LEWISTON – Central Maine Medical Center’s heart program has received a clean bill of health after state review of its first full year of operation.

The Department of Health and Human Services said the hospital has so far met the conditions it imposed four years ago in the hospital’s hard-fought quest for certification. That department had two general requirements: The center must be financially self-sustaining and the hospital must demonstrate that the center meets quality standards.

According to DHHS officials, after one year of operation, the hospital has provided financial documents to show it didn’t divert money from other departments to run its Central Maine Heart and Vascular Institute.

State officials said that, as required, the hospital also is participating in outside quality assurance programs, as well as making public the outcomes of all cardiac-related procedures. Those requirements will remain in place for the first three years of the heart center’s operation.

Level of service

One issue that had concerned state officials was whether the heart center would do enough procedures to achieve the expected level of quality. In October 2000, when CMMC was granted a certificate of need for the heart center, Kevin Concannon, who was then commissioner of the Department of Human Services, expressed reservations about the need for the program here, since Maine Medical Center performs the same procedures less than an hour away in Portland.

An independent-needs study commissioned by DHS cautioned that the volume of cardiac surgery at CMMC was likely to be low. Those projections “only slightly exceed the accepted health planning guideline minimum volume of 200 procedures per year by the third operating year,” Concannon wrote CMMC. “This expected low volume raises legitimate concerns that will need to be affirmatively addressed to assure the quality and financial feasibility of your proposed cardiac surgery program.”

After one year, the heart program narrowly missed its initial target for the number of heart surgeries it expected to perform. It had estimated a total of 148 open-heart procedures; it performed 142. DHHS officials expressed no concern with the small difference.

By contrast, doctors performed many more angioplasties than anticipated. In its application, CMMC wrote that it expected to treat 178 heart patients with the procedure, in which a tiny balloon is inserted into a narrowed artery and then inflated to increase blood flow. The hospital ended its first year having done 274 angioplasties.

Chuck Gill, CMMC spokesman, explained in an interview that the hospital’s original projections were based on the latest and best available technology and practices. Since then, with the advent of a medicated stent, some patients who would otherwise have been candidates for open-heart surgery had been treated instead with the less-invasive angioplasty, he said.

Stents – metal tubes inserted into arteries to prevent them from collapsing – often had posed problems because of subsequent tissue growth and plaque buildup around them. Now, the stents are treated with medicines that reduce the likelihood of those complications, Gill said.

He said CMMC’s experience in shifting volumes for the two procedures is mirrored by heart programs nationally.

“We were not surprised,” he said. Despite that shortfall, Gill said he was confident the hospital would meet its target of 200 surgeries by the third year in order to meet the quality threshold that Concannon referred to in his certification letter.

The medical numbers

Hospital officials provided first-year statistics that revealed its medical outcomes for cardiac surgery and angioplasty patients.

Using as benchmarks the data from the top 100 heart programs in the country, as well as averages from various professional organizations, CMMC’s patients appear to have faired well.

The center’s statistics suggest there were no deaths among the surgical patients, with a 0.0 percent mortality. The top 100 programs’ benchmark is a mortality of less than 2.5 percent.

Other surgical statistics provided by the hospital also looked favorable compared to the top 100 programs. (See related graphic.) Gill declined to release the actual numbers and would not elaborate on the figures.

“We stand by the data we submitted,” he said.

Of the 274 angioplasty patients treated, 1.3 percent died, according to the data released by the hospital. That is comparable to the top 100’s benchmark of less than 1.4 percent, and to less than 1.2 percent, an average from the American College of Cardiology.

Despite the rosy picture those statistics paint, the data’s usefulness are limited, said Wayne Clark, spokesman for Maine Medical Center. Maine Med is one of the other two hospitals certified to perform open heart surgery in Maine and was a vigorous opponent of CMMC’s effort to create its center.

Information missing from CMMC’s public numbers includes details on the surgical procedures performed on the 142 patients and whether they suffered other complications that didn’t show up in morbidity statistics, he said.

“We need to know what the caseload looks like,” Clark said.

The documents also fail to note the number of high-risk patients who may have been transferred to other hospitals, including Maine Med, he said. The simpler the cases, the better the outcomes should look, he said.

“It’s hard to rate apples to apples,” he said. “If they are able to select patients carefully, they’re going to do fairly well.”

Michael Norton, spokesman for DHHS’ Bureau of Medical Services, said state officials were satisfied with CMMC’s numbers and reporting procedures.

Only aggregate outcome information was supplied to the state. The state did not request detailed information about each patient and CMMC didn’t supply it, Norton said. CMMC’s Gill said it was the same information given to the quality assurance groups cited in the hospital’s documents.

Showing a profit

The hospital also sent a profit-loss statement for the heart center’s first fiscal year of operation to the state. It shows that the new cardiac program took $21 million, netting about $12.8 million after paying for contracted services. Its expenses, including $7.5 million for salaries and non-employee labor, totaled just over $12.7 million. That left $94,484 in income.

Clark of Maine Med said the financial statement isn’t detailed enough to determine whether CMMC charged the same amount or less for heart procedures than Maine Med or Eastern Maine Medical Center in Bangor, the third Maine hospital performing open heart surgery.

In his Oct. 2, 2000, letter, Concannon noted that CMMC’s application for the heart center says it intended to “price cardiac services for all payers at or below market price.”

According to hospital documents, CMMC’s heart center treated patients from nearly 100 towns or cities from all regions of Maine, most from central and western Maine. More than 130 doctors referred patients to the program.

St. Mary’s Regional Medical Center was among the hospitals referring patients to CMMC’s heart center during the year, “and we’re happy to continue to do that,” said St. Mary’s President James Cassidy through a hospital spokeswoman.

In 2000, after several delays, Concannon said he decided to approve the hospital’s launch of its heart surgery program because of the outpouring of support by the community and region.

Gill cited that sentiment in his one-year assessment of the program.

“This is what people wanted,” he said.