Open Heart Surgery Program at Cabarrus Memorial Hospital

Introduction and Institutional Mission

The decision to found an open heart surgery program at Cabarrus Memorial Hospital (CMH) is clearly in accordance with the hospital's mission as a major regional hospital. CMH appears to have — or could raise — sufficient infrastructure and financial resources to support the program. As a teaching hospital affiliated with a university medical school, CMH has a genuine need for an open heart surgery center to expand its teaching curriculum. The hospital possesses the basic infrastructure but must expand if it is to retain its reputation as a world-class teaching institution.

The hospital's existing cardiac unit already includes a Chest Pain Unit, a Cardiac Catheterization Lab, a state-of-the-art cardiovascular operating team, and a Cardiac Rehabilitation Center, staffed by highly skilled physicians, nurses, and clinicians who diagnose and treat heart patients ("Healthy Beginnings for," 2011).

Regional Demographics and Competitive Landscape

From a competitive standpoint, CMH needs to offer this service before other hospitals in the area do. As noted in the case study, demographic projections are pushing hospital management in this direction. These include a general population increase across the six-county and surrounding area, as well as a projected 38.3% increase in the local at-risk population in the 45-to-64-year-old age category over the next ten years (Swayne, Duncan, & Ginter, 2007, pp. 803–811).

While there are 16 open heart surgery centers in North Carolina located across 11 counties, none are in the Cabarrus Memorial Hospital service area. The closest facilities are in Charlotte — Mercy Hospital, Presbyterian Hospital, and Carolinas Medical Center — all approximately 25 miles from Cabarrus. This distance poses a dangerous situation for area residents who currently must travel that far to receive life-saving heart surgery. Notably, one of the state's 16 existing heart surgery programs had already claimed Cabarrus County within its primary service area.

Historically, the CMH board considered that Cabarrus patient volumes had been claimed eight years earlier when a competitor opened its heart center. The committee also noted that only 5.6% of CMH patients who came from Cabarrus County were included in Carolinas Medical Center's primary service coverage area (ibid, p. 812).

Utilization Rates at Competing Hospitals

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

Carolinas Medical Center, which operates six rooms classified as "open heart surgery/thoracic suites," submitted a Certificate of Need (CON) application for an additional open heart surgery room. However, Carolinas Medical Center later withdrew that application because the Department of Facilities Services requires a utilization rate of 80% or higher before approving expansion (ibid).

Mercy Hospital presents a different picture. Its heart program has not followed a pattern of year-to-year growth in utilization; room utilization remained under 50% each year for the previous ten years. Furthermore, Mercy Hospital did not appear to serve the proposed CMH open heart service area effectively. 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. This pattern represents both a perceived and real barrier to access at Mercy for residents of the CMH service area counties. Evidence suggests that Mercy Hospital's actual patient population was concentrated much farther south and east of Charlotte (ibid).

Conclusion: The Case for Open Heart Surgery at CMH

In the opinion of this author, Cabarrus Memorial Hospital should apply for a license for an open heart surgery unit and move forward with opening it. For CMH to maintain its positive reputation as a progressive teaching hospital and to grow in step with the region's expanding population, this program is not merely desirable — it is a necessary next step for the hospital's long-term viability and for the health and well-being of the population it serves. Failing to act risks losing patients and institutional standing to competing hospitals that are already stepping forward to provide these services. As regional healthcare competition intensifies and demographic pressures mount, inaction is itself a strategic choice — and a costly one.

Works Cited

Heart. (2011). Retrieved from

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Nilsson, J., Algotsson, L., Hoglund, P., Luhrs, C., & Brandt, J. (2006). Comparison of 19 pre-operative risk stratification models. European Heart Journal, 27, 867–874.

Swayne, L. E., Duncan, W. H., & Ginter, P. M. (2007). Strategic management of health care organizations. Malden, MA: Blackwell.