A rendering of the proposed Prince George’s Regional Medical Center. (Courtesy of Dimensions Healthcare System)

The long-awaited Prince George’s County regional hospital is too big and too expensive to win state regulatory approval without major changes, according to the Maryland Health Care Commission member reviewing the project.

Commissioner Robert E. Moffit told project leaders last week that they must reduce the number of beds, shave off square footage and bring down the price by more than $100 million before he can recommend approval of a “certificate of need.”

The teaching hospital, projected to cost $651 million, has been touted for years as a crucial part of improving health care for Prince George’s residents and bringing high-paying jobs and economic development to the county. It had strong backing from then-Gov. Martin O’Malley (D) and continues to be a priority for leaders of the Democratic-controlled General Assembly in Annapolis.

But delays in receiving state approval have pushed the hospital’s projected opening date from 2017 to at least 2020 — and that was before the latest round of questions. Twice in the past two years, Gov. Larry Hogan (R) has clashed with Democratic lawmakers over state funding for the hospital.

Gov. Larry Hogan (R), center, announces $55 million in funding over five years for the Prince George’s Regional Medical Center in February. (Brian Witte/AP)

Dimensions Healthcare Systems and the University of Maryland Medical System (UMMS) — which would run the proposed Prince George’s Regional Medical Center near the Largo Town Center Metro station — said they will modify the application by the end of August but need Moffit to clarify some of his proposed changes.

In a response letter delivered Monday, attorneys for the project questioned many of Moffit’s concerns, saying his comments about size and cost may “conflict” with the project’s “vision to adequately address the health care needs” of the residents of Prince George’s and nearby jurisdictions.

Senate President Thomas V. Mike Miller Jr. (D-Calvert), who sponsored legislation mandating state funding for the project, agreed. “It’s just unbelievable,” Miller said in an interview. “The hospital will serve all of Southern Maryland, and instead of being scaled back, it needs to be allowed to grow.”

Moffit, a health-policy fellow at the conservative Heritage Foundation, raised pointed questions about key financial projections, essentially saying that the hospital as proposed is a larger facility than the market can bear.

His letter said planners should be more conservative in estimating how many patients the hospital would attract and how much money their stays would generate, especially given a decline in hospital rates and changes in health care and technology that generally mean patients are admitted for shorter periods of time.

Specifically, Moffit said, the hospital should reduce the number of beds from 251 to no more than 219, and reduce the space per bed from 2,987 square feet to no more than 2,400 square feet. Moffit also said that the capacity of the hospital’s emergency department should be limited to 45 patients and that the proposal should eliminate at least one planned operating suite and jettison plans for a dedicated ambulatory-care center.

Moffit pointed to the lower costs of the recently approved relocation of Washington Adventist Hospital, in Montgomery County, as proof that the Prince George’s hospital is “unnecessarily large” and can do more with less.

“Reducing the cost of this project,” Moffit concluded, “should reduce the risk that this project will be inefficiently used.”

Dimensions said comparing the two projects is unfair, noting that Washington Adventist does not have a trauma center and that the Prince George’s hospital, which will rely on public money, must follow wage and hiring restrictions that increase overall costs by 15 percent.

“It’s obviously a very conservative view, but the fact of the matter is he’s the one that’s been selected to make the decision,” said Maryland House Speaker Michael E. Busch (D-Anne Arundel), another longtime backer of the project. “It’s part of the give-and-take process. I don’t think anyone wants this project to fail. It is too important to the state to not move forward.”

Moffit expressed deep doubts about the capacity of Dimensions to run an efficient operation. The private nonprofit corporation, which leases and manages county hospitals, has struggled to sustain the existing Prince George’s Hospital Center in Cheverly, seeking county and state subsidies to overcome operating shortfalls and watching top medical staff — and their patients — head to better-performing hospitals in neighboring jurisdictions.

“The history of PGHC has been one of long-standing managerial and financial difficulties,” wrote Moffit, who asked for more details about what will happen to Dimensions once the regional hospital is built. “One of the key objectives of UMMS’ involvement is to assure a turnaround and put the institution on a path toward permanent progress.”

Hogan expressed similar concerns about Dimensions this year, people involved in the discussions have said. He was reluctant to guarantee public funding for the hospital project until he had more information about who would ultimately run it.

Prince George’s elected officials said the plan is simple. The county government would get out of the hospital business once the new facility is built, and UMMS would take over Dimensions’s role in managing the hospital and its related primary-care network privately.

Although the project proposal was first submitted to the Maryland Health Care Commission in October 2013, it was not taken up for consideration until April 2015, according to state documents. It is by far the oldest application currently on the docket.