Concerned that Maryland has far more hospital beds than it needs, state lawmakers are considering establishing a blue-ribbon commission to determine which hospitals should be closed because they have become obsolete.
The idea -- immediately opposed by the hospital industry yesterday at a health care summit in Annapolis -- is to appoint a group like the federal military base-closing commission that would examine the need for each of Maryland's 50 hospitals.
High-cost hospitals that have too few patients would be prodded to convert into another type of health facility such as a nursing home, drug treatment center or outpatient clinic.
"We're not talking about taking these facilities and mothballing them," said Del. John A. Hurson, a Montgomery County Democrat and the House majority leader. "We're talking about taking these facilities and using them in a much more productive way."
Legislative leaders, chief among them House Speaker Casper R. Taylor Jr., plan to include the proposal in a bill that will be introduced in the coming session to reform the complex system that regulates how much Marylanders pay for hospital care.
Hospital officials, physicians and other industry groups were quick to line up against the prospect of such a commission at the daylong summit that Taylor had convened. They argued that there is a sharp distinction between closing a military base and a hospital: the hospital, after all, is not owned by the government.
Critics predicted that even the best efforts by a commission would go nowhere, just as past state "hit lists" to close hospitals have only panicked communities.
"To abstractly select hospitals for closure, I think is suicidal at the community level," said Michael Chiaramonte, executive vice president of the Southern Maryland Hospital Center in Clinton.
Jack C. Keane, who served on a state commission in the early 1980s that recommended hospital closings and is now a national consultant, also voiced doubts.
"Our report had a half-life of about 12 seconds," he said. "Basically, it had no real broad base of support -- and no real effect. I don't think one hospital closed. It's very tough to close hospitals -- especially through regulation, even more than through a competitive market."
Despite strong opposition, Taylor and others said the time has come to confront the politically sensitive question of how many underused hospitals should be allowed to remain open.
At least 30 percent of the roughly 12,000 hospital beds in Maryland are considered excess. In Baltimore, experts estimate that nearly half the total beds in the city's more than a dozen hospitals are no longer needed.
"We have too many hospitals," said Taylor, an Allegany Democrat who saw two hospitals in his hometown of Cumberland -- Memorial and Sacred Heart -- merge services after a storm of controversy.
"The hospitals we have were all part of a health-care delivery system that is no longer in existence, when you went to the hospital for almost everything, and you were there for a week or 10 days," he added. "You go to the hospital now, you're lucky to be there for two or three days. Our infrastructure is costing our economy. It's costing everyone."
In Maryland as elsewhere in the nation, hospitals are licensed for more beds than they need because of the growth of managed care -- and outpatient clinics. Many health maintenance organizations, in an attempt to hold down costs, have limited the length of hospital stays and sent patients to freestanding clinics for routine procedures.
The excess in hospital beds is worst in Baltimore, where the population has dropped from nearly 1 million to 650,000. New Children's Hospital, for example, is licensed for 76 beds -- but only has about 10 patients on an average day. That hospital is facing closure of its inpatient beds, as is Liberty Hospital, which was acquired by Bon Secours.
Sen.-elect Clarence M. Mitchell IV, a West Baltimore Democrat who represents the neighborhood where Liberty Hospital has long been a fixture, said if a blue-ribbon panel is formed, it could learn from that hospital's experience.
"They have to consult with the community," he said. "Bon Secours got the community to sign onto the idea to change Liberty Hospital into elderly assisted living, and that's in keeping with the demographics of the population."
He suggested that job training be offered for displaced hospital employees, especially for those at the lower end of the pay scale.
TTC Insurers and managed care groups argue that the state is essentially keeping underused hospitals afloat with its rate-setting system, the only one of its kind in the nation.
At the summit yesterday, some insurance industry representatives urged that the rate system be scrapped altogether, saying it would force poor-performing hospitals to change or go out of business -- without any recommendations from a special commission.
Hurson, the House majority leader, said the legislature would be reluctant to make such a dramatic change, since the state would lose millions in additional federal Medicaid subsidies it gets for the poor because of its rate system.
Pub Date: 12/17/98