Decision to Found an Open

¶ … decision to found an open heart surgery program at Cabarrus Memorial hospital definitely is in accordance with the hospital's mission as a major regional hospital. CMH appears to have or could raise sufficient infrastructure and financial resources/leverage necessary to add the program. As a teaching hospital associated with Duke Medical school, it is a teaching hospital that has a need for a service as an open heart surgery center to expand upon its teaching curriculum. The hospital has the basic infrastructure, but needs to expand if it is to retain its reputation as a world class teaching hospital.

Presently, the hospital cardiac unit includes a Chest Pain Unit, a Cardiac Catheterization Lab, a state-of-the-art cardiovascular operating team and the Cardiac Rehabilitation Center, highly skilled and trained physicians, nurses and clinicians diagnose and treat heart patients ("Healthy beginnings for," 2011).

From a competitive standpoint, the hospital needs to supply this service before the other hospitals in the area do. As noted in the chapter 19 case study, demographic projections are pushing the hospital management staff in this direction. These include a general population increase in the six county and surrounding area and an increase in the local at risk population in the 45 to 64-year-old age category is expected to 38.3% in the next ten years (Swayne, Duncan, & Ginter, 2007, 803-811).

In addition, while there are 16 other open heart surgery centers in North Carolina located in 11 counties, but none are in the Cabarrus Memorial Hospital area. The closest to the hospital service area is in Charlotte, including Mercy Hospital, Presbyterian Hospital and Carolinas Medical Center. These hospitals are all about 25 miles from Cabarrus, a dangerous situation for area residents that now have to go that far for life giving heart surgery. Also, one of the state's 16 heart surgery programs had claimed Cabarrus County in its primary service area.

Admittedly, this has not been the case until recently. Historically, the CMH board considered that Cabarrus patient volumes claimed eight years earlier when it opened its heart center. Further, the committee considered that a mere 5.6% of the CMH patients hailed from Cabarrus County were included in the Carolinas Medical Center's primary service coverage area (ibid, 812).

The three Charlotte programs had reported previous year operating room utilization for cardiac surgery with the following statistics: Mercy Hospital at 36.3%, Presbyterian Hospital 78.5% and Carolinas Medical Center at 84.5%. Procedure volume increased yearly at both the Carolinas Medical Center and Presbyterian hospital. The two hospitals open heart surgery suites operated 78.5% of nominal capacity (ibid, 812).

The Carolinas Medical Center has six rooms that were classified at were "open heart surgery/thoracic suites," submitted a CON application for an additional open heart surgery room. Unfortunately, earlier in the year Carolinas Medical Center withdrew their application their CON application since the Department of Facilities Services requires a rate of 80% or higher (ibid).

This is also the case with Mercy Hospital whose heart program has not followed a year-to growth utilization pattern. Room utilization had been under 50% each year for the previous ten years. Also, Mercy Hospital did not appear to reach the proposed CMH open heart service area. In the previous year only 9% of the 174 people from Cabarrus County and none from Rowan County received open heart surgery at Mercy Hospital. Due to this, the pattern poses a perceived as well as a real barrier to access at Mercy for people in the Cabarrus Memorial Hospital area counties. Moreover, it appears that Mercy Hospital appeared to serve an actual population that was much more south and east of Charlotte (ibid).

Given the projected demographic trends and the actual statistics from the surrounding hospitals considered above, it is obvious that the "business" for open heart surgery is moving into the Cabarrus Memorial Hospital area. In the interim however, the hospital administrators on the Board will have to consider possible alternative strategies before making a "go/no-go" decision on the possible addition of the open heart program. Unfortunately, a helicopter medevac average price is $7,500-$8,000. This will of course vary based upon the medications and supplies used during trip ("How much does," 2011).

First of all, in the opinion of the author, we have identified an access problem for the present CMH area residents to the existing open heart surgery facilities at the surrounding hospitals. As noted in the case study text, driving to Charlotte is a major problem. The immediate issue will be relieving this before an open heart surgery center is functioning at CMH (ibid, 812-813). This is a very sticky problem with few immediate alternatives short of a full open-heart surgery program.

Also, it will be the continued gradual expansion of open heart surgery programs at the CMH, such as the cardiac catheterization program that was started two years earlier. Even with the success of the program, CMH 82 patients to outside hospitals for angioplasty as well as 117 to open heart surgery. To make matters worse, Rowan Memorial Hospital which is located a half-hour's drive to the north in Salisbury opened its own cardiac catheterization service and might compete in the future for the cardiac catheterization "market (ibid, 813-814)." If Rowan provides open heart services the results are clear, the hospital desperately needs to provide full service cardiac services, including open heart surgery to its patients.

This primarily leaves financial considerations. Capital costs will $3, 273, 180. The hospital had sufficient reserve funds to cover this. Significantly, there will need to be an increase in 23 new staff employees for the new open heart surgery unit and a need for ten new beds to become operational as coronary care beds and one new open heart operating suite. The clinical personnel will cost $711, 793 (Ibid, 815-816).