaluation Board will examine Metro Health’s application and make a recommendation to MDCH staff in Lansing.

Henderson said he intends to comply with Alliance for Health President Lody Zwarensteyn’s request for a legal opinion about the method Metro Health employed in its application to count potential surgical cases.

Based on commitments from other hospitals, the Michigan Inpatient Data Base and the formula in CON standards, Metro Health counted a potential for 126.57 surgical cases. State standards require 300 cases within three years of establishing a program.

By adding commitments from physicians to divert their heart patients to Metro Health, the hospital’s application boosts its estimate of open heart procedures by 389.99 to 507.56.

While CON standards don’t require that open heart surgery applications take into account physician referrals, it’s not prohibited, either, Henderson contended, and physician referrals are used for other CON-covered services.

CON standards also require that a facility offering therapeutic cardiac catheterization have an open heart surgery program in case of complications.

In written comments, Henderson noted that the 12-county health service area has one open heart surgical program per 700,000 residents, compared to a statewide ratio of one program per 290,000.

In addition to Spectrum, Mercy Health Partners, another Trinity Health hospital, also provides open heart surgery in the health service area. Together, the two perform 1,250 procedures annually. Spectrum performs more than 900 heart surgeries annually, making it the busiest program in the state.

Spectrum Health argues that by taking away part of its volume, a program at Metro Health would depress quality measures in both locations.

Metro Health would consult with the University of Michigan, St. Joseph Mercy Health System in Ann Arbor and Borgess Medical Center in Kalamazoo in setting up the program, according to its application.

“Our response to whether or not there is quality in this application is quite simply whether or not you believe that those partners, all three of them in some combination, would help Metro and Saint Mary’s to build a quality program. We’re obviously confident of that,” Henderson said.

In his written comments, Byrnes pointed out that Michigan already has 33 open heart surgery programs, and 18 of them do not meet the CON standard of 300 cases per year. The number of surgeries has declined statewide by 14 percent since 2005, he said.

“More open heart programs are not needed anywhere in Michigan,” Byrnes stated.

Lyda Phillips, a HealthLeaders-InterStudy Michigan market analyst, said that cardiac services make money for hospitals.

“They’re very lucrative,” she said. “One of the things that makes providers like cardiology is that it is more predictable revenue, for the most part.”

Metro Health’s application indicated that it anticipates margins from the proposed programs would average between about $1,900 and $2,900 per case.

However, heart doctors across the country have been seeking hospital employment because of big Medicare reimbursement cuts that went into effect this year, according to Cardiology Business magazine.

The Alliance for Health Evaluation Board is scheduled to meet at 9 a.m. Oct. 21 at Grand Valley Health Plan, 829 Forest Hill Ave. SE.

After the board’s recommendation, the application moves to CON staff at the MDCH. The proposed decision then is accepted or rejected by the MDCH director. Applicants may appeal a decision and go through a hearing with an administrative law judge. After a final decision from the Michigan Department of Community Health director, the appeals process moves into Circuit Court, according to Larry Horvath, manager of the CON section.

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