State allows angioplasty to be performed at Kent

In a departure from previous requirements that angioplasty programs be backed up by open-heart surgery capabilities, the R.I. Department of Health last week approved a request by Kent Hospital to begin performing angioplasties without setting up a cardiac surgery program.
Dr. David R. Gifford, the state health director, granted the approval following a recommendation issued March 25 by the Health Services Council that, in turn, followed the advice of a committee convened by Gifford to review the regulation of cardiac services.
The decision could have affect for another struggling hospital, Landmark Medical Center, which started an open-heart surgery program three years ago.
Landmark initially projected that it would be doing hundreds of heart operations per year by now, but it’s actually doing only about 80 per year, according to a spokesman, and it’s losing more than $3 million on the surgery program, even as the catheterization lab thrives.
Gifford is already reviewing the heart surgery program, concerned that it threatens the financial health of the entire hospital. On March 28, Landmark filed a waiver request seeking to drop the surgery program while continuing to offer diagnostic catheterization and angioplasties. The hospital performed about 800 and 400 of those procedures, respectively, last year, Fisher said.
Fischer noted that 40 states already allow hospitals to offer angioplasty without open-heart surgery. And indeed, the Kent decision shows Gifford sees the appeal of that approach.
“This program will provide residents of Kent and Washington Counties suffering a heart attack more rapid access to a procedure that can help save lives,” Gifford said in a news release. “The Health Services Council’s in-depth review of the benefits of primary coronary angioplasty, the ability of Kent to perform this procedure safely, and the needs of the community to make this program effective was instrumental in establishing conditions that Kent must follow when implementing this program.”
Because complications from angioplasty, while relatively rare, can be serious and life-threatening, historically regulators have required that hospitals that want to offer angioplasty also have open-heart surgery programs. That’s why Landmark set up its surgery program.
But in a letter to Kent Hospital President Mark E. Crevier, Gifford noted that the hospital had demonstrated the need for only an angioplasty program and that the need for specialized services must be balanced with the need for primary care and prevention.
As a result, Gifford’s approval came with a long list of conditions, some recommended by the Health Services Council and others added by him.
For starters, the capital costs of setting up Kent’s new angioplasty program must be limited to $76,900, all from equity, and that the first full year of operating the program must be limited to $387,210. In addition, Kent must set up an agreement with Rhode Island Hospital – which has a full-fledged cardiac program, including multiple catheterization labs and open-heart surgery capabilities – to receive oversight and support from that hospital’s experts.
Moreover, to ensure angioplasties are performed as promptly as possible, Gifford required that Kent work with local emergency services, following a model recommended by the American Heart Association, to ensure that patients get electrocardiograms while on the way to the hospital, so if they need an angioplasty, preparations can begin right away. &#8226