Mid-Atlantic Health Law TOPICS

1. In February, the Health Resources Planning Commission (HRPC) agreed to reconsider its September, 1998 decision to withdraw Allegany InterCare Associates' Certificate of Need (CON) to develop a 103 comprehensive care bed facility in Western Maryland. HRPC staff not only urged the Commission to deny InterCare's reconsideration request, but staff also unsuccessfully argued that the HRPC did not have the power to "reconsider" its withdrawal decision because there are no explicit regulations pertaining to the reconsideration of CON withdrawals. The HRPC will hear InterCare's arguments to re-instate its CON at a future meeting.

2. In February, the HRPC approved CON exemptions to close Liberty Medical Center in Baltimore City and to relocate 42 acute inpatient psychiatric beds from Liberty to its affiliate, Bon Secours Hospital located three miles away. Occupancy at both hospitals had been about 40%. The closure of Liberty's acute beds will reduce Baltimore City's excess inpatient hospital beds by 242 beds. According to the Health Services Cost Review Commission (HSCRC), charges for each hospital were more than 10% above the statewide average, and the consolidation of inpatient services at Bon Secours should enable Bon Secours to bring its charges to acceptable levels while remaining financially viable.

3. In February, the Health Care Access and Cost Commission (HCACC) released the results of a study, based on 1996 data, titled "Determinants of Site of Service for Ambulatory Surgery in Maryland." The study attempted to identify the effect that price and payor played on a patient's choice for services at a freestanding ambulatory surgery center versus a hospital outpatient department. Although price and payor had a significant effect on the location of patient care, the study found that the surgeon's preference of location had the strongest influence on the patient's choice of site. Based on the data, the study also noted that free-standing locations were less likely to be used when the patient's payor is a private insurer.

4. In February, HSCRC staff released its analysis of the average cost per adjusted hospital admission during the period of 1992-1996. During that time, Maryland's average cost per adjusted admission increased by 22% from $5,192 to $6,331, the nation increased 9% from $5,691 to $6,498, and the states that comprise Maryland's business region increased 10.5% from $5,888 to $6,508. The HSCRC is seeking to improve Maryland hospital performance by establishing health system performance targets for 2001 and beyond. Staff will also be studying the reasons for the difference in case mix between Maryland hospitals and the rest of the nation.