In the latest battle for profitable cardiac cases, a controversial physician contract for a Maine heart center slated to open next year has angered some local cardiologists and state officials.
Central Maine Medical Center in Lewiston plans to open a 16-bed cardiology center in April 2003, more than two years after winning certificate-of-need approval.
Local cardiologists may apply for privileges only if they agree in writing to not participate in a competing cardiac-surgery center. Central Maine Medical Center would not release a written copy of the contract it's asking physicians to sign.
Chuck Gill, spokesman for the 172-bed hospital, said the facility wants a dedicated team that will attract a steady stream of patients to pay for the approximately $6.5 million capital cost of the heart center, as required by its CON.
"You can't be on two teams at the same time," he said.
Representatives of Maine Medical Center in Portland, which operates one of two existing heart programs in the state, and some local cardiologists argue the policy amounts to "economic credentialing" because it dictates where physicians may admit patients. They claim the policy is a way to retaliate against opponents of the hospital's CON petition.
Economic credentialing is opposed by the American Medical Association, which defines it as the "use of economic criteria unrelated to quality of care or professional competency" in determining qualifications for hospital privileges.
Among the opponents was 560-bed Maine Medical Center, which annually performs more than 1,600 open-heart surgeries and 2,000 angioplasties.
"There is no need to have another cardiology center only 40 miles away. It is a duplicative program that doesn't improve access and quite likely raises costs," Maine Medical Center spokesman Wayne Clark said.
Under the policy, the 42 cardiologists who practice at Maine Medical Center would be barred from seeing patients at Central Maine Medical Center.
"We are concerned about being decredentialed," said cardiologist Robert Weiss. He has been credentialed at Central Maine Medical Center for 17 years. Though he doesn't practice at Maine Medical Center, Weiss' medical group is merging with a Portland medical group whose members do.
Attempts by hospitals to gain exclusive loyalties from physicians are not unprecedented, particularly when it comes to cardiac care. For example, two-hospital Roman Catholic Sisters of Charity Providence Hospitals in Columbia, S.C., recently enacted a policy that prohibited cardiovascular physicians from practicing at its facilities if they have a financial relationship with competing hospitals, in response to the announced construction of a competing heart hospital (March 18, p. 30).
The dispute has reached Maine's state officials, largely because of cardiologists who have arranged legislative breakfast meetings and have encouraged residents to write letters to the local newspaper.
"There is no need to try to browbeat doctors into choosing which facility to use," said Keith Concannon, Maine's Department of Human Services commissioner. "Doing this is going to turn people away."
Concannon last week asked state Attorney General Steven Rowe to investigate whether the policy violates fair trade practice or the spirit of the CON law.
"If I knew the hospital was considering this edict, I would have made a condition of the CON prohibiting them from doing so," Concannon said.
State lawmakers also have jumped into the fray. Democratic State Sen. Neria Douglass, who has constituents in Lewiston, said she expected legislation curtailing economic credentialing to be introduced this week. "Patient choice and quality of care are priorities before the hospital's right to own a doctor," she said.
The Maine Medical Association has stayed on the sidelines.