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In the Maryland Health Care Commission

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In the Maryland Health Care Commission IN THE MARYLAND HEALTH CARE COMMISSION Modified Application for Certificate of Need for Prince George’s Regional Medical Center As a Replacement and Relocation of Prince George’s Hospital Center Co-Applicants Dimensions Health Corporation d/b/a Prince George’s Hospital Center and Mt. Washington Pediatric Hospital, Inc. January 16, 2015 TABLE OF CONTENTS Page PART I - PROJECT IDENTIFICATION AND GENERAL INFORMATION ....................... 5 1. FACILITY ................................................................................................... 5 2. OWNER ..................................................................................................... 5 3. APPLICANT ............................................................................................... 5 4. NAME OF LICENSEE OR PROPOSED LICENSEE ................................. 5 5. LEGAL STRUCTURE OF APPLICANT ..................................................... 6 6. PERSON(S) TO WHOM QUESTIONS REGARDING THIS APPLICATION SHOULD BE DIRECTED .................................................. 6 7. TYPE OF PROJECT .................................................................................. 7 8. PROJECT DESCRIPTION ......................................................................... 7 A. Executive Summary of the Project .................................................. 7 B. Comprehensive Project Description ................................................ 8 I. BACKGROUND: THE STATE OF HEALTH CARE IN PRINCE GEORGE’S COUNTY ....................................... 8 A. Introduction ................................................................ 8 B. History of Prince George’s Hospital Center ............. 10 C. Prince George’s Hospital Center Today .................. 11 II. TRANSFORMING PRINCE GEORGE’S COUNTY’S HEALTH CARE DELIVERY SYSTEM ............. 13 A. The July 2011 Memorandum of Understanding ......................................................... 13 B. The Public Health Impact Study .............................. 14 C. Development of the Proposed Regional Medical Center ........................................................ 15 D. Commitment to Primary and Community Care ......................................................................... 16 E. Vision & Rationale For An Academic- Affiliated Regional Tertiary Medical Center .............. 19 III. THE PROPOSED PROJECT ............................................. 23 A. Project Location and Service Area........................... 23 B. Regional Medical Center Proposed Services .......... 24 C. Program Descriptions .............................................. 25 i D. Mount Washington Pediatric Hospital ...................... 26 E. Use of Existing PGHC Campus After Relocation of Hospital .............................................. 27 F. Proposed Project Size and Cost Comparison ............................................................. 27 9. CURRENT PHYSICAL CAPACITY AND PROPOSED CHANGES ............................................................................................... 29 10. REQUIRED APPROVALS AND SITE CONTROL ................................... 29 11. PROJECT SCHEDULE ............................................................................ 31 12. PROJECT DRAWINGS ........................................................................... 31 13. FEATURES OF PROJECT CONSTRUCTION ........................................ 31 PART II - PROJECT BUDGET ...................................................................................... 33 PART III - APPLICANT HISTORY, STATEMENT OF RESPONSIBILITY, AUTHORIZATION AND RELEASE OF INFORMATION, AND SIGNATURE ................ 40 PART IV - CONSISTENCY WITH GENERAL REVIEW CRITERIA AT COMAR 10.24.01.08G(3) ............................................................................................................ 43 COMAR 10.24.01.08G(3)(a). THE STATE HEALTH PLAN ................................ 43 COMAR 10.24.10 ACUTE CARE CHAPTER ......................................... 43 .04A. GENERAL STANDARDS..................................................... 43 Standard .04A(1) – Information Regarding Charges .......... 43 Standard .04A(2) – Charity Care Policy ............................. 44 Standard .04A(3) – Quality of Care .................................... 46 .04B. PROJECT REVIEW STANDARDS ...................................... 49 Standard .04B(1) – Geographic Accessibility ..................... 49 Standard .04B(2) – Identification of Bed Need and Addition of Beds....................................................... 53 Standard .04B(3) – Minimum Average Daily Census for Establishment of a Pediatric Unit ........... 83 Standard .04B(4) – Adverse Impact ................................... 83 Standard .04B(5) – Cost-Effectiveness .............................. 90 Standard .04B(6) – Burden of Proof Regarding Need ...................................................................... 117 Standard .04B(7) – Construction Cost of Hospital Space .................................................................... 117 ii Standard .04B(8) – Construction Cost of Non- Hospital Space ...................................................... 129 Standard .04B(9) – Inpatient Nursing Unit Space ............. 130 Standard .04B(10) – Rate Reduction Agreement ............. 131 Standard .04B(11) – Efficiency ......................................... 131 Standard .04B(12) – Patient Safety .................................. 135 Standard .04B(13) – Financial Feasibility ......................... 139 Standard .04B(14) – Emergency Department Treatment Capacity and Space ............................. 142 Standard .04B(15) – Emergency Department Expansion .............................................................. 153 Standard .04B(16) – Shell Space ..................................... 153 COMAR 10.24.12 - OB SERVICES CHAPTER ..................................... 155 .04 REVIEW STANDARDS ......................................................... 155 Standard .04B(1) – Need.................................................. 155 Standard .04(2) – The Maryland Perinatal System Standards .............................................................. 157 Standard .04(3) – Charity Care Policy .............................. 157 Standard .04(4) – Medicaid Access .................................. 158 Standard .04(5) – Staffing ................................................ 159 Standard .04(6) – Physical Plant Design and New Technology ............................................................ 160 Standard .04(7) Nursery ................................................... 160 Standard .04(8) – Community Benefit Plan ...................... 160 Standard .04(9) – Source of Patients ............................... 161 Standard .04(10) – Non-metropolitan Jurisdictions .......... 161 Standard .04(11) – Designated Bed Capacity .................. 161 Standard .04(12) – Minimum Volume ............................... 162 Standard .04(13) – Impact on the Health Care System ................................................................... 162 Standard .04(14) – Financial Feasibility ........................... 163 Standard .04(15) – Outreach Program ............................. 163 COMAR 10.24.07 - PSYCHIATRIC SERVICES CHAPTER .................. 165 COMAR 10.24.11. GENERAL SURGICAL SERVICES ......................... 174 iii .05A. GENERAL STANDARDS................................................... 174 Standard .05A(1) – Information Regarding Charges ........ 174 Standard .05A(2) – Charity Care Policy ........................... 174 Standard .05A((3) – Quality of Care ................................. 176 Standard .05A(4) – Transfer Agreements......................... 176 .05B. Project Review Standards.................................................. 177 Standard .05B(1) – Service Area ...................................... 177 Standard .05B(2) – Need- Minimum Utilization for Establishment of a New or Replacement Facility ................................................................... 177 Standard .05B(3) – Need - Minimum Utilization for Expansion of An Existing Facility ........................... 180 Standard .05B(4) – Design Requirements ........................ 181 Standard .05B(5) – Support Services ............................... 181 Standard .05B(6) – Patient Safety .................................... 181 Standard .05B(7) – Construction Costs ............................ 182 Standard .05B(8) – Financial Feasibility ........................... 183 Standard .05B(9) – Preference in Comparative Reviews ................................................................. 183 CARDIAC SERVICES ...................................................................................... 185 10.24.01.08G(3)(b). Need. .............................................................................. 202 10.24.01.08G(3)(c). Availability of More Cost-Effective Alternatives ............... 209 10.24.01.08G(3)(d). Viability of the Proposal ................................................... 211 10.24.01.08G(3)(e). Compliance with Conditions of Previous Certificates of Need. .............................................................................. 214 10.24.01.08G(3)(f). Impact on Existing Providers and the Health Care Delivery System ..................................................................................... 215 AFFIRMATIONS.......................................................................................................... 227 TABLE OF EXHIBITS .................................................................................................
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