Filed 1/16/15

242 Pages·2015·5.8 MB·English

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
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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
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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
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.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 .................................................................................................. 237
TABLE OF TABLES .................................................................................................... 239
TABLE OF FIGURES .................................................................................................. 241

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For internal staff use

MARYLAND
____________________
HEALTH
MATTER/DOCKET NO.
CARE
13-16-2351
COMMISSION
DATE DOCKETED

HOSPITAL
APPLICATION FOR CERTIFICATE OF NEED

PART I - PROJECT IDENTIFICATION AND GENERAL INFORMATION

1. FACILITY

Name of Facility: Prince George’s Regional Medical Center

Address:
The Boulevard At The Largo 20774 Prince George’s
Capital Centre (Project
Site)
Street City Zip County

Name of Owner (if differs from applicant):

2. OWNER

Name of owner:

3. APPLICANT. If the application has co-applicants, provide the detail regarding each co-
applicant in sections 3, 4, and 5 as an attachment.

Legal Name of Project Applicant
Dimensions Health Corporation d/b/a Prince George’s Hospital Center

Address:
3001 Hospital Drive Cheverly 20785 MD Prince George’s
Street City Zip State County

Telephone: [phone]

Name of Owner/Chief Executive: Neil J. Moore, President/CEO

4. NAME OF LICENSEE OR PROPOSED LICENSEE, if different from applicant:

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5. LEGAL STRUCTURE OF APPLICANT (and LICENSEE, if different from applicant).


Check or fill in applicable information below and attach an organizational chart
showing the owners of applicant (and licensee, if different).

A. Governmental
B. Corporation
(1) Non-profit
(2) For-profit
(3) Close State & date of incorporation

Maryland, 10/05/1982
C. Partnership
General
Limited
Limited liability partnership
Limited liability limited

partnership
Other (Specify):
D. Limited Liability Company
E. Other (Specify):

To be formed:
Existing:

6. PERSON(S) TO WHOM QUESTIONS REGARDING THIS APPLICATION SHOULD BE
DIRECTED
A. Lead or primary contact:

Name and Title: Jeff Johnson, Healthcare Strategy Consultant
Mailing Address:
Prince George’s Hospital Center Cheverly 20785 MD
3001 Hospital Drive
Street City Zip State
Telephone: [phone]
E-mail Address (required): [email protected]
Fax: [phone]

B. Additional or alternate contacts:
Mary Miller, CFO/Vice President
Name and Title: of Finance and Business Development
Mailing Address:
Mt. Washington Pediatric Hospital Baltimore 21209 MD
1708 W. Rogers Avenue
Street City Zip State
Telephone: [phone]
E-mail Address (required): [email protected]
Fax: [phone]
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Name and Title: Thomas C. Dame, Esq.
Mailing Address:
Gallagher Evelius & Jones LLP Baltimore 21201 MD
218 N. Charles St. Ste. 400
Street City Zip State
Telephone: [phone]
E-mail Address (required): [email protected]
Fax: [phone]

Name and Title: Ella R. Aiken, Esq.
Mailing Address:
Gallagher Evelius & Jones LLP Baltimore 21201 MD
218 N. Charles St. Ste. 400
Street City Zip State
Telephone: [phone]
E-mail Address (required): [email protected]
Fax: [phone]

Name and Title: Andrew L. Solberg
Mailing Address:
A.L.S Healthcare Consultant Services Columbia 21044 MD
5612 Thicket Lane
Street City Zip State
Telephone: [phone]
E-mail Address (required): [email protected]
Fax:

7. TYPE OF PROJECT

The following list includes all project categories that require a CON under
Maryland law. Please mark all that apply.

If approved, this CON would result in:

(1) A new health care facility built, developed, or established
(2) An existing health care facility moved to another site
(3) A change in the bed capacity of a health care facility
(4) A change in the type or scope of any health care service offered
by a health care facility
(5) A health care facility making a capital expenditure that exceeds the
current threshold for capital expenditures found at:
http://mhcc.maryland.gov/mhcc/pages/hcfs/hcfs_con/documents/con_capital_threshold_20140301.pdf

8. PROJECT DESCRIPTION
A. Executive Summary of the Project: The purpose of this BRIEF executive
summary is to convey to the reader a holistic understanding of the proposed
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project: what it is; why you need/want to do it; and what it will cost. A one-page
response will suffice. Please include:

(1) Brief description of the project – what the applicant proposes to do;
(2) Rationale for the project – the need and/or business case for the proposed
project;
(3) Cost – the total cost of implementing the proposed project; and
(4) Master Facility Plans – how the proposed project fits in long term plans.

Dimensions Health Corporation (“Dimensions”) and the Mt. Washington
Pediatric Hospital (“MWPH”) propose the construction of a new hospital,
Prince George’s Regional Medical Center (“PGRMC”), to replace Prince
George’s Hospital Center (“PGHC”), and the relocation of the MWPH unit
currently at PGHC to the new hospital.

B. Comprehensive Project Description: The description must include details, as
applicable, regarding:

(1) Construction, renovation, and demolition plans;
(2) Changes in square footage of departments and units;
(3) Physical plant or location changes;
(4) Changes to affected services following completion of the project; and
(5) If the project is a multi-phase project, describe the work that will be done in
each phase. If the phases will be constructed under more than one
construction contract, describe the phases and work that will be done under
each contract.

Comprehensive Project Description
The overriding purpose of this proposed project is to transform the healthcare delivery
system for Prince George’s County residents, who for far too long have been underserved.
I. BACKGROUND: THE STATE OF HEALTH CARE IN PRINCE GEORGE’S
COUNTY
A. Introduction
Prince George’s County is the second most populous county in Maryland, and is
Maryland’s most diverse county. In 2010, minority groups accounted for more than 80
percent of the County’s population of 863,420.
Despite the population size, higher-than-average median income, and rich diversity of
Prince George’s County, available statistics paint a concerning picture of the health of
County residents, and their access to care, when compared to neighboring Maryland
counties. County residents suffer from higher rates of chronic diseases, including diabetes,
heart disease, hypertension, asthma and cancer, than those residing in neighboring counties.
A 2011 report by Maryland Nonprofits found that Prince George’s County’s mortality rate
ranked 17th out of Maryland’s 24 counties. By contrast, neighboring Howard and
Montgomery Counties had the State’s lowest mortality rates.1

1 The 2011 Maryland Nonprofit report is available at:
http://marylandnonprofits.org/Portals/
0/Files/Pages/Nonprofit%20Resources/Nonprofit%20Research/PG%20Co%20Health%20Ra
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The health of County residents is exacerbated by the lack of a well-functioning
ambulatory care safety net. Prince George’s County has a substantially lower ratio of
primary care providers to the population compared to surroundings counties and the state. A
2009 study by the Rand Corporation (the “Rand Study”) found that Prince George’s County
had higher rates of ambulatory care–sensitive hospitalizations and emergency department
visits than surrounding jurisdictions. That Study further found that these admissions were
concentrated in poor regions of the County, suggesting that more affluent residents are able
to access primary care outside of the County.
Patient trends also suggest County residents are either disastisfied with or have
limited access to inpatient care within the County, as the majority of County residents who
receive inpatient care are discharged from hospitals outside of the County.2 As the Editorial
Board of the Washington Post stated in August of 2013, “[t]he absence of a top-flight hospital
in a locality of 880,000 people — one that provides a variety of specialty care and tertiary
services — is a long-running scandal.” See Exhibit 3.
Prince George’s Hospital Center (“PGHC”), managed by Dimensions Health
Corporation d/b/a Dimensions Healthcare System (“Dimensions”), plays a vital and unique
role in the health security of the County. While Dimensions has made efforts over the years
to address the healthcare needs of County residents, these efforts have been thwarted by
financial challenges and operational limitations. Historically, PGHC has had the highest
percentage of Medicaid and self-pay patients compared to any other hospital in the County,
and it has become the healthcare safety net for low-income Prince George’s County
residents. Since fiscal year 1999, as a result of the changing demographics of the County
and growth in the high proportion of uninsured and underinsured patients that it served,
PGHC has been burdened with significant operating losses. In addition, the PGHC facility is
aging and in need of a variety of improvements. PGHC’s current facilities are not designed
for modern, patient centered, family oriented medicine, and are undersized in various critical
areas. Absent a significant overhaul involving an investment in facilities as well as the
growth of an ambulatory-care network that will enable County residents to seek preventive
care and primary care treatment rather than relying on inpatient and emergency care, PGHC
risks being unable to continue serving its already underserved population.
The proposal set forth in this CON application results from the collaboration of
numerous stakeholders who have agreed to assume leadership in addressing the public
health problems in Prince George’s County and the difficult financial and operational status
of the current PGHC facility. The proposed Prince George’s County Regional Medical
Center (“PGRMC”) aims to provide County residents with the hospital and health care
network they deserve by transforming PGHC into a thriving regional medical center that will
provide efficient, high-quality care while minimizing reliance on inpatient care and improving
the health of its service area population by building a strong ambulatory care network.
An academically-affiliated regional medical center greatly enhances the probability
that new care models and technologies will speed improvements in raising health status and

nkings.pdf (last accessed 11/26/14); the 2009 Rand Study is available at http://www.rand.org
/pubs/technical_reports/TR655.html (last accessed 11/26/2014).
2 The Rand Study found, for example, that in 2006, “[a]mong all inpatients who resided
in Prince George’s County, 37.2 percent were discharged from Prince George’s County
hospitals. By contrast, 77.0 percent of patients from Montgomery County were hospitalized in
Montgomery County, and 92.4 percent of patients from the District of Columbia were
hospitalized in the District of Columbia.”
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