The length of time between when a patient suffers a heart attack and gets to a hospital for diagnosis can be, well, not short enough.
That’s well known. What might not be as well known is that, if you live in the Annapolis or North County areas of Anne Arundel County and have that issue — and need surgery, as soon as possible — you may have to make a trip (maybe via helicopter) to another nearby hospital that has an open heart surgery center.
That’s not comforting news. However, it is heartening to hear that Anne Arundel Medical Center (AAMC) and the University of Maryland Medical System’s Baltimore Washington Medical Center (BWMC), in Glen Burnie, have applied to the Maryland Health Care Commission (MHCC) for approval to open an open heart surgery center.
Only one will be granted a license, however. Both formally applied Feb. 20, 2015, with the applications docketed June 26, 2015. Executives at AAMC said they’re wondering about the length of the wait.
The Numbers Work
Paula Widerlite, chief strategy officer for AAMC, pointed out that not many hospitals in Maryland offer open heart surgery centers. There are just 10 between the approximately 60 hospitals in the state, including the University of Maryland Medical Center (UMMC), Union Memorial Hospital, Sinai Medical Center and The Johns Hopkins Hospital, all in Baltimore City; and St. Joseph’s Medical Center, in Towson.
Locally, like AAMC, Howard County General Hospital does not house an open heart surgery center, but does offers extensive heart-related services.
The numbers from AAMC that Widerlite provided are enough to make a community member wonder if, indeed, now is the time.
“In 2014, 500 people had to leave Anne Arundel County to have open heart surgery; more than 200 of them went from AAMC to Washington Hospital Center (WHC, in Northeast D.C.), others went elsewhere,” she said, adding that AAMC has the potential to perform more than 300 such surgeries annually and “that would save the state of Maryland $12 million a year.”
Widerlite added that the state health plan was recently updated by the MHCC, and AAMC demonstrated significant need for such an addition. “You must demonstrate that you can perform 200 surgeries in a year. The other main requirement is to prove that you can run a quality program in a cost-effective way,” she said, “and we are a very busy cardiac center already” at what she termed “the third busiest hospital in the state,” according to the Maryland Hospital Association (MHA).
She said that capital costs to add an open heart surgery center at AAMC, which is a $700 million nonprofit, would be “about $2.5 million,” which is a low figure, partially because adding such a facility was part of the hospital’s design. In addition, Johns Hopkins Medicine is AAMC’s partner in the effort, so it would provide AAMC with cardiac surgeons.
A Busy Place
Dr. Jerry Segal, medical director for cardiovascular services at AAMC, said obtaining approval to add the open heart surgery center at the 10-year-old facility has been “lobbied for, for a long time,” and stressed that the closest hospital that offers the service “is about 30 miles away,” meaning UMMC, Hopkins or WHC.
Like Widerlite, Segal pointed out that most interventional cardiac procedures are already conducted at AAMC. “We’re one of the busiest [cardiac centers] in Maryland, already,” he said. “We handled about 185 C-PORT cases in 2015, twice as many as Hopkins and most hospitals in the state, so our heart attack patients can have an emergency percutaneous coronary intervention to open up the vessels.
Also, the national standard for treating [a heart attack] “is about 90 minutes, before scar tissue starts to form. We were among the best in the state in the last national rankings, and we made it about 98% of the time,” he said.
“We sent out more than 350 patients that could have been placed in surgery here last year,” said Segal. All told, AAMC performed 1,200 diagnostic cardiac catheterizations, and electives with a stent totaled 275 in 2015, “plus 350 other procedures for pacemakers, defibrillators,” etc.
“The only thing that we don’t offer,” said Segal, “is cardiac surgery.”
As for being part of a comparative review with BWMC, Segal pointed to AAMC’s location and access (an extra entrance was built for the hospital area many years ago, off of Route 50), calling it “superior to that of BWMC.
“I think that we’re better positioned to provide the service in our community and to our patients,” he said, “and remember, BWMC is part of UMMS, and UMMC is fairly close by (on Greene Street, in Downtown Baltimore), and they have other hospitals in the system that offer that service.”
When approached for comment for this article, BWMC spokesperson Kevin Cservek would only accept questions via email that were answered with short responses. He confirmed that most heart surgery patients from BWMC were taken to UMMS, and said that in fiscal 2014, 258 patients receiving a cardiac catheterization procedure at BWMC were referred for a cardiac surgery evaluation.
Cservek added that project costs to add a surgery center at BWMC would be $1,259,117, with a capital expenditure of $1,159,117; incremental staffing costs were projected to be $2.8 million.
It’s interesting to note that most people don’t think about such services offered at their local hospital until they need them. “Many people come here and assume that we offer open heart surgery, but we don’t,” said Widerlite, “and they may end up needing a helicopter ride that can cost from $12,000 to $50,000,” which isn’t always covered in full by insurance.
Today, the question is about when the MHCC will make a decision. By press time, Ben Steffen, executive director of the MHCC, had responded to an email from The Business Monthly and said the applications are “in the final stages of review,” with information, but did not agree to answer questions for this article. Also, Carmela Coyle, president and CEO of the MHA, did not respond to requests for an interview.
“We hope by the end of the year we’ll hear something,” Widerlite said. “I think the community, and region, deserves better access for cardiac surgery, and we’ve waited long enough.”