MedStar Health is asking a court to block new open-heart surgery regulations, charging that the Maryland Health Care Commission "arbitrarily and capriciously 'cooked the books' " to justify an additional open-heart program in Maryland's Washington suburbs.
MedStar, with headquarters in Columbia, owns seven hospitals, including Washington Hospital Center, which runs the dominant heart surgery program in the District of Columbia and its Maryland suburbs.
MedStar also does open-heart surgery at Georgetown University Hospital, and is hoping for that program to grow.
Suburban Hospital in Bethesda, Holy Cross Hospital in Silver Spring and Southern Maryland Hospital Center in Clinton have indicated interest in starting programs, which could compete with Washington Hospital Center and Georgetown.
Under the health plan update adopted this year by the commission, one of those hospitals (or another hospital in the D.C. suburbs of Maryland) could receive permission by next year to open a cardiac surgery program.
But MedStar filed suit this week in Howard County Circuit Court seeking to block the plan, arguing that it "changes dramatically and unlawfully the methodology for projecting need for cardiac surgery programs."
Barbara McLean, acting executive director of the commission, said yesterday that her office had not been served with the suit.
But, she said, "We stand by our methodology," which involved a "thorough and systematic" process, lasting more than six months and including public hearings, to develop the update to the health plan for heart surgery.
The commission limits the number of open-heart surgery programs, along with some other medical services, to control price and quality.
In addition to the D.C. area programs (including Washington Adventist Hospital in Takoma Park and Prince George's Hospital Center in Cheverly), there are five open-heart programs in the Baltimore area and one each on the Eastern Shore and in Western Maryland.
The commission updates the heart surgery health plan every few years.
Cardiac surgery is a major revenue generator for hospitals, and each update round produces lobbying by hospitals that want to start programs, and counter-lobbying by hospitals that have programs and oppose the creation of new ones.
Hospitals that offer heart surgery say new programs would add to the cost and dilute quality, while "have-not" hospitals argue that more competition could lower cost and that patient access would be improved.
MedStar's court action challenges a new method used by the commission to calculate program capacity.
MedStar's Washington Hospital Center performs about 3,000 operations a year, nearly three-quarters of the heart surgeries in the District of Columbia and its Maryland suburbs.
The commission, after arguments by Suburban and Holy Cross that more competition would benefit consumers, decided to limit its capacity figure for any hospital at half the volume in the region, producing a lower capacity estimate for Washington Hospital Center.
John L. Green, executive vice-president of MedStar, said this capacity calculation was "a thinly disguised political solution on the part of a body that is supposed to be nonpolitical."
Green said he thought the political issue was that Washington Hospital Center's popularity had produced "a great concern that patients are being seen at an institution that is not in the state of Maryland."
MedStar also charges in its court filing that the commission acted improperly in giving final approval to its plan and regulations because the General Assembly's Joint Committee on Administrative, Executive and Legislative Review (AELR) had opposed them.
A majority of joint committee members had signed a letter saying they opposed parts of the regulations, but the committee did not take a formal vote to block them.
McLean said the commission was advised by the attorney general's office that "the letter is not an official action of AELR."
She said she hoped the court action would not delay the review to choose the new open-heart surgery hospital in the Maryland suburbs of Washington.
The commission plans to begin reviewing applications in September, McLean said, with a decision probably in the spring.