Landmark heart program scrutinized by R.I.

PROVIDENCE – Concerned that Landmark Medical Center’s cardiac surgery program is falling so short of volume targets that it must be hurting the cash-strapped hospital, state Health Director Dr. David R. Gifford today announced that he is launching a review of the program’s financial impact.

The Landmark cardiac care program, which offers angioplasties as well as open-heart surgery, was launched in 2005. At the time, regulators gave it until this May to meet the state’s minimum volume requirement for bypass surgery programs: 500 operations per year.

Right now, Landmark spokesman Bill Fischer said, the program is doing about 100 surgeries per year. But the low volume, he stressed, is not affecting quality, the main stated reason for having that 500-surgery minimum. And on that point, Gifford actually agrees.

“I have no issues or concerns about the quality of care at the hospital,” Gifford said. “The reports we get, frankly, are good. … This is an issue about the impact it has on the finances of the hospital.”

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The two other providers of open-heart surgery in the state – Lifespan members Rhode Island Hospital and The Miriam Hospital – have both fallen below the 500-operation line themselves; Gifford has given them waivers so their programs can continue. He has also appointed a team to review the state standards and determine whether lower volume targets may be appropriate for bypasses, angioplasties and cardiac catheterization, because nationwide, volumes have dropped with the advent of new medications and a shift toward less-invasive procedures.

Still, even if the target number were to be revised downward, Gifford said, Landmark would still fall well short of the new number. And, he added, cardiac surgery is such an expensive service to provide that it may not be feasible for Landmark, which has been struggling financially for years.

“I’m concerned it’s a financial drain on an already financially weak hospital, and it may be jeopardizing the hospital’s ability to do other things,” Gifford said. The R.I. Department of Health also has to figure out what it will do about the missed targets, he said – so, with the three-year review period nearing, he decided to address the issue right away. “I don’t want to wait until the last minute.”

Landmark lost about $7 million last year, according to Fischer, and the hospital acknowledges it is losing money on open-heart surgery, even though it originally projected profits.

He said the hospital is making money on cardiac diagnostics and angioplasties, but the open-heart surgery component is losing money, so together, its heart programs are expected to lose about $300,000 this year. But, he argued, for a hospital with a $120 million budget, that’s not a big amount – especially when compared with the cost of uncompensated care, which last year amounted to $7 million.

“We look forward to talking to Dr. Gifford about the state of the cardiac unit, but we have to have a broader conversation about the fiscal status of community hospitals in this state, not just Landmark,” Fischer said. “Do we have financial woes at this time? The answer is yes. But when you look at our reimbursement rates and you look at uncompensated care, that’s the reason.”

The Department of Health approved Landmark’s application for a phased implementation of cardiac services in August 2000. The hospital teamed up with Beth Israel Deaconess Medical Center for the project, predicting that, not only would the program would not only meet the needs of local residents who weren’t getting cardiac care because they couldn’t easily get to Providence, but also that peoplefrom nearby Massachusetts and other wealthier communities also would opt to get their cardiac care at Landmark.

Gifford said a review committee is being set up to look at the Landmark situation. Separately, the group that has been looking at volume standards in general is expected to report its findings shortly, he said.

Landmark Medical Center, based in Woonsocket, is a regional hospital with specialties in cancer and cardiac care. Its cardiac program and emergency department are affiliated with Harvard Medical Faculty Physicians at Beth Israel Deaconess Medical Center in Boston. Additional information is available at www.landmarkmedical.org.

For news and information from the R.I. Department of Health, visit www.health.ri.gov.

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