Community demand, medical needs square off

Meetings to shape S.C. Health Plan begin this week

By BEN WERNER

bwerner@thestate.com

Fulfilling a community’s demand for health services is not always the same as meeting its need for care.

This week, the State Health Planning Committee will try to strike a balance by sorting out the difference between the two in a series of public meetings across the state. The information gathered by the governor-appointed committee will form the basis for the S.C. Health Plan.

Developed every two years, the health plan is significant because it sets the priorities for state health-care providers by establishing what types of medical services are needed in South Carolina. For instance, state regulators issue licenses for beds dedicated to various medical procedures.

This year, Lexington Medical Center’s battle to receive state permission to operate an open-heart surgery program will be on the agenda. Unable to convince a judge and state regulators to allow its open-heart surgery program, Lexington Medical is seeking to change the health plan.

Also, this year, the number of hospital beds is expected to be a pivotal point for the balancing act between what various communities want and what they need.

The Department of Health and Environmental Control board will have final say on the plan.

Joel Grice, director of DHEC’s Bureau of Health Facilities and Services Development, said the state health planning process is good because it allows the state to adapt to new technology or changing demands.

“We can change standards more quickly in the plan than you can through legislation,” he said.

Deciding the number of hospital beds is important because:

• The way hospitals expand their services is to add more beds or change the types of beds they are licensed to have.

• The state tries to make sure all residents have access to all medical services by regulating some of the types of beds hospitals are allowed to have.

Based on written testimony submitted by hospitals, physicians and the public, DHEC’s Grice said some specific needs include beds for long-term acute care and cardiovascular care. Other needs include equipment to treat cancer — which is not a bed but goes through the same regulatory process.

Grice said there is a growing need for more long-term acute care beds. Patients using these beds typically are on a ventilator and are considered too sick to be in a nursing home.

Medicare has been clamping down on how much hospitals receive for treating such patients, unless these beds are outside the traditional hospital, Grice said.

In response, several new small free-standing hospitals have begun to specialize in providing long-term acute care.

“A number of these hospitals have been leasing their beds from larger hospitals,” Grice said. “Now, some of these (larger) hospitals want their beds back.”

Locally, the most talked about aspect of the debate is Lexington Medical Center’s quest to operate an open-heart surgery program.

Lexington Medical wants to perform heart catheterizations, a less-invasive procedure than open-heart surgery, increasingly being used to treat heart problems.

But current state regulations bar Lexington Medical from performing these procedures because the hospital does not have an open-heart surgery program.

After failed attempts to get legislative changes and to get a court to overturn a DHEC ruling, Lexington Medical this fall submitted to the state health plan committee a proposal to change the state’s requirements regulating where open-heart surgery beds can be located.

Margaret Gregory, a hospital spokeswoman, said this week Lexington Medical does not plan to amend or add any comments to what has been submitted before the committee meets.

While a local issue for the Midlands — Palmetto Health and Sisters of Charity Providence Hospitals oppose Lexington Medical’s bid — if approved, the changes likely will send ripples throughout the state.

Lynn Bailey, a Columbia-based health economist, said she suspects at least a half-dozen hospitals in the state want to add heart catheterization to the services they offer.

“There are hospitals that have busy emergency rooms and sufficient (numbers of) patients that they can be doing these cardiac procedures,” Bailey said.

If Lexington Medical’s proposal is approved, it will open the door for these other hospitals to expand their services.

All are likely to claim a community demand for more open-heart surgery. But does demand equal need? That is the question likely to be asked by opponents of loosening the open-heart surgery regulations.

Reach Werner at (803) 771-8509.

WHAT’S NEXT

• After this week, the State Health Planning Committee will recommend changes to the S.C. Health Plan.

• Members of the Department of Health and Environmental Control board have final say whether any changes are made to existing health regulations or if more information about proposed changes is needed.

• The board’s decision is expected next year.