HEART SURGERY: Hospitals Vie for Lucrative Licenses

      Several states are engaged in battles over regulations that tightly control the number of hospitals allowed to perform lucrative heart surgeries. In Maryland, some of the state's "most prominent lobbyists" are working on behalf of a dozen hospitals that want a share of the state's open-heart surgery market. Currently, the Baltimore Sun reports, open-heart surgeries are allowed at only eight of Maryland's 50 hospitals. And while decisions about which facilities are allowed to perform the procedures has typically been the responsibility of the state's Health Resources Planning Commission, "hospitals are taking a step further by asking legislators for the first time in a decade essentially to deregulate a specific medical procedure." Nelson Sabatini, a former state health secretary who now lobbies for the University of Maryland Medical System, said, "They're saying, 'Let health policy be made in a political process.'" Opponents say it could turn the health services decision making process into a political free-for-all, and predict "similar lobbyist-laden battles ... over such specialties as neonatal intensive care, organ transplants and burn treatment" that will cause health costs to soar. However, for state Del. Thomas Dewberry (D), whose parents had to "leave their local hospital ... and travel to other facilities for heart procedures," the issue is one of "power and money." He said, "These large hospitals have their tentacles throughout the whole health system in the state." The Sun reports that prospects of defacto deregulation effort are uncertain (Waldron, 3/18).

Practice Makes Perfect
      State regulators in Massachusetts are similarly involved in debates over the number of hospitals certified to perform open- heart surgery. The Boston Herald reports that the state health department will likely allow only three community hospitals -- half the number expected -- to perform open heart surgery. The department grants licenses to those hospitals that they estimate would be able to perform 300 open-heart operations annually, noting that "patients of busy surgeons fare better than those of doctors who perform the procedure less often." The health department commissioned a study, concluding that Southcoast Health System, Cape Cod Hospital and North Shore Medical Center would all qualify for licensure, however Brockton Hospital, MetroWest Medical Center and South Shore Hospital would be denied. The license is particularly attractive to hospitals, because state policy bars them from performing less-invasive heart operations without the open-heart license. Health care consultant Ellen Lutch Trager predicted that the restrictions "would change," saying, "Through either legislation or regulation -- open-heart surgery is going to be provided in a community- based setting" (Convey, 3/18).

Priming the Pump
      In other Massachusetts news, the University of Massachusetts medical center yesterday received state regulators' approval for a new heart transplant program, bringing the state's total to five. Warning that UMass' competition could strain an already critical supply of organs, the state Department of Public Health will require the medical center to participate in a public campaign to encourage organ donation. And to ensure that surgeons perform enough transplant operations to stay experienced, UMass must perform at least nine heart transplants by the program's second year (Kong, Boston Globe, 3/17).