State set to decide on cardiac program in county

After 25 months of waiting, an Anne Arundel County hospital could be approved for an open-heart surgery program today.

The Maryland Health Care Commission is expected to decide if Anne Arundel Medical Center or Baltimore Washington Medical Center will receive a certificate of need for a cardiac surgery program. A reviewer for the commission, Dr. Craig Tanio, has recommend that AAMC receive the CON application. But BWMC, other regional hospitals and politicians from neighboring Prince George's County are against the recommendation.

At today's meeting, the hospitals will have 15 minutes to argue for the CON application, while interested parties will have 10 minutes. The commission is an independent regulatory agency of 15 members appointed by the governor. Two members live in Anne Arundel County.

The hospitals submitted their applications for the CON in February 2015. Cardiac patients at both hospitals are currently treated by angioplasty with a stent with the more serious cases sent to hospitals in the vicinity of Baltimore or Washington.

BWMC wrote in its application that the University of Maryland Medical System, which the hospital is a part, would hire two more cardiac surgeons and has been training the nursing staff. The hospital's proposal would cost $1.3 million for equipment and would expect to have 204 cardiac surgery cases in fiscal year 2017.

AAMC said it would work with Johns Hopkins Hospital and bring Hopkins' cardiac surgeons to the hospital to start the program. The Annapolis' hospital proposal would cost $2.5 million for equipment and expect to have 241 cardiac patients in FY17.

The road to today has been long and loud. To review:

Vote(s) of confidence

In late December, Tanio, who served as a reviewer for the applications, recommended that AAMC receive the CON application and denied BWMC.

He wrote in the 147-page report that AAMC "has the highest potential for establishment of a lower charge cardiac surgery program that will also be high performing."

Tanio also wrote that AAMC is the larger hospital and has a better geographic location than BWMC, putting it in a better position to have "the most positive impact on reducing travel time for cardiac surgery services."

But Tanio's recommendation did come with conditions: The first, he wrote, is that if the hospital's cardiac surgery program fails to receive 200 open-heart surgery cases by its second year, AAMC will have to cooperate with the commission's required evaluation of closure of the program. The second and third conditions are that AAMC and Johns Hopkins Hospital cannot approach the state's Health Services Cost Review Commission to ask for an increase in global budgeted revenue.

Tanio released a revised recommended decision in March that made changes to the original memo, but didn't alter his overarching findings or recommendation. He reconfirmed support for AAMC but wrote that some information in the original recommendation "should have been provided to the parties with sufficient time for them to comment on this information prior to the commission's consideration of my recommendation."

Similar to his December recommendation, Tanio wrote that only one cardiac surgery program should be started in Anne Arundel at this time. While both AAMC and BWMC could have a "competent program," he decided to go with the "most prudent approach."

Critical opinion

Regional hospitals and politicians have since publicly questioned if there should be a cardiac surgery program in Anne Arundel.

BWMC; Dimensions Health Corp., the parent company of Prince George's Hospital Center; and MedStar Health filed papers soon after the initial recommendation asking the MHCC to reject the recommendation. The hospitals argued AAMC and Tanio didn't carefully consider the impact the certificate of need will have on Prince George's Hospital Center.

A month ago, the Prince George's hospital filed a motion for recusal and strike of the updated recommended decision, citing that Tanio had a conflict of interest. The hospital wrote that Tanio's ex-wife is a Johns Hopkins cardiologist and both are raising their children together. Tanio is also an unpaid faculty member at Johns Hopkins School of Medicine.

The hospital wrote that the information should have been disclosed earlier and the "proper remedy is to vacate the recommended decision and begin the application review anew."

AAMC filed paperwork opposing the motion and wrote that it was a "last ditch effort to derail this process after participating as an interested party in these proceedings for approximately a year and a half without complaint." AAMC clarified that Johns Hopkins doesn't own the Annapolis hospital but is rather affiliated.

Tanio responded he would have recused himself if a conflict of interest existed. But PGHC's motion, "neither demonstrate actual prejudice on my part, nor do they provide a basis upon which my impartiality can reasonably be questioned," he wrote.

Prince George's County elected officials have been outspoken in their opposition to the creation of a cardiac surgery program in Anne Arundel. Prince George's County Executive Rushern L. Baker III, a Democrat; the Prince George's County Council; Maryland Senate President Thomas V. Mike Miller Jr., a Democrat whose district includes part of Prince George's; and Senate and House of Delegates delegations from the county held a news conference in January about how they believe a cardiac surgery program in Anne Arundel will negatively affect the upcoming Prince George'sRegional Medical Center.

Anne Arundel County Executive Steve Schuh, a Republican, has been a vocal supporter of a cardiac surgery program in the county. He wrote a letter to BWMC in January, asking the hospital to withdraw its challenge to a cardiac surgery program at AAMC because it "threatened to undermine Anne Arundel County's chances of establishing a much needed cardiac care program."

Miller's counterpart in the Maryland House of Delegates, Speaker Michael E. Busch, a Democrat who is a member of the University of Maryland Medical System's board of directors and whose district includes Annapolis, has also backed the establishment of an open-heart surgery program at AAMC.

Credit: By Meredith Newman - mnewman@capgaznews.com