Weaker, less efficient hospitals in Maryland would be forced to cut back their facilities, merge with other hospitals or close under regulations proposed today by a state health planning committee.
The proposals did not target specific hospitals for closure or mergers, but officials promised a ranking of hospitals' efficiency by Nov. 1 that would help determine the goals for cuts.
Officials of the state's Health Resource Planning Commission, speaking to a joint state legislative committee on health costs, recommended a carrot-and-stick approach to persuade hospitals to cut back, merge, or close voluntarily to meet goals set by the commission.
If those measures failed, officials said, they would seek to have the licenses removed for hospital beds or for entire hospitals.
Richard Wade, a spokesman for the Maryland Hospital Association, said hospital administrators are relieved that specific hospitals are not targeted for closing or for mandatory cuts in service, as suggested in a consultants' report that was released two months ago.
Wade said that administrators are confused, however, by the complexity of the proposed regulations and are not sure what effects the regulations would have.
Five public hearings on the proposed regulations are scheduled for early October. The regulations then could be amended. They also must be submitted to the General Assembly's legislative review committee to ensure that they conform with state law.
State health officials say the number of excess beds at Maryland's 54 acute care hospitals is rising.
According to the report by consultants Booz-Allen & Hamilton Inc. in July, more than 5,126 of the state's 15,600 hospital beds regularly are empty.
The annual cost of these beds, and the staff and facilities that support them, was calculated by the health commission as between$131 million and $231 million in 1983.
The proposals to reduce these excess beds include no "hit list," Stanton said, but allow "for flexibility to give hospitals a chance to work things out."
Under the proposed regulations, the commission would determine the number of excess beds in each hospital and in each jurisdiction of the state and establish bed-reduction targets.
Hospitals that met those goals by eliminating beds or merging with other hospitals could be rewarded with exemptions from the complicated "certificate of need" procedures that hospitals normally go through to get permission for new equipment, departments, and other capital projects.
Because obtaining certificates of need is a costly and time-consuming process, commission officials and the hospital association described this proposal as an important incentive.
"The certificate of need is a big deal," said commission spokesman Sue Panek. "It is really a tyranny over some of the most minute kinds of processes."
That is the carrot; the stick, in effect, is the ranking. Under a complicated formula, the lowest ranked hospital in any given jurisdiction would be expected to eliminate150 percent of its excess beds, while the highest ranked hospital could, in theory, keep some of its excess.
Under the proposed regulations, hospitals that fail to meet the goals would be examined closely before being granted certificates of need.
The regulations also propose that the commission be able to request the state's secretary of Health and Mental Hygiene to take away state licenses for hospital beds or entire hospitals in cases where the hospitals do not take voluntary action.
The details of how that would work will not be decided until voluntary action proves unsuccessful, Stanton said. He described it as "a last resort-type action."
Wade, of the hospital association, said that the number of hospital beds and the number of hospitals is bound to be reduced, regardless of the regulations.
He added that hospital administrators, faced with shorter periods of hospitalization and reduced admissions, are "eventually compelled by those kind of numbers to do some downsizing."
Wade cited the recent firing of about 650 employes at Prince George's General Hospital as one example.
"These trends are going to continue," he said. "We see no sign that there's going to be any swelling of admissions."