Wednesday, July 25, 2007

Ducky Trachtenberg: It’s a certificate of need, but it doesn’t always fill the bill

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When a hospital, nursing home, outpatient facility or other major health provider wants to change or develop an institutional health service, the Maryland Health Care Commission must issue a certificate of need agreeing the project has merit for the community.

The local board of health has an important role to play in this process. Here in Montgomery County, the County Council also sits as the board of health, and as a trained public health professional on the council, I take this role seriously. Indeed, as someone who has faced serious illness without medical insurance, I feel a personal responsibility to speak for those who rarely have a voice in this kind of debate.

In a time of shrinking financial resources and looming cuts in state and local budgets, I believe Montgomery County needs to engage in a frank and transparent conversation about infrastructure across the board. I’m not just talking about roads, transit projects and development, but also about the foundation of our public health system and our social contract with the people.

In recent months, the council has been looking at the implications of the relocation of Washington Adventist Hospital six miles from its current Takoma Park location. The hospital is seeking a certificate of need from the state and it has been suggested that we contract with consultants to study the impact on the region’s health care delivery system if this one hospital is not able to move and if that occurrence will jeopardize the hospital’s long-term financial viability.

It would be one thing if we were to contract with a respected school of public health to conduct an overall needs assessment of the county’s medical facilities, including hospitals. Many cities and counties have such arrangements that, among other things, facilitate the awarding of grants for needs identified by the process. But instead of looking at the big picture of how best to use and⁄or change our current infrastructure, the narrow focus some prefer would be entirely on the economic vitality of the county’s private hospitals. Why should the council conduct what is essentially a marketing study for any hospital? Why should public dollars be spent on this kind of exercise?

As we engage in this debate over the next week or two, it’s also important to remember that despite the best efforts of some to make this a business story, it’s really about health care policy.

The council’s job is to debate and determine public policy. Acting as the board of health, the council has a responsibility to act in keeping with best community medicine practices and up-to-date scientific information. Public policy, in this case of hospital relocation, involves two independent sources of concern: health care and economic development.

From a public health perspective, the question is primarily the issue of availability of services. The number of uninsured and under-insured people is growing rapidly in the county, and our first response has to be to them. What does the population need and what do the area hospitals provide? The data to answer these questions should be collected by trained public health professionals, not business consultants.

While I don’t believe the economic development perspective of the proposed hospital move should dominate the debate, I do of course recognize its importance. What impact will hospital relocation have on the job market in the new location and the old? What are the ancillary impacts on the county job market and on service industries?

Last November, a new County Council was elected by voters who decided development in Montgomery County needed more scrutiny, not lighter brakes. Whether it’s a new hospital complex in East County or a condominium in North Bethesda, the council must confront the reality of today’s infrastructure. Before we support a certificate of need for any hospital, we need to step back and adjust our vision to see the entire landscape.

Duchy Trachtenberg, a Democrat from North Bethesda, is an at-large member of the County Council.