An indication that there is little respect for planning: Maryland healthcare edition

For as long as I have been writing this blog actively (since 2/2005), I have been writing about health and wellness care planning vs. hospital planning, and making the point that economic problems in the Prince George's County Hospital system, Howard University Hospital (which had/has a big push to build a new hospital somewhere in the city not on their campus), and Greater Southwest Hospital (now United Medical Center) are connected because of the amount of uncompensated care that the facilities provide, and are exacerbated by the lack of true regional planning for health care.

Clearly, we need at least five different types of health care institutions based on scale/type of service:

a. Big anchor hospitals/teaching hospitals/high level trauma care;

b. Hospitals that aren't necessarily high level trauma care but have various specialty care foci (such as heart health or cancer);

c. Long term or specialty care centers like the Hospital for Sick Children or the National Rehabilitation Hospital or long term nursing care;

d. Acute care centers that aren't full blown emergency rooms/high level trauma centers;

e. community clinics.

Ideally, regional and state health and wellness care plans would address each of these areas comprehensively, and facilities (for profit and nonprofit) would get the licenses to provide the care that is necessary.

That's not how it works though. There isn't a comprehensive plan--there is in some places, but not apparently in DC or Maryland.

Hospitals pursue licensing on their own, although the "certificate of need" process helps to manage the growth process.

This comes up in the process to resuscitate the United Medical Center in DC, or the Prince George's County Hospital system in Maryland (I've decided I am not gonna write about the various proposals to link this system with the University of Maryland Medical System until they are firmer, now they are just press releases and speculation, see "Pr. George's to get teaching hospital" from the Post), as well as in expansion plans for Holy Cross and Adventist Hospitals in Upper Montgomery County, Maryland, as well as the relocation plan for Washington Adventist Hospital in Montgomery County, which has Prince George's County supportive but also worried, because a location closer to upper Prince George's County could siphon off paying patients from Laurel Regional Hospital (see "Md. hospital to make case for move" from the Post). (These issues as it relates to Maryland-based facilities have been covered in great detail in the various editions of the Gazette.)

One of the concerns expressed in the Post is that moving the Washington Adventist Hospital to White Oak from Takoma Park will reduce the amount of care made available to the Langley Park area, which apparently has a great deal of demand. From the article:

But other hospitals in the area oppose the move, which they say would hurt their own growth and hurt care for some of the region’s poorer people.

Washington Adventist serves many people from lower-income communities, including Langley Park in Prince George’s, and the absence of a full-service hospital in the area is a concern of some officials, including Prince George’s County Executive Rushern L. Baker III.

Jepson said Adventist will not be abandoning anyone. “We are seeking to serve the same patients we always have,” he said. The hospital has plans for a clinic on the Washington Adventist site, which state Sen. Victor R. Ramirez (D-Prince George’s) said has alleviated his concerns about patient care.

Sounds like that area would be a good place for combination (d)/(e) facilities. St. Mary's Center, an operator of community clinics in DC, will be opening a clinic on the campus that WAH is leaving in Takoma Park.

But maybe it would be better from a health and wellness planning perspective to locate such a facility, along with greater acute care services, in Takoma Crossroads/Langley Park.

Etc.