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Published in Health Care

New Spectrum center would move low-risk cardiac procedures away from hospital

BY Sunday, October 10, 2021 05:45pm

Spectrum Health wants to move certain cardiac catheterization procedures out of the hospital setting to a new $23.2 million outpatient surgical center planned on Grand Rapids’ northeast side.

The Spectrum Health Cardiovascular Surgery Center would handle non-emergency diagnostic cardiac catheterization procedures, as well as elective procedures to open and implant stents in blocked arteries, known as percutaneous coronary intervention, or PCI.

In planning the outpatient center, Spectrum Health looks to shift the low-risk procedures to a lower-cost outpatient setting that’s specifically designed and better suited for the procedures, and that lacks the overhead of a hospital.

Spectrum Health would shift procedures “that we think can very easily and safely be done in an outpatient setting,” offering better convenience and access for patients than going to the downtown Butterworth campus, said Chad Tuttle, Spectrum Health’s senior vice president for hospital operations.

“It allows us to shift those very low-risk procedures so our high-volume medical center has capacity to focus on the higher acuity cases that we’re already seeing,” Tuttle said, adding that Spectrum doesn’t “have enough wiggle room” at its medical center campus.

“If we can move or keep lower acuity services away from the medical center, frankly we can give a better patient experience in most cases elsewhere for those patients who are going to walk in and out on the same day,” he said. “Coming downtown is not always the most convenient for them.”

State approval needed

Spectrum Health recently filed a certificate-of-need (CON) application requesting approval for the project from the Michigan Department of Health and Human Services. If approved, the Grand Rapids-based health system would build the 37,500-square-foot Cardiovascular Surgery Center on acreage it’s owned for years at Bradford Street NE and Leffingwell Avenue NE, along Interstate 96.

The proposed project comes after a state panel earlier this year updated CON regulations to allow elective cardiac catheterization and PCI procedures at outpatient centers.

“We think — through this opportunity through the CON standards — that we have an ability to shift a portion of our cath lab procedures to the outpatient setting in a way that in the long run can be more affordable for patients and an overall better patient experience in a new facility,” Tuttle said.

The Michigan Certificate of Need Commission in June adopted the updated standards for diagnostic cardiac catheterization and elective PCI procedures. The move came after an advisory committee consisting of medical professionals, as well as business, labor, insurance and consumer representatives, spent seven months studying and crafting the policy change.

Shift from hospitals

The change is consistent with a trend that’s been occurring for years in health care to move more medical procedures from hospitals to lower-cost outpatient settings when appropriate, said James Falahee, vice chairman of the CON Commission and senior vice president for legal and legislative affairs at Bronson Healthcare Group in Kalamazoo.

That trend has occurred as medical technology, equipment and techniques have improved to allow care providers to do more safely outside of a hospital, Falahee said. Knee and hip replacement and Lasik eye surgeries that were done in hospitals years ago are now routinely performed at outpatient centers, he said.

“In this whole era of procedures moving to outpatient (centers) and away from the hospital … this is just another example of that,” Falahee said. 

Following that trend, Spectrum Health also has plans to build a $17 million outpatient orthopedic surgery center at East Beltline Avenue NE and 3 Mile Road in Grand Rapids Township on land adjacent to an Integrated Care Campus.

In updating the CON standard for cardiac catheterizations, the 17-member state advisory committee concluded that outpatient centers can safely perform cardiac catheterization procedures.

Elective cardiac catheterizations and PCIs have been performed for years at hospitals that do not perform heart surgery “with no signals of adverse harm to any patients,” said Dr. Ryan Madder, an interventional cardiologist at Spectrum Health who chaired the standard advisory committee that unanimously recommended the change in the CON regulation.

Patients typically go home the same day that their elective PCI is performed, Madder said.

“So unlike 10 (or) 20 years ago when patients would often stay in a hospital overnight, that is no longer the standard of care. Many of these patients, particularly the more simple interventions that we do in the coronary arteries, go home the same day and that has been found to be a safe practice,” Madder said during a March presentation to the CON Commission.

Madder noted that professional medical societies such as the American Heart Association, the American College of Cardiology, and the Society of Cardiac Angiography and Intervention “have all supported the performance of elective PCIs” in outpatient surgical centers.

First in state

Spectrum Health appears to be the first health system in Michigan to seek approval under the new state standard for cardiac catheterizations. Spectrum Health’s proposed facility would open with two cardiac catheterization labs and one operating room. The planned design sets aside shelled space in the facility for expanding catheterization labs and adding another operating room in the future, according to CON filings.

Spectrum Health predicts the outpatient center would perform 1,128 elective PCIs and 1,334 diagnostic cardiac catheterization procedures in the first year of operation. In 2019, the most recent year for which data are available, Spectrum Health performed more than 8,600 diagnostic and therapeutic cardiac catheterizations, according to a state database.

The Cardiovascular Surgery Center would join Spectrum Health Medical Group offices and a Spectrum Health Medical Group Cardiovascular Medicine clinic that now occupy the southern end of the Bradford Street site, plus a new nursing and rehabilitation center now under construction on the north side of the property.

In the years ahead, Spectrum Health intends to further develop the highly visible 77-acre site that offers easy access, although “we’ve not yet determined how we would utilize that land,” Tuttle said. The property was once considered for Spectrum’s Center for Health Transformation and Innovation that’s now going up north of downtown Grand Rapids.

“But predominantly, we think that it would be utilized for whatever we need to improve access for ambulatory care and procedures,” he said. “That will be a big question for us. What do we do with that middle spot on the campus in the long run?”

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