Although its is known that the more often that doctors and hospitals do certain medical and surgical procedures the better they do them, some hospitals in Rhode Island don’t do these procedures often enough to reach minimum performance levels, a study of the state’s health care system reports.
The study, compiled by consultants on behalf of Blue Cross & Blue Shield of Rhode Island, says research has shown that there are recommended “volume thresholds” for some complex procedures. Examples include carotid endarterectomy (a cleaning out of the neck arteries to prevent stroke) and lower extremity bypass, which improves blood flow to the legs for patients with hardened arteries.
The study says that at many hospitals in the state, the number of some of these procedures falls well below those thresholds, which could negatively affect outcomes.
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“Those performing more of certain procedures tend to have better outcomes than those that only perform a few, in line with the concept of ‘practice makes perfect,’” the report reads. It suggests “exploring options for aligning services.”
The finding could raise questions for hospitals that have upgraded clinical services in recent years to provide higher-margin cardiac or cancer care – and for state regulators considering requests by hospitals to add new services.
For example, seven hospitals provide carotid endarterectomy, though only two of those performed more than the recommended volume of 100 procedures in 2000 (the year data for the study was taken), according to the report.
Robert Marshall, spokesman for the Health Department, said state regulations require the department to consider the issue of volume only when licensing hospitals to perform four specific procedures: angioplasty, cardiac bypass, organ transplant and neonatal intensive care.
Otherwise, the department is not required to consider the volume issue when reviewing proposals by hospitals to add new services, although regulators often do so anyway, Marshall said.
Blue Cross spent $3 million on the SHAPE (Statewide Health Assessment Planning and Evaluation) study, which was compiled over the past year by independent research firms Booz Allen Hamilton and RAND. A 29-member advisory committee made up of state business leaders, regulators, legislators and members of the health-care industry oversaw the study.
Blue Cross officials say the report is an effort to gauge the future supply and demand for the state’s health-care delivery system. They have said the study does not signal any changes in the way Blue Cross will do business. Rather, it should serve only as a starting point for discussion on health policy and a planning tool for health-care providers, policymakers, regulators, insurers and others, said Ronald A. Battista, president and chief executive officer of Blue Cross.
“This provides one more acid test to determine need, but it’s not the only one,” Battista said.
When hospitals apply to the Health Department for approval of capital expenditures necessary to upgrade services, Battista said they now make their case based largely on anecdotal evidence of need.
“Now we have some facts; for example, we know that there are too many MRI screeners in the state,” Battista said, referring to the study’s finding that by 2006, the state’s “large number of MRI scanners” could meet all demand using just 39 percent of available capacity.
“If someone tried to come into the state and say we need a new MRI center, (the state) would look at it a lot differently than it would have before the study,” Battista said.
The exhaustive SHAPE study, which Gary D. Ahlquist of Booz Allen Hamilton called “perhaps the most comprehensive (health-care) information base ever assembled here,” included a number of notable findings:
• Rhode Islanders visit their doctor 43 percent more often than the national average
• Hospitals in Rhode Island are operating at or above capacity now – especially in the Providence area – although some parts of the state still have room for growth. By 2006, demand for medical/surgical beds and adult intensive care will outstrip supply.
• Rhode Island will need an additional 1,600 nursing home beds by 2006 in order to meet swelling demand from an aging population.
• The state has enough physicians to meet health-care demands through 2006, though many doctors do not see patients full time, which makes it difficult to peg future capacity. It recommends further study of the physician work force.
Louis Giancola, president and chief executive officer of South County Hospital and a member of the SHAPE advisory committee, said the study will serve as an additional tool to help the hospital plan for future needs.
“It has already helped us confirm the need for medical/surgical beds going forward,” Giancola said.
The hospital has filed a certificate of need with the Health Department to replace outdated medical/surgical facilities.
Blue Cross says the SHAPE research team will meet with various members of the health-care community to go over the report in more detail.
For more information about the SHAPE report, visit www.shaperi.org or call the SHAPE office at (401) 831-1300.
The study originally had a projected pricetag of $2 million, but higher-than-expected costs associated with getting access to and sorting data from a number of sources pushed the cost up to $3 million, Battista said.
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