The Washington area would get a new open-heart surgery program, but the rest of the state - including the Baltimore region - would not, under recommendations issued yesterday by the staff of the Maryland Health Care Commission.
If the commission - which usually agrees with its staff - approves the proposals at its meeting next month, hospitals could apply for the new Washington area program. Suburban Hospital in Bethesda, Holy Cross Hospital in Silver Spring and Southern Maryland Hospital Center in Clinton have indicated interest in starting programs.
Tackling another thorny issue at its meeting, the commission approved a series of changes designed to keep premiums down on the health policies offered by small employers. The trade-off for lower premiums, however, is higher costs for patients in deductibles and copayments.
Both issues have brought vigorous testimony at public hearings. The open-heart plan generated so much written reaction - about 500 pages' worth - that commission staffers took to calling the stack of comments "the Harry Potter book."
An open-heart program can be worth tens of millions of dollars a year to a hospital, and the state limits the number to control costs and ensure quality. Hospitals without the program have been trying to get the commission to approve more programs, saying more programs would improve patient access and, because of competition, lower costs.
The hospitals that already offer open-heart surgery have argued that they can serve all the patients who need the care, so any new programs would add cost and dilute the quality of existing programs.
The commission's staff recommended yesterday that another program be approved in the Washington suburbs not because existing programs are full, but because one hospital, Washington Hospital Center, dominates the market, performing about two-thirds of the open-heart procedures in the District of Columbia and its Maryland suburbs.
Hospitals that want to open more programs have gone not just to the commission, but to the legislature, seeking to deregulate the process. The commission is to discuss next month whether to recommend a change in the approval process. Such a change would require legislative action.
In the Baltimore area, hospitals that have shown interest in starting open-heart programs include Greater Baltimore Medical Center in Towson, St. Agnes Health Care in Catonsville and Anne Arundel Medical Center in Annapolis. Current Baltimore area programs are at Johns Hopkins Hospital, St. Joseph Medical Center, Sinai Hospital, Union Memorial Hospital and University of Maryland Medical Center.
In the rest of the state, hospitals that do not perform open-heart surgery would, under the staff's proposals, have a shot at performing angioplasty, a procedure in which a tiny balloon is used to unblock blood vessels. Generally, angioplasty is done only at hospitals that perform open-heart surgery, in case the patient develops problems.
For several years, however, the state has allowed an experiment with angioplasty at some hospitals that do not have open-heart programs, and the staff proposed convening a medical committee to draw up rules for allowing more types of angioplasty in similar experiments.
The staff also recommended a plan to ease the process for a hospital to get approval to offer an obstetrics program.
Under the staff proposal, hospitals would still need commission approval, but the standard for projecting need would be eased and the review process would be speeded up.
In a series of votes yesterday, the commission approved higher deductibles and copayments in the state-regulated policies offered by companies with up to 50 employees. The policies cover nearly half a million Marylanders.
Commission members indicated reluctance to impose more out-of-pocket costs on patients, but said they were bound by state law to keep premiums affordable. Without some kind of change in benefits, actuaries projected that the premiums could exceed the affordability ceiling next year.
The deductibles - the amount a patient must pay before insurance coverage begins - will increase in indemnity plans from $750 per person to $1,250, and in preferred-provider plans from $600 to $1,000. (Family deductibles are double the individual figure.)
For people covered by HMOs from small employers, copayments for visits to the doctor, now $10 for primary care and $20 for specialists, will go to $20 and $30. And there will be a new $250 deductible on hospitalizations.
For all policies, the deductible on prescriptions will increase from $150 to $250.