Dimensions Healthcare System

By Neil Adler
Staff Writer - The Gazette Newspapers

Hospitals protest proposal to give Suburban program

Northern, southern centers say open-heart options needed further out from city.

A proposed decision by a member of the Maryland Health Care Commission to approve an open-heart surgery program at Suburban Hospital in Bethesda has left officials at the three other area hospitals vying for the recommendation concerned and disappointed.

Although the full commission must approve commissioner Larry Ginsburg's Nov. 6 decision, "the large majority of the time the commission goes with the recommendation," said Michael J. Chiaramonte, executive vice president of Southern Maryland Hospital Center in Clinton, one of four hospitals in the Washington, D.C., area that filed applications with the state.

The commission will consider Ginsburg's decision at a public meeting Dec. 10. Suburban's three competitors -- Holy Cross Hospital in Silver Spring, Shady Grove Adventist Hospital in Rockville and Southern Maryland Hospital Center -- plan to fight for their proposals at that meeting, officials at the three hospitals said this week.

Ginsburg's decision was made after his review of the hospitals' applications and other documentation, as well as an analysis of rate offers by the state Health Services Cost Review Commission and seven days of public hearings.

"I concluded that Suburban Hospital will offer the greatest program effectiveness of the applicants, based on its likelihood of achieving [open heart surgery] and [catheterization] volumes above minimum utilization levels while not adversely impacting existing Maryland programs, combined with its strong community outreach program for minority and indigent patients, and its impressive cardiovascular research and training program," he wrote in a memo.

As part of the application process, Dimensions Healthcare Systems, which operates Prince George's Hospital Center in Cheverly and other health care entities in Prince George's County, has opposed the applications of Holy Cross and Southern Maryland. Washington Adventist Hospital in Takoma Park, a sister hospital to Shady Grove Adventist, has opposed the applications of Holy Cross, Southern Maryland and Suburban.

The reason for such opposition is clear: Prince George's Hospital Center and Washington Adventist currently have the only two open-heart surgery programs in the Washington suburbs, and both say a third in the region could hinder their programs.

However, officials at the three hospitals that did not receive the preliminary approval said giving the program to Suburban will limit access to heart surgery for residents in the Washington area.

"Now the north -- and frankly the wealthy county -- will have two [OHS programs] close together," Chiaramonte said. "But we've got a lot of people here. We're disappointed for the community."

Chiaramonte argued that the Suburban program will not provide much relief to the roughly 800,000 Maryland residents who live south of the Capital Beltway.

"We're troubled from a point of access," he said, noting in particular the large black population in southern Prince George's County. African Americans, Chiaramonte said, have a 12 percent higher incidence of heart disease than whites.

"There's definitely a need down here," he said.

Robert Jepson, a spokesman for Adventist HealthCare Inc., the Rockville parent company of Shady Grove Adventist and Washington Adventist, said the Suburban plan "ignores the needs in upper Montgomery and lower Frederick counties."

This region, he said, is experiencing a large population surge, yet Suburban's proposal "does not figure that into the equation."

Jepson and Chiaramonte agreed that the relatively close distance between the current program at Washington Adventist and the proposed one at Suburban is a serious concern.

"Prince George's Hospital Center has a program about 35 miles away from us, [yet] Suburban is [roughly] six miles from Washington Adventist. This is disappointing," Chiaramonte said.

Jepson, after hearing Chiaramonte's comment, added: "That's a very, very good point. The downcounty area is well-served. It makes sense to put this new program in a fast-growing region."

Like his counterparts at Southern Maryland and Shady Grove Adventist, Mike Hall of Holy Cross said his hospital is disappointed by Ginsburg's preliminary recommendation.

"We are preparing a response right now. I do hope we have a legitimate shot before the commission. Given our community and the people we serve, our greatest asset is providing quality health care to those who can't afford it," said Hall, a hospital spokesman.

"We have particular expertise in reaching patients with special needs, including racial and ethnic minorities."

Officials at the three hospitals were vocal about their disappointment and concern over Ginsburg's decision, but Suburban executives have remained quiet outside of a company statement released Nov. 6 by President and CEO Brian Gragnolati.

"Suburban Hospital is very pleased" with Ginsburg's recommendation, Gragnolati said, adding that if his hospital's plan is approved by the commission in December it will move forward with its OHS program, which includes partnerships with Johns Hopkins Medicine and the National Heart, Lung and Blood Institute, part of the National Institutes of Health in Bethesda.

"That was pretty sexy. It was interesting," Chiaramonte said of Suburban's proposal to work in conjunction with those two parties.

"The question is, do you want someone to do stem-cell research on hearts or give access to those who need it? [Ginsburg has] elected the former. Research above access."

Chiaramonte pointed out that the winning hospital will be able to charge only between $13,000 and $15,000 for open-heart surgery because there was a bidding process in terms of cost to help determine which hospital should get the program.

By comparison, he said, open-heart surgeries can range from $18,000 to $40,000, depending on the complexity of the surgery and the deal made between the hospital and a managed care company.

"Suburban is a very good hospital, but I do worry a little bit about their volume. Between the low price and competition, [the hospital that does get the program has] got their work cut out for them," Chiaramonte said.

Nancy Fiedler, a spokeswoman for the Maryland Hospital Association, said her group declined to comment on Ginsburg's decision because its members include both hospitals that have OHS programs as well as those vying for one.

"Some will argue we do need more [OHS programs], if they don't one," she said. "And some will argue that we don't need more, because they already have one."

Despite the early nod to Suburban, the other three hospitals will keep fighting the battle until the commission's hearing.

"The reason we filed an application, and will continue to advocate, is because the hospital has a responsibility to serve the needs of our community," Jepson said.

"We'll make some arguments in December and try to hang in there," Chiaramonte said.

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