By Adam Wilson, The Olympian, Olympia, Wash.
Jul. 9–New standards for angioplasties would harm smaller hospitals, such as Olympia’s Capital Medical Center, opponents said during a public meeting Tuesday in Tumwater.
Doctors and administrators from Longview, Skagit County, Yakima, Walla Walla and Vancouver, Wash., came to the Department of Health headquarters to speak against the proposal, which could take effect as soon as July 15.
An angioplasty is a potentially life-saving operation that involves sticking a balloon in a clogged artery. Only “expert” hospitals — those that perform angioplasties more than 300 times a year — would be allowed to perform the procedure except in emergency cases under the Department of Health proposal.
Because cardiologists expect to be able to perform angioplasties, the proposal would make it difficult for small hospitals to recruit the doctors, said Jody Carona, who helped organize a coalition of hospitals opposed to the rule changes.
The procedure costs an average of $64,000, which includes three years of follow-up treatment, according to a 2006 study published in the magazine Circulation. About 16,000 such procedures are performed statewide each year, Carona said.
The money from doing scheduled angioplasties helps pay for being set up for emergency angioplasties, she said.
“For the hospitals who are doing emergency procedures, it becomes very, very expensive,” Carona added.
The new rules would bar Capital Medical Center from performing non-emergency angioplasties. Providence St. Peter Hospital, also in Olympia, would be large enough to continue performing the procedures.
“Emergencies are more complicated. It’s more difficult, and yet we have excellent outcomes,” said Capital’s chief nursing officer, Lisa Moylan.
Offering elective angioplasty at two hospitals 10 minutes apart wouldn’t improve access for South Sound patients, said Dr. Bill Gavin, medical director of Providence’s Regional Heart Center.
Allowing more hospitals to offer the procedure would take revenue away from Providence, making it more difficult for the hospital to recover the costs involved in setting up for the procedures, he said.
“It would make no sense to damage that program,” Gavin said.
Many of those who testified against the proposed rules Tuesday said that 45 other states, including Oregon and Idaho, do not restrict the procedure. They cited a new study suggesting that performing as few as 200 scheduled angioplasties a year still ensures doctor expertise and patient safety.
Some of the state’s biggest hospitals disputed that claim.
Dr. Michael Ring of Sacred Heart Medical Center in Spokane said that study has yet to be published, but 400 procedures a year still is considered a “low-volume” hospital.
High volumes are linked to greater patient safety, said Dan Dixon of Swedish Medical Center in Seattle. “It’s not only all about access. It’s about balance,” he said.
The earliest the rule could go into effect is Tuesday. Before then, Tuesday’s comments will be sent to Health Secretary Mary Selecky, who will make a final decision about the proposal and could alter the rules.
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