before the maryland health care commission in the...
TRANSCRIPT
BEFORE THE MARYLAND HEALTH CARE COMMISSION
IN THE MATTER OF
ADVENTIST HEALTHCARE, INC. DB/AWASHINGTON ADVENTIST HOSPITAL
Matter No. 13-15-2349
COMMENT OF INTERESTED PARTY, LAUREL REGIONAL HOSPITALON WASHINGTON ADVENTIST HOSPITAL'S MODIFIED CON APPLICATION
Marta D. Harting
VENABLE LLP750 East Pratt StreetSuite 900Baltimore, Maryland 21202410-244-7400mdharting@venabl e. com
Counsel for the Interested Party,Laurel Regional Hospital
Interested Party, Dimensions Health Corporation, d/b/a/ Laurel Regional Hospital
("LRH"), pursuant to COMAR 10.24.01.08F, submits this comment in response to Washington
Adventist Hospital's ("WAH") September 29, 2014 modified certificate of need ("CON")
application.
COMMENT
The Negative Impact on Existing Providers and the Health CareDelivery System Is Unnecessary and Unwarranted [COMAR10.24.01.08G(3)(fj]
COMAR 10.24.0108G(3)(~ provides:
An applicant shall provide information and analysis with respect tothe impact of the proposed project on existing health care providersin the service area, including the impact on geographic anddemographic access to services, on occupancy, on costs andcharges of other providers, and on costs to the health care deliverysystem.
The Commission's instructions also direct applicants to demonstrate that the project
"does not duplicate existing health care resources."
The Negative Impact on Costs and Charges of Other Providers is Significant
Using the methodology developed by the Reviewer in the September 4, 2012
Recommended Decision in the Matter of the Proposed Relocation of Washington Adventist
Hospital, Docket No. 09-I 5-2295, I LRH and Interested Party MedStar Montgomery Medical
~ Pursuant to the methodology, the White Oak/Fairland service area was determined for separate age cohorts in theMSGA service area, and for obstetrics service based on the proximity of WAH's new location to Maryland zipcodes, compared to other hospitals, based on the existing Takoma Park service area. Population projections bycohort assumed a 14.7% growth in total population, varying by age/service cohorts, between CY 2013 and CY 2023.Use rate changes by cohort assumed an 11.2% decline in use rates for MSGA, and a 2.0% decline in obstetric userates. Population and use rate adjustments were applied to the CY 2013 service area discharges to estimate the CY2023 White Oak service area discharges. Market share for each zip code was calculated by cohort relative to theproximity of other hospitals to the zip codes. Using drive time differences between WAH's current and proposedlocation and other surrounding hospitals to patient zip codes, a proximity ranking was assigned to each zip code inthe Takoma Park service area. With this, the Interested Parties recalculated other hospitals' market shares, bycohort, by applying their CY 2013 pro rata market share in each zip code to the change in WAH's market share, andapplied those market share to the expected total discharges in each zip code. See Exhibit 4 for further description ofthe analysis.
Center ("MMMC") have estimated the impact of the relocation on the primary service area,
patient volumes, and costs at LRH and MMMC.
Application of the Reviewer's methodology indicates that, accounting for expected
changes in population and use rates over the next ten years, MMMC will lose 284 inpatient cases
and revenues of $5 million or 3.1%per year, and LRH will lose 582 inpatient cases and revenues
of $10 million, or 9.3% per year, solely as a result of the proposed location of WAH's
replacement hospital. This is 3.7% of MMMC's expected CY 2023 discharges, and 11.6% of
LRH's expected CY 2023 discharges. A chart depicting the results of this volume impact
analysis is attached as Exhibit 1.
The proposed relocation of WAH to White Oak/Fairland will have an unwarranted
negative impact on MMMC and LRH, which relies on the White Oak/Fairland area as a
significant part of their primary service areas (Exhibits 2 and 3). This negative impact would not
occur if WAH were to remain in the Takoma Park area. Furthermore, the negative impact on
LRH could have the effect of undermining the important State and Prince George's County
project for the revitalization of healthcare delivery in Prince George's County through the
affiliation of Dimensions Healthcare System with UMMS. LRH with its location near the ICC
(MD Route 200) and I-95 is an important part of the project. WAH's relocation to White
OaklFairland would threaten the long-term viability of LRH and the project.
CONCLUSION
For the reasons stated, the Interested Party requests that WAH's modified CON
application be denied.
-2-9125384-v1
Respectfully submitted,
Marta D. Harting
VENABLE LLP750 East Pratt StreetSuite 900Baltimore, Maryland 21202410-244-7400mdharting@venable. com
Counsel for the Interested Party,Laurel Regional Hospital
-3-9125384-v1
AFFIDAVIT
Y hereby declare and affi~~nl under tl~e penalties of petjttry that the facts stated in thecomments and attachments filed by Laurel Regionat Haspita] on February 9, 201 S ai~e hue andco~~reat to the best aFmy k~towledge, information and belief,
f
Date: ~ 'z. ~~' ,;. - ~~.~-fit:
~,isa M, Gaod ett, C~'A, MBA, FACH~Maloolm Baldrzdge ExaminerSVP and Chief Financial OfficerDimensions ~Sealthcare Systems
AFFIDAVIT j
I hexeby declare and affirm under the penalties of perjury that the facfis stated in thecomments aa~d attachments filed by Laur~1 Regional Hospital on February 9, 2015 a~~e true andcorrect to tk~e best of my knowledge, information and belief,
Marls W, Higdon, CPA
Exhibit List
1. WAH Relocation Impact by Hospital
2. Overlap of Laurel Regional and WAH Service Areas
3. Overlap of MMMC Primary Service Area and Proposed WAH Service Area
4. Demand Assessment
Demand Assessment of
Wash
ingt
on Adventist Hospita I
•..~~
- ~:_,~
Relo
cati
on
January 7, 2015
Contents
• Bac
kgro
und
• App
roac
h
• Results
• Impact of WAH Rel
ocat
ion by Hos
pita
l
• Con
clus
ion
• Appendix
• Impact by Zip
and Cohort for:
• MedStar Montgomery Medical Cen
ter
• L
aurel Regional Hos
pita
l
i. ' t •
• Washington Adventist Hos
pita
l (WAH) has
sub
mitt
ed a
Certificate of Need ~COIV) ap
plic
atio
n to
relocate
its
faci
lity
to a lo
cati
on out
side
the DC Beltway in th
eWhite Oak community of Montgomery Cou
nty.
s This location
is approximately ten
to twelve mil
es from
member hos
pita
ls of MedStar and Dimensions,
incl
udin
g MedStar Montgomery Medical Center, Laurel
Regi
onal
Hos
pita
l, and Pri
nce George's Hospital Ce
nter
.
• MedStar and Dimensions ant
icip
ate th
at the WAH
relo
cati
on wil
l likely hav
e an
adverse impact on the
semember hos
pita
ls,
3
A~ ro
ach
ppSe
rvic
e Area Definition
• Obtained CY 2013 Mar
ylan
d, DC, and Virginia hospital dis
char
gedata for all zip codes fro
m which WAH had
at [
east 1 discharge
• Applied the
met
hodo
logy
included in the
Maryland Health Care
Commission's MHCC} response to
the
Adv
enti
st Healthcare and
WAH CON app ication in 2010 to define WAH's new service area
• Obtained dri
ve times from WAH's current (Takoma Park) and proposed
loca
tion
White Oak) and oth
er sur
roun
ding
hospitals to the zip co
des
obtained above
• S
ervi
ce are
as were det
ermi
ned for ea
ch of the fo
llow
ing cohorts: MSGA
15-6
4, 65-74, and 75+and Obs
tetr
ics.
Ped
iatr
ic and Psychiatric ser
vice
swere exc
lude
d as they
will not be part of
WAH's service off
erin
gs at the
White Oak proposed _fa
cili
ty.
• WAH's Takoma Park service area was determined by using WAH's
current address and ran
king
Maryland zi
p co
des from clo
sest
to
farthest (compared to ot
her ho
spit
als}
unt
il 85% of total di
scha
rges
was
achi
eved
for eac
h in
divi
dual
coh
ort
• The Whi
te Oak service are
a was determined fo
r ea
ch coh
ort based on
proximity of WAH's new location to
Maryland zip cod
es, compared to
other hospitals, usi
ng the same cut
-off
for
each coh
or- ~ tha
t was use
dfo
r the Takoma Park service ar
ea.
~:
A
roac
h cu
nt.
pp
impact of.
Chan
~es in Population
• Obtained population projections from Cla
rita
s by
zip code for eac
h cohort in WAH's White Oak
service area
• Assumed a 14.7% gro
wth
in tot
al population
• Assumed a shi
ft in population towards older coh
orts
Proj
ecte
d Po
pula
tion
CY13-CY23
CY2013
CY2023
Change
MSGA (75+)
103,032
143,136
38.9
°0MS6A (65
-74j
192,792
322,862
67.5%
MSGA (15
-64)
1,453,581
1,540,245
6.0°0
OB
171,
218
173,
018
1.1%
Total~i~
1,749,405
2,006,244
14.7%
Note
(1}; To
tal po
pula
tion
equals MSGA IS+
popu
lati
on; OB is
already inc
lude
d wi
thin
this po
pula
tion
.
A
roach
cone
.pp
Impact of Changes in Use Rat
es
• Cal
cula
ted CY 2012 to CY 2013 change in use rates
(in th
e White Oak service area) and, in
conjunction
with
Mil
lima
n~pr
ojec
tion
s, determined use ra
teas
sump
tion
s through 2023
• For the per
iod CY 2012 — CY 2023, assumed an 11.2%
decl
ine in
use rate for MSGA 15-64, 6~
-74,
and 75+and
a 2.0% decline in use ra
te for Obstetrics
Use Rates
CY1Z-CY23
CY2012
CY20i3
CY2023
Change .
MS6A (75+)
361.30
345.01
320.96
-11.2%
MSGA (65
-74)
184.24
172.78
163.
59-1
1.2°
0
MSGA (15
-64)
50.30
47.41
44.66
-11.2%
O B
69.54
67.22
68.1
5-2.O1
Total
~l~
~ 89.50
8533
89.39
-0.1
°a
fVote (
1). Due to the sh
ift i
n population from CY2012 to
CY 2013 to ol
der co
hort
s Yhat havehi
gf~e
r us
e rates,
the to
tal bl
ende
d us
e ra
ce is
onl
ypr
ojec
ted to decline -0.1%from LY 2D12 to
LY 202
3.
v
A
roac
h cont.
ppIm
pact
.of Relocation on Hos
pita
l Ma
rket
Share
• Calculated WAH's CY 2013 average market share for
each
prox
imit
y ra
nkin
g in the Takoma Park service ar
ea• Applied the
ave
rsge
mar
ket share fo
r each proximity ranking
in the
Takoma Par
k se
rvic
e ar
ea to zi codes of a similar
proximity in
the White Oak service area
• Adjusted WAH's exp
ecte
d market sha
re, by
coh
ort,
in eac
hzi code (White Oak service are
a) re
lati
ve to th
e pr
oxim
ity
o~other ho
s it
als to the
zi
codes
p p
• Caf
cula
ted the resulting change in ot
her ho
spit
als'
market
shares, by
cohort, by ap
plyi
ng the
ir CY 2013 fro
rat
a market
share in
each zip code to the change in WAH s mar
ket sh
are
• App
lied
expected ma
rket
shares fo
r WAH (White Oak) and
other hospitals by
coh
ort,
by zip code, to the
expected to
tal
disc
har es in ea
ch zi
code
g
p
Res u Its
Impact on Hospital Discharges
Compared projected dis
char
ges fo
r ea
ch hospital
by coh
ort after WAH relocation to pro
ject
eddi
scha
rges
at existing mar
ket sh
ares
. prior to WAH
relocation.
• Ref
er to th
e subsequent slide for
the
exp
ecte
dim
pact
of WAH's relocation by
hospital
Results co nt
.WAH Rel
ocat
ion Impact by Ho
spit
al
Hosn
itai
Washington Adver~list Hospital
CY73 White Dak
Serv
ice Area
Dischames
8,27
4
PopulatioN
Use Rat
eAdiustmenf
1,447
CY23 Whi
te Oa
Service Area
Discharges
(ore
-rel
ocat
ion)
lmpad of
Relocation,
lrtc
ludi
ngProximity AdL
CY23 White Oa
Service Area
07sc
harg
es(post relocation
9,72
1549
10,270
Laurel Re t
onal Hos
pita
l _.:_
- r'
4,295
',-~
." 698
-':-
-d993
~.
Hour
ard Co
unty
Generale
8,230
Z 683
9 973
(485J
9 428
~HospRal
~d2~~..~.~.~~'rdl Ces:~~.. ~~~~r.
...::.~ '8.,263.
~..sl . ~~
~'.~
, ~,~s'
V~~_..~.-.~$~1 rl"' ~~ s.; ~L 353
Subu~an Hos
pita
l1U,3iB
2,49
612,804
(169
)72,635
Shady Gro
ve Hnsp'ttal
13,6
802,
444
16,124
(168
)15,956
Johns Hopkins Hos
pita
lS,
1a9
934
6,D43
(i67
J5,
876
Holy Cross Hos
pita
l79,083
3,00.3
22,0
86(116)
21,9
70Anne Aru
ndel
Med
ical
Cen
ter
9,26
62,
660
71,946
[i0~
t'1,839
llni
vers
ity of
Maryland Me
dica
l Ce
nter
3,931
703
4,63
4(B
4)4,55
Haff
[mor
e Washington Med
ical
Center
4,62
9J,874
6,5 3
(41)
6,463
St Agnes Hos
pita
lT 3B5
318
t,7f
73(3
3)7 671
[iaT7ior
,' F47asp
H 7~~
ente
r::.
.~..
.v.~
ta..
.~:~
~ -..
....
._.~
4&~,
X_
_ 7'TSh
.,<~
s:_`
.:`.64 T~oiti'.c'' ~
V~~~f~ -
..,.._~~~~_
Mer~~Medical Center
760
180
940
(4J
936
UmonMe~of~aF`k~~ s-
m4.~'~y.,+,t:.ri
~~
-- ^-
426
~~
~. ?X8.-"
._._
_v';
~.~
13t:.:,:~~
~ ~ ~(
3J~~
Frederick Me
mori
al Hos
p"Aa
l~388
78
466
463
Greater 6a
ltim
ore Me
dica
l Center
337
79
4t6
(2)
4'IS
Sinai Ho
sp)t
a(731
160
891
(1J
890
Johns Ho
pkin
s Bayview Me
dipl
'Cen
fer
718
135
H53
(1J
852
llni
vers
ity of
Maryland Charles Regions[
Metlical Center
-298
83
3fl~
(0)
380
Fnd Washington Me
dica
l Cerrter
726
236
96Z
4966
Sovtfiem,lfAaHPs~fa4Cen£~', ~
y.~,
6~53.
:,,,;
760~..~,,,,
~ ':8
'554
,4~;~a,.
._v. 8
`6~:
.Pr
ince
Geo
ige'
s.Ho
spif
at'G
ente
l' ~:
- - . -_
~ ~.:
fi.OD4
;' ~
. $i$~
..__
:...
~ ~ .':6,818
;:' : ; '~ ~B8-
.:..
_
.. 6;98G
DoGols Community Hosydal
9,46
Q1,737
11,7
97Z69
71,465
• Ot
her MD Hos
p"rt
als
4,24
454
5,75
60
5,15
8To
tal MD Hos
pita
ls12
5,93
725
,997
151.934
f1.2
t6)
~50,
71H
Total MD Hos
pita
ls (Exclu~ng WAH)
117,
663
24.550
142,
213
(1,7
65)
t4D,
448
Sibl
ey Mem
oria
l Ho
spit
al2,
616
592
3,2 8
(t8j
3,190
Greater So
uthe
ast Community Has
pdai
Z97
44
341
1342
Chldreds National Me
ddca
l Center
95H
(2)
956
22
97H
utne
r uV tlosp~tals
690
68
758
Q75B
Tota
E DC Hos
pita
ls21
.032
3,65/
24,689
9,21
425,904
Inova Fa
ir Oaks Hos
pita
l112
it
123
(0)
923
]nov
a Fa
ir(a
~c Hos
pita
l632
102
734
(OJ
734
(nov
a Alexindria Hos
pita
l327
63
380
0380
Inov
a MauniVemon Hosp~l
372
97
469
i470
Vrginia Ho
spit
al Cer
rter
-Afi
ingf
onSe6
96
682
2684
Othe
r VA Hos
pita
ls282
49
331
0331
Total VA Hos
pita
ls2,
311
409
2720
22,722
t~To
tal
.94
9.28
0 30.064
779.
344
(J
179.344
~onc1 usion
• As a result of
WAH's relocation, MedStar Montgomery
Medi
cal Center is ex
pect
ed to lose 284 dis
char
ges by CY
2023
• MedStar Health as
a who
le is ex
pect
ed ~o ga
in 627 dis
char
ges
• Similarly, La
urel
Reg
ions
( Ho
spit
al is expected to lo
se 582
disc
harg
es due to WAH's relocation
After considering the projected positive impact to Pr
ince
Geo
rge'
sHo
spit
al Cen
ter of
168 discharges, Dimensions Hea
lth System i
sex
pect
ed to lose 414 dis
char
ges
• A summary of the im ac
t on MedStar and Dim
ensi
ons'
hosp
ital
s is
re
sent
e~be
low.
pMedStar
Montgomery Medical Center
{284)
Harbor Hospital Center
(4)
Unio
n Memorial Hos
pita
l(3)
Southern Maryland Hospital Center
46
Georgetown University Hospital
SO
Washington Hos
pita
l Center
792.
Total
627
Dimensions
Laur
el Regions! Ho
spit
al
{~82}
Prince George's Hospital Center
168
Tots 1
(414)
r~r•;
A
endix
pp
lm~act on Mont~omery Medical tenter by Ziq and Cohort
Zip Code
i'nwn
MSGA 15-64
MSGA 65-74
MSGA 75+
OB
Total
20904
Siber Spring-Cotesville
(27)
(23)
(37)
(8)
(95)
208D5
Silver Spr
ing
(23)
(22)
(28)
(5)
(79)
20906
Silver Spring
(9)
(6)
(30)
4(40)
20866
Burtonsville
(T7)
(4)
(I)
(1)
(24)
20861
Ashton
(~
(4)
(4)
(1}
(13)
20860
Sandy Spr
ing
(0)
(2)
(1'[}
0(13)
20832
Olne
y(4)
1{0)
(2)
(5)
20533
Broo
kev~
lte
(2)
2(3
)(7)
(4)
20872
Damascus
(9)
(1)
(1)
-{2)
20853
Rockville
(0)
(1)
(0)
(0)
(2}
20705
Beltsville
--
-(2)
(2)
20886
MontgomeryV~lage
(1)
(1)
(0)
-(2
)20855
Derwood
(0)
(1)
(0}
(0)
(2)
20901
Silver Spring
(2)
--
-(2 )
20902
Silver Spring
(2)
--
-(2
}20882
Gaithersburg
~ (0)
(7)
(0)
-(9
)21029
Clarksville
(0)
-(Q)
-(1
)20
85'i
Rockville
(0)
(0)
(0)
-(1
)20868
Spencervile
(0}
(0)
0-
(aj
20877
Gaithersburg
{D)
0(D)
-(0
)20759
Fulton
-(0)
--
(4)
21738
Glenwood
(0)
j0)
(0)
-(0
)20871
Clar
ksbu
rg0
(0)
--
(0)
20763
Savage
-(0
)-
-(0
)20777
Highland
'[(D
)(0
)(0)
(0)
21036
Dayton
-(~)
~Q)
-(Q?
20841
Boyds
--
(0)
-(0}
20880
Washington Grove
(0)
--
-(~
)20907
Silver Spring
0-
--
~20849
Rockville
D-
--
~2D876
Germantown
0-
--
~21797
Woodbine
-0
--
020879
Gaithersburg
f9)
10
-1
20903
Silver Spr
ing-
Hill
anda
le-
--
5$
Total Decrease in Pr
ojec
ted MedStar Montgomery Medical Cenfar
Discharges Sased on WAH Relocation
(S&)
(65)
(123)
'10
(284)
A
e n
~x ~o
nt.
pp
Impa
ct on lau
rel Re
gion
al Hos
pita
l by Zib and Coh
ort
Zip Code
Town
MSGA 75-64
MSGA 65-
74MSGA 75+
OB
Tota1
20707
Laur
e[(9
1}(61)
(6~
('[1
)(230)
207Q5
Beltsville
(61)
(32)
(43)
(~
{743)
20723
Laur
el~
(28)
(16)
(11)
(3)
(58)
20904.
Silver Spring-Co(esvlle
(17)
(1'[)
(25)
-(5
3)20708
South Laurel
(16)
{2)
(8)
(13)
(39)
20866
Bctrtonsviile
(16)
(5)
(7)
(1)
(30)
20724
Laur
el(9
)(~
{3)
{4)
(20)
20720
Bowie -North
(1)
(2)
(0)
{3)
(~
20706
Lanh
am-G
tena
rden
--
-(g
)~g~
20740
Cot[ege Pa
rk(~[)
0(0
)(5
)(6
)20763
Savage
{1)
(0)
(D)
(0)
(2)
2D725
Laur
el(~
)(p
)~a)
-~~)
2077D
GreenbeftArea
0-
2;(3)
(1)
20794
Jessup
-(0
)('f)
-(1
)21046
Colu
mbia
--
('[)
-{1j
20721
Bowie
--
-(~
)(q
)21029
Clar
ksvl
fe-
(0)
{0)
-(0)
20775
Bowie - I~
Iort
h(0
)-
--
(0)
20769
Glenn Dale
--
_~p~
~p~
20914
Silver Spr
ing
(0)
-
~-
-(0
)20718
Bowie-5ouihEast
-(0}
(0}
-(0
)20704
Belt
svil
le-
--
(OJ
(OJ
20774
Upper Marlboro
--
-(p
)(p
)20755
Foh Meade
(0)
--
-(0
}21045
Columbia
--
(p)
_rp
~20703
Lanham -
Seabrook
(0)
--
-(pj
20791
Capitol He
ight
s0
--
-0
20787
Hyaftsville
--
-D
02a
74'I
College Pa
rka
--
-p
20784
Hyat
tsvi
lle - Landover HiI[s
-0
--
020710
Bladensburg
--
~-
~20722
Colmar Manor
--
2_
224712
Mount Rainier
--
2-
220
78'[
Hyaf
isvi
lte Ar
ea-
-Z
-2
20753
Hyattsville-Adelphi
--
--
70
10
Tota
l De
crea
se inPr
ojec
ted Laurel Reg
iona
l Ho
spit
al Dis
char
ges
Based on WAH Relocation
(243)
(133)
(158)
(48)
(5S2)
~3