Mercy Health Saint Mary’s and Holland Hospital can now treat heart patients they previously had to refer elsewhere for a procedure to clear clogged arteries.
Both hospitals received state certificate-of-need approval late last month to perform elective PCI, or percutaneous coronary intervention, to treat patients with coronary artery disease.
Saint Mary’s and Holland Hospital were able to immediately begin offering the procedure on an elective basis, alleviating the need to transfer patients, which often resulted in both inconvenience and frustration.
“We had very unhappy patients,” said Marlene Hanson, director of heart and vascular services at Saint Mary’s. “It’s a hassle for patients and their families.”
The CON approvals came a year after the Michigan Certificate of Need Commission adopted and sent for public comment a new standard that allows hospitals without an open-heart surgery program to perform elective PCI.
Prior to the change, hospitals lacking an open-heart program could only perform emergency PCI to save the life of a patient who was suffering a heart attack. They had to transfer non-emergency cases to a facility with an open-heart program, such as Spectrum Health in Grand Rapids or Mercy Health Muskegon, where the procedure was often done by the same cardiologist as at the referring hospital.
Patients transferred from Saint Mary’s sometimes have to wait two or three days or longer in the hospital until they could get on the schedule to have the procedure done at Spectrum Health, Hanson said. However, high acuity cases are typically scheduled and done sooner, if not the same day a blockage was discovered, she said.
The delay served as an inconvenience and an added cost, as well as a source of anxiety for patients who worried about whether they would suffer a heart attack before they could have the procedure done, she said.
“Now we can take care of the patients and they don’t have to go through the waiting period,” Hanson said.
Saint Mary’s and Holland Hospital were among the first hospitals in the state to secure CON approval to perform elective PCI under the new standard that took effect in September 2015. Four others, all in Oakland County, received approval during February and March.
Metro Health Hospital in Wyoming filed a letter of intent in January with the Michigan Department of Health and Human Services to initiate elective PCI. A full CON application is pending.
Saint Mary’s expects to perform 200 elective PCI procedures in the first year, meeting the new CON standard. On an annual basis, the hospital refers for treatment at Spectrum Health about 100 elective PCI patients whose blockage was diagnosed at Saint Mary’s.
Holland Hospital transfers 20 to 30 patients a year to Spectrum Health for an elective PCI, said Todd Knight, the hospital’s clinical director of invasive/interventional procedures and the catheterization lab. The hospital expects to do about 200 elective PCIs a year.
Saint Mary’s and Holland are now able to retain those patients and many others who are suspected of having a blocked artery. In the past, cardiologists typically referred those patients straight to Spectrum Health for a diagnostic cardiac catheterization. If a blockage was found, they ended up having a therapeutic procedure done immediately to restore blood flow.
“Right out of the gate, the physician seeing them in the office would say, ‘Look, let’s just take you downtown. You’re probably going to need something,’” Knight said. “Now we can do that right here.”
To earn CON approval to perform elective PCI without on-site surgical backup, a hospital must project it would do a minimum of 200 procedures annually using data from the most-recent 12-month period. A hospital also would have to meet quality benchmarks.
The change in the standard last year came more than a decade after the CON Commission allowed hospitals that met volume requirements to do emergency PCI. Hospitals in the state that initiated emergency PCI back in 2004 — including Saint Mary’s, Metro and Holland — pushed for the latest standard change, arguing that they had proven they can do emergency procedures safely.
“So let’s take on those lower risk populations and apply our skills to that population and allow them to stay in their community,” Knight said. “It just makes sense.”