At its MAY 20 BOARD MEETING, CNYHSA's voted to approve Community General Hospital's 2.6 million dollar proposal to establish an adult cardiac catheterization laboratory. The vote was 8 for, 0 against, and 1 abstention. The project features use of existing operating room infrastructure and space to minimize construction costs and collaborative relationships which draw on St. Joseph Hospital for clinical direction and Syracuse Community Health Center for outreach and patient access.
The project will increase the number of cath labs in Syracuse to 9 (Syracuse currently has 4 labs at St. Joseph's, 3 at Crouse, 1 at University Hospital) and increase the number of labs in the CNYHSA area to 14 (9 in Syracuse, 3 in Utica, 1 in Watertown, 1 in Ithaca).
Following the meeting, CNYHSA’s recommendation was submitted to the NY State Department of Health where the proposal will next be taken up next by the State Hospital Review and Planning Council.
The RATIONALE for HSA APPROVAL involved the following factors:
- Diffusion of cardiac catheterization lab technology in New York State indicates that diagnostic cardiac catheterization is an appropriate service for Community General, given its size, clinical capabilities and range of other cardiac related services. Community General is a 356 bed facilty which includes a 306 bed hospital and a 50 bed Skilled Nursing Facility.
- The clinical program affiliation and linkage for the proposed service with St. Joseph's Hospital Health Center will assure quality oversight and seamless access to interventional cath procedures and cardiac surgery. In addition, St. Joseph's has indicated that it did seek approval of a 5th catheterization lab at its facility, based on the collaborative proposal by the applicant to establish the service.
- The proposal will improve access of minority populations in Syracuse and the applicant has entered into a collaborative program with the Syracuse Community Health Center to screen the population in the service area and begin early treatment for those with cardiac disease.
- Excellus, the region's major health insurer, supports based the project based on its assessment of cardiac catheterization use and capacity as well as the positive impact of the proposal on access and quality standards due to the collaborative nature of the service with St. Joseph's Hospital Health Center and the Syracuse Community Health Center.
REVIEW PROCESS
In conducting the review, the agency utilized an informational panel format which proved very useful in setting the context for the review and facilitating Board discussion and questions. Panelists included:
- Robert Carhart Jr., M.D., University Cardiologists
- Jeffrey Bastable, Director Network Partnerships/Contracting, Excellus, Central NY
- Rob Makenzie, M.D., President/CEO, Cayuga Medical Center at Ithaca
- Joe Fitzgerald, Vice-President, Business Development, Cayuga Medical Center at Ithaca
Issues addressed during the Board’s deliberation on the project included:
- cardiac catheterization utilization trends and patterns:
- Hospital-based use rates in New York State are fairly uniform (range of 103.6 procedures/10,000 population in Albany region to 115.5 in Central NY), when comparing all Upstate regions and the NY City Metropolitan area (NYC, Hudson Valley and Nassau-Suffolk combined).
- national use rates also appear to be consistent with NY state experience and may suggest some leveling off in the growth rates of catheterization.
- Information supplied by the applicant indicated that patient origin adjusted utilization in Onondaga and four contiguous counties is 99.9 per 10,000 and is slightly below the state's regional ranges.
- appropriateness of service based on extensive physician training and certification requirements; current day practice standards and expectations; and improvements in catheterization techniques and corresponding risk reduction of the procedure
- degree to which advances in cardiac imaging techniques may lead to substitution of non-invasive diagnostic techniques for a significant number of catheterization candidates; conversely, degree to which these techniques may ultimately be considered complementary or supplementary to, catheterization.
- strength of the proposed linkage and affiliation with an existing cardiac catheterization and surgery center (St. Joseph's Hospital Health Center)..
- availability of, and access to, catheterization services at other Syracuse hospitals (St. Joseph's, Crouse, and Upstate).
- impact of proposal on underserved, minority populations and relationship to reduction of cardiovascular disease through prevention, health education, and lifestyle changes.