By Barry Rascovar
Here we go again: Another liberal-conservative showdown over a new hospital for Prince George’s County. Only this time, the confrontation isn’t between Republican Gov. Larry Hogan, Jr. and the Democratic legislature.
Instead, the tug-of-war is between a conservative political scientist from a Republican think-tank and Democrats in the county who control its hospital system.
The think-tank guru, Robert Moffit, was placed on the Maryland Health Care Commission by Hogan. It’s his second time around, having been on the panel before under Republican Gov. Bob Ehrlich.
Due to a quirk in the way the commission conducts its business, Moffit has life-or-death powers over the proposed $655 million Prince George’s Regional Medical Center. He’s been assigned to evaluate this project and if he’s unwilling to sign off, the panel won’t issue the essential certificate of need (CON) for construction.
Wring price concessions
At the moment, Moffit is playing hardball.
He wants to wring $112 million from the project’s cost by cutting the number of acute care beds and dramatically shrinking room size. Moffit’s modifications call for fewer inpatient beds, fewer operating rooms, fewer emergency room bays and no specialty wing run by the Mt. Washington Pediatric Center.
It would be a stripped-down model designed to break even with far fewer customers coming through the doors.
That’s in keeping with both conservative Republican mantra (do more with less) and a trend in health care that stresses outpatient treatment over hospital admissions.
Moffit, who works at the Heritage Foundation, doesn’t want a white elephant – a hospital that is half-empty and unable to pay its bills or avoid red ink.
That’s been the sorry state of county hospitals for decades under Dimensions Healthcare System, which has shortchanged county residents through long-standing management incompetence, political cronyism and an inability to offer quality medical care.
Deal in Annapolis
A running battle in Annapolis finally led to an agreement in which the state and county governments would chip in for a brand-new regional medical center in Largo, replacing the run-down, 75-year-old hospital at Cheverly and consolidating county in-patient beds at one site.
What sealed the deal was agreement by county politicians to relinquish control to the University of Maryland Medical System (UMMS), which has a record of turning woebegone hospitals into winners for patients and the bottom line.
But Moffit doesn’t seem impressed with what UMMS brings to the table. He’s so focused on the financials that he may be missing key, unspoken elements.
First, most of Prince George’s County is a health care desert. It is bereft of any decent hospitals. No wonder sick residents go elsewhere for in-patient hospital care – to Anne Arundel County, to Montgomery County and to the District of Columbia.
A gleaming, ultra-modern regional medical mecca at Largo, with all the bells and whistles patients and doctors demand, could reverse the out-migration of patients in a hurry.
Indeed, the combination of a cutting-edge, high-tech hospital run by a nationally ranked teaching hospital could result in a stampede of primary care physicians seeking office space nearby. The dearth of primary care docs has been a major shortcoming in the county – a situation UMMS already is working hard to fix.
Apples and oranges
Moffit also wrongly compares costs for the P.G. regional medical center to the new community hospital Washington Adventist Hospital is building in upper Montgomery County. The two have as much in common as apples and oranges.
The Largo project will be far more expensive because the demands for services are far greater in Prince George’s – and infinitely more complex.
The current Dimensions hospital in Cheverly is the second busiest trauma center in Maryland. With violent crime rising in the populous county, you can expect an even greater need for more emergency room bays and high-cost trauma medical care. That’s not factored into Moffit’s equation.
Nor does the commissioner take into account the enormous size of the county with a population that will hit 1 million in the not too distant future. Yet there’s a lack of even one high-caliber hospital.
Centerpiece of change
Moffit concedes “a new general hospital campus in Prince George’s County is needed.”
What he doesn’t acknowledge is that this large, fast-growing subdivision with a huge minority population has always been short-changed. For too long, this populous region of Maryland has been denied a first-class regional medical center that can handle diverse and complex cases.
The last thing Prince George’s needs is a shrunken, run-of-the-mill general hospital.
Additionally, Moffit fails to take into consideration that a highly competent and experienced operating team from a premier teaching hospital will be running things.
Moreover, the mission isn’t just cost-efficient management of the new Prince George’s hospital. There’s a larger goal: to transform the county’s entire health care delivery system.
The centerpiece of that transformation is the new regional medical center.
Dumbing down the medical centerpiece denies county residents the kind of top-flight regional inpatient facility they deserve. It sets the stage for a penny wise/pound foolish decision from the Health Care Commission.
It also could lead to an angry response in Annapolis from dismayed Democratic legislators who are unwilling to accept a second-rate compromise.
They could demand sweeping changes in laws governing the Health Care Commission, reconstituting the panel and ensuring that one commissioner no longer gets to rule with near-dictatorial authority on hospital-construction projects.
There’s still time for a sensible resolution. Dimensions and UMMS have until Aug. 31 to respond to Moffit’s unreasonably stiff demands. It would be just as unrealistic to under-build as to over-build at Largo.
This is one decision the Health Care Commission had better get right.
Barry Rascovar’s blog is www.politicalmaryland.com. He can be reached at firstname.lastname@example.org