| Home » News » News Archive » Cardiovascular Editorial |
The need for additional cardiac surgery services in central Maine has been widely debated of late. This service requires a Certificate of Need from Maine Department of Human Services (DHS). The DHS, in a competitive bid process, selected Public Health Resource Group (PHRG) to study the need and demand for this and related cardiac services in Maine. Healthcare decisions under CON require the evaluation of each of three key dimensions: access, quality, and costs. These dimensions speak to the public's rights and expectations to have access to needed services that are of high quality, and at a reasonable cost.
For this study PHRG analyzed extensive (ten years) data about each hospital applicant and the people they serve, including risk factors for heart disease (such as smoking, exercise, obesity, high blood pressure, high cholesterol, and age trends), disease patterns, outcomes of care, use of cardiac services, travel distances, and many other aspects of quality and access to care. For each applicant, we created a profile of their immediate community, using established heart health measures. We studied the need/demand for open heart surgery as well as cardiac catheterization and angioplasty, trends in treatment, advances in technology, and other relevant issues.
The good news is that heart health in Maine is improving, techniques for treating heart attacks are advancing, and the need for open heart surgery, is declining. However these findings were not uniform throughout the state. In northern Maine some risk factors are improving but outcomes are worsening. In central Maine, however, heart health has improved substantially- for example, smoking rates have declined and exercise rates have improved over the past 10 years; doctors are doing a better job diagnosing and treating heart disease resulting in lower heart disease mortality. And central Maine was the only community we studied where the rate of cardiac catheterizations has actually declined. It also has the slowest increase in open heart surgery and angioplasty rates. Clearly services to heart disease patients in central Maine are both available and effective.
To determine the number of open heart surgeries and angioplasties that would result if a program were approved for Central Maine Medical Center, we used three different methods. To give CMMC the benefit of the doubt, each method assumed that a new program would be as successful as Maine Medical Center is in attracting market share from its service area. Moreover, we assumed that most of St. Mary's (hospital) catheterization patients would utilize CMMC for heart surgery. Even with these generous assumptions, volume estimates for a new program barely reached 200, the minimum standard for a program in Maine.
From this analysis, we concluded that a new cardiac surgery program in central Maine would, almost certainly, be a low volume one that would face difficult challenges to achieving high quality outcomes. Like many procedures in medicine, studies continue to show that the more open heart surgery or angioplasties a program does, the better the results in terms of fewer complications and fewer deaths.
Thus our recommendation that additional open heart surgery services are not needed in central Maine at this time was based upon:
DHS's goal is to ensure that communities have access to needed health care services. Adding unneeded services, however, drives up everyone's health care costs. These costs flow through health care providers to the insurer and then onward to the employer and employee, government programs such as Medicare and Medicaid, and ultimately is passed in higher costs to the taxpayer.
DHS is faced with a striking a delicate balance between community need, quality, access, and the Maine people's ability to bear new costs. We are proud of our work, and our role in helping DHS make a decision that will affect everyone for years to come.