Provider/Technology Name

Background and Recommendation

Project
Date

Proposal

Final outcome

CTAAB concluded there is need for the surgical robot:
·          Patient and provider demand for robotic surgery continues to increase.
·          Indications for robotic surgery are expanding.
·          Available surgical robots in the region are operating close to capacity.
·          Unity has 12 surgeons trained in robotic surgery, eight of whom are currently performing such surgeries at other area hospitals.
The surgical robot is expected to be operational in the third quarter of 2012.

CTAAB concluded there is need for the second surgical robot:
·         Patient and provider demand for robotic surgery continues to increase.
·         Indications for robotic surgery are expanding.
·         Available surgical robots in the region are operating close to capacity.
·         Highland Hospital has an established robotic surgery program with a dedicated surgical team.
The surgical robot is expected to be installed and ready for use by the end of 2011.

CTAAB concluded there is not a need for the proposed services:
There is not a community need for additional MRI capacity.

Appeal:  CTAAB received an appeal from the applicant.  Based on additional information presented, CTAAB made no recommendation on the need for the service.

CTAAB concluded there is need for the additional beds:
·          As presently operated (six beds, four nights per week), the capacity being utilized is the same as that previously available (four beds, six nights per week).
·          The present operation provides for more stable staffing patterns.
·          The specification of an operational date is moot; the number of sleep beds has already been expanded.

The following conditions were also recommended by CTAAB:
·          The applicant return to CTAAB for approval before expanding into additional nights’ use of the six-bed capacity.
The applicant provide annual monitoring data for Finger Lakes Health Systems Agency staff such that there is a measure of use of the six-bed unit.

CTAAB concluded there is need for the proposed services:   
·          The sleep center will nominally serve areas, primarily in Orleans County, which experience less access to sleep diagnostic services than other areas in the region.
·          There are extensive wait times at existing services that could potentially serve these areas.
·          The sleep center and consulting sleep specialist physician accept all insurances, including Medicaid.
·          The specification of an operational date is moot; the sleep center is currently operational.  

CTAAB concluded there is need for proposed services:   
·          Imaging services are not available at Alexander Park, where there is a substantial number of physician practices and more practices are expected to locate. 
·          The proposed center would expand geographic access to care. 
·          Approximately 35% of revenue would be derived from Medicaid.
·          When CT scanning services are available at the Alexander Park site, use of the oldest and least used of the three CT scanners currently on site at Rochester General Hospital will be discontinued.  The two CT scanners remaining in operation at Rochester General Hospital will be sufficient to handle the volume of scans for inpatients, emergency department patients, and outpatients continuing to use the hospital imaging services.
·          The anticipated operational date for the imaging center is the end of the first quarter 2012.  

CTAAB concluded there is need for the fixed PET-CT:
·          Clinical need for PET scanning continues to expand.
·          Clinical quality and patient comfort and safety will likely be improved.
Anticipated project completion date is six to nine months.

CTAAB concluded there is a need for the proposed MRI.
·          The proposed service would add MRI services to a hospital where it does not currently exist.
·          The proposed service would add geographic access.
The hospital is projecting appropriate levels of access for financially disadvantaged patient groups.

CTAAB concluded there is need for the relocation and renovation:

·          There presently is a low rate of appropriate screening for colorectal cancer in Wayne County, the hospital’s primary service area.

·          The proposed renovation will support colorectal screening and other endoscopic activities with clinically efficient settings, will correct present violations of hospital building codes, and will bring the suite up to industry standards.

CTAAB concluded there is need for the creation of the neuromedicine unit:

·          The proposed unit would provide some beds now to meet present need for beds as calculated by the 2020 Commission.  Those beds, potentially not needed in the future as effective demand management initiatives are implemented, should be acknowledged as part of the existing bed complement of the URMC/Strong Health system as the area hospitals develop their current and future bed projects.

·          The grouping of neuromedicine patients should lead to improvements in quality of care through development of specialized nursing skills and application of specialized technology.

·          The creation of the unit would renovate an older section of the hospital and provide private patient rooms.

·          Anticipated project completion date is July 2011.

CTAAB concluded there is need for the additional ORs:

  While there is no current community-wide need for additional surgery capacity, Highland Hospital has demonstrated an institutional need for additional OR capacity based on established criteria that reflect high usage rates of existing capacity.

CTAAB concluded there is need for the renovation:
·          There is need to replace or modernize the existing ED based on both functionality and capacity.
·          Quality of patient care will be enhanced.
·          The design offers the opportunity to provide lower intensity care in a more efficient setting.  

CTAAB recommended that the hospital provide bilingual-bicultural staff within the ED and the hospital at large in accordance with New York State regulations.   

CTAAB further recommended that the hospital be an active participant in a collaborative, regional planning process to assure effective and non-duplicative investment in the region’s and subarea’s health care delivery system.

CTAAB concluded there is a need for the fixed MRI:
·          The proposed fixed unit will increase the timely availability, accessibility, and quality of MRI services to the patients at the hospital, including its rural patient base.
·          The large bore unit will provide clinical benefit to some overweight and claustrophobic patients.
         There is only a small cost difference between the present part-time service and the proposed full-time service.

CTAAB concluded there is a need for the proposed modernization, with the contingency that the number of Emergency Department stations be reduced to 16 and that the number of pre-admission stations be reduced as FLHSA staff determines based on additional information from Geneva General Hospital.

·         Use of radiology services has increased.  Increased demand for cardiology services is expected following the addition of two hospital-based cardiologists.

·         The rooms in the current intensive care unit (ICU) are small and outdated; no new ICU beds will be added during the renovation.  Given current demand, the current number of ten beds is needed to have an ICU bed available 99% of the time.

·         The current operating suites are small and outdated; no new operating rooms will be added.

·         Based on available utilization data, the emergency department needs 16 stations.  There are no utilization standards for pre-admission stations; FLHSA staff will work with the applicant to determine an appropriate number of stations.

·         Modernization of the applicant’s hospital rooms is important; current standards for acute care hospitals call for single patient rooms.  The applicant’s renovation of current hospital rooms to create 17 single rooms and construction of 24 new single rooms will help the hospital meet these standards.  

CTAAB concluded there is need for the laboratory:
·          Monroe County facilities, including Unity Hospital’s, are used at a rate well above state standards.
·          Literature supports the use of non-surgical approaches to treating cardiac problems.

CTAAB concluded there is need for the six sleep beds:
·          There is an extensive wait time to obtain sleep consultations and diagnostic testing.
      The occupancy rate at existing sleep facilities based on six nights of operation 50 weeks a year was over 95%.

Anticipated project operational date is June 2012.

CTAAB concluded there is a need for the proposed robot:

• Highland Hospital does not have a robotic system.
• Demand for this type of surgery will continue to grow.
• The proposed unit will not add to community cost from a reimbursement perspective.
• Quality of care is improved.

Geneva MRI
2007

Background:

Geneva MRI proposes to provide mobile MRI service, followed by fixed magnet service, in Geneva, NY.

Recommendations:

CTAAB concluded there is no need for the proposed MRI services:

• Community MRI capacity is sufficient to meet current and projected demand.

Beverly Prince , MD
2007

Background:

Beverly Prince, MD, (Warsaw ENT) proposes to build and operate a two-bed sleep lab.

Recommendations:

• Application was withdrawn.

 

Geneva General Hospital

2007

Background:

Geneva General Hospital proposes to replace a 1.5T mobile MRI with a 1.5T fixed MRI.

Recommendations:

CTAAB concluded there is need for the proposed MRI:

·       The change from a mobile to a fixed unit will afford improvements in quality; and

·       MRI ownership will enable greater scheduling flexibility and extended coverage, as needed, and thus improve access.

·       Anticipated project completion date is within one year of approval of the Certificate of Need application.

Radiologists of the University of Rochester

2007

Background:

Radiologists of the University of Rochester propose to use the PET-CT at Science Park on a full-time basis.

Recommendations:

CTAAB concluded there is need for recognition of the full-time use of the PET-CT:   

·       Although there is not community need for additional PET capacity, the RUR unit is nearing full utilization of its “approved” capacity of 0.6 full-time-equivalent use; and

·       With consideration of the machine’s use for research applications, movement to “full-time” use represents minimal expansion of capacity.

Strong Memorial Hospital

2007

Background:

Strong Memorial Hospital proposes to build an off-site hospital-based ambulatory surgery (outpatient) center.

Recommendations:

CTAAB concluded there is need for the proposed ambulatory surgery center:

·       Although there is no community-wide need for additional operating room capacity, Strong Memorial Hospital (SMH) has demonstrated institution-specific need;

·       Development of hospital-sponsored capacity will maintain and may increase financial access to care;

·       The requirements of medical education and training and recruitment of physicians will be served by a hospital-sponsored ambulatory surgery center;

·       The ambulatory surgery center will be located on Sawgrass Drive; anticipated project completion date is April 2009 (assuming New York State Department of Health approval).

University Medical Imaging

2007

Background:

University Medical Imaging proposes to purchase and install a fourth MRI, which will be a 3T.

Recommendation:

CTAAB concluded there is need for the 3.0 Tesla MRI:

·       Although there is not a current community-wide need for additional MRI capacity, UMI is operating its MRIs significantly above CTAAB’s benchmark for scanner utilization;

·       The 3.0T MRI currently available in the community is fully utilized; and

·       Given UMI’s overall MRI volume, it is reasonable to add a specialized scanner to its mix of capabilities when adding incremental capacity.

·       Anticipated project completion date is March 2008

Soldiers & Sailors Memorial Hospital

2007

Background:

Soldiers & Sailors Memorial Hospital proposes to expand and upgrade its Emergency Department, Rehabilitation Services, and Cardiology department.

Recommendation:

CTAAB concluded there is need for the proposed renovation and reconfiguration:

·          The project will improve function in the Emergency Department;

·          The project will improve accessibility and function of a number of high-traffic services;

·          The project will improve the facility’s infrastructure;

·          Anticipated project date is third quarter 2009.

Finger Lakes Radiology

2007

Background:

Finger Lakes Radiology proposes to purchase a 1.5T MRI and make it a fixed unit in Geneva General Hospital .

Recommendation:

Application was withdrawn.

Strong Memorial Hospital

2007

Background:

Strong Memorial Hospital proposes to add an extension clinic certified for outpatient medical oncology infusion services at Highland Hospital; this clinic would consolidate the Highland Hospital infusion center within the Wilmot Cancer Center and would expand the services at the Highland Hospital site.

Recommendation:

CTAAB concluded there is need for the proposed outpatient medical infusion center at Highland Hospital :

·          Cancer chemotherapy volume continues to increase;

·          The change in auspice will enable qualification for 340b “best federal price” purchase of pharmaceuticals;

• Anticipated operational date is third quarter 2008. 

United Memorial Medical Center

2007

Background:

United Memorial Medical Center proposes to construct an outpatient diagnostic radiology center and add a 40-slice CT scanner and ultrasound and EKG services at its Bank Street Campus (the former St. Jerome’s Hospital) in Batavia, Genesee County.

Recommendation:

CTAAB concluded there is need for UMMC’s proposed 40-slice CT scanner:

• Evidence supports institutional need despite the lack of community-wide need for an additional CT scanner;
• The proposed CT scanner is technologically superior to the existing scanner and will improve quality of care; 
• UMMC received NYSDOH approval and HEAL funding for the proposal;
• Anticipated operational date is second quarter 2008.

Strong Memorial Hospital

2007

Background:

Strong Memorial Hospital proposes to add an incremental linear accelerator within the Wilmot Cancer Center .

Recommendation:

CTAAB concluded there is need for the proposed radiosurgery linear accelerator:

·       Indications for radiosurgery are increasing;

·       Radiosurgery appears to be less costly than the alternative treatment (invasive surgery) for many tumors;

·       Radiosurgery permits treatment of some tumors that are otherwise not treatable;

·       Anticipated project completion date is the end of the calendar year 2008.

Elizabeth Wende Breast Clinic

2007

Background:

Elizabeth Wende Breast Clinic proposes to obtain a 1.5T MRI to replace the mobile unit currently in use part-time.

Recommendation:

CTAAB concluded there is need for the proposed fixed MRI unit:

• General community MRI capacity is fully utilized; while other centers could provide the service, capacity to perform breast MRIs is presently limited;
• Clinical indications for breast MRI are increasing;
• Delay or lack of MRI appears to negatively impact the course of clinical care for some patients;
• Operating cost of the proposed unit is similar to the operating cost of the present mobile arrangement;
• The applicant states the MRI should be operational in the third quarter of 2007.

Rochester General Hospital

2007

Background:

Rochester General Hospital proposes to obtain an additional linear accelerator.

Recommendation:

CTAAB concluded there is need for the proposed linear accelerator::

·       Rochester General Hospital ’s radiation therapy units are currently operating above benchmark volume levels, suggesting the need to increase capacity;

·       The project will decompress the medical oncology services, enhancing patient privacy;

·       The project will reduce wait times to initiate cancer treatment;

·       The project will increase capacity to relatively underserved portions of the city of Rochester and Monroe County ;

·       The project will be sited at Linden Oaks; anticipated project completion date is June 2008.

Thompson Health

2007

Background:

Thompson Health proposes to expand its Sleep Center from two to four beds.

Recommendation:

CTAAB concluded there is need for F.F. Thompson to expand its sleep beds, with the further proviso that physician availability be improved at the earliest possible time:

• Thompson’s existing capacity is maximally used;
• Wait times for services are up to six months;
• Expansion will be completed within 180 days of the State’s approval of the certificate of need application.

Rochester General Hospital

2007

Background:

Rochester General Hospital proposes to add a 64-channel CT scanner unit in conjunction with the expansion of its Emergency Department.

Recommendation:

CTAAB concluded there is need for the proposed 64-slice CT scanner:

• There is evidence supporting an institutional need despite the lack of community-wide need for additional CT scanner capacity.  Specifically, current RGH CT scanners are utilized beyond benchmark levels and additional growth in CT volume is reasonably anticipated;
• The need for the proposed unit is not premised on cardiac imaging;
• Anticipated project operational date is first quarter 2008.

Rochester General Hospital

2007

Background:

Rochester General Hospital proposes to provide in-house mobile lithotripsy in an existing operating room in the hospital.

Recommendation:

CTAAB concluded there is no community need for the proposed lithotripter:

• The units that are currently available are not fully utilized;
• The proposed service would duplicate existing resources and increase community cost;
• There is no compelling evidence the proposed unit would provide improved quality of care.

  Appeal:

  Following an appeal, CTAAB recommended approval of the proposed lithotripter for two half days per week:

  ·         Extracorporeal shock wave lithotripsy appears to be the standard of care for treating kidney stones.

  ·         No supply-induced demand is expected to result from the additional lithotripter.

  ·         Concern regarding additional community costs is not significant.

  ·         A mobile unit would allow flexibility in responding to demand.

  Anticipated project operational date is January 2009.

Strong Memorial Hospital

2007

Background:

Strong Memorial Hospital proposes to add a 64-slice CT scanner and a 1.0T open MRI.

Recommendation:

CTAAB concluded there is need for the proposed 64-slice CT scanner:

• There is evidence supporting an institutional need despite the lack of community-wide need for additional CT scanner capacity;
• The need for the proposed unit is not premised on cardiac imaging;
• Anticipated project operational date is first quarter 2008.

CTAAB concluded there is need for an open MRI unit at Strong Memorial Hospital (SMH):

• Certain classes of patients (obese, pediatric, ICU) would experience improved quality of imaging and improved safety with the use of an open MRI;
• There are few community alternatives to provide open MRI services to SMH patients;
• Anticipated operational date is first quarter 2008.

University Cardiovascular Associates

2007

Background:

University Cardiovascular Associates proposes to install a 64-slice multidetector CT scanner at its office.

Recommendation:

CTAAB concluded there is no community need for the proposed 64-slice CT scanner:

There is adequate available community capacity of CT scanners capable of performing cardiac CT angiography

University Medical Imaging

2007

Background:

University Medical Imaging proposes to install a second Computed Tomography (CT) scanner.

Recommendation:

CTAAB concluded there is need for the proposed 64-slice CT scanner:

• There is evidence supporting an institutional need despite the lack of community-wide need for additional CT scanner capacity.  Specifically, the existing UMI CT scanner is utilized well beyond benchmark levels;
• The need for the proposed unit is not premised on cardiac imaging;
• Anticipated project operational date is first quarter 2008.

Pluta Cancer Center

2007

Background:

Pluta Cancer Center proposes to add a second linear accelerator.

Recommendation:

CTAAB concluded there is need for the proposed linear accelerator:

• While Monroe County facilities are utilized at benchmark levels, Pluta Cancer Center is over-utilized; its volume greatly exceeds benchmarks;
• Pluta Cancer Center is the only program in the region without treatment capacity redundancy, either on site or at an affiliated site, leaving its patients at risk of treatment interruption;
• Pluta Cancer Center is the natural service area for Southeast Rochester and Monroe County which have received less than average radiation therapy, compared with the local average adjusted for age/sex/race and cancer incidence (based on information provided by the New York State);
• The second linear accelerator is expected to be functional by April 1, 2008 .

Cardiac CT Angiography

2007

Background:

Cardiac CT Angiography:  Using CT scans to visualize coronary arteries has been receiving increasing attention.  Although insurers have considered this technique investigational, the published scientific evidence has been growing. 

Recommendation:

Based on its review of the Technical Advisory Committee (TAC) report on Cardiac CT Angiography, CTAAB recommends to insurers that:

·         Cardiac-related CT angiography by advanced CT scanners (CTA) should be accepted for insurance coverage.  Coverage should be limited, however:

a.       Cardiac CT angiography should be approved and reimbursed when careful clinical assessment by a cardiologist finds that the patient has a low to moderate pre-test risk of coronary artery disease and the test will resolve clinical uncertainty;

b.       Cardiac CT angiography should not be approved or reimbursed when the test is done for screening purposes;

c.   Cardiac CT angiography will only be reimbursed when ordered by a cardiologist.

·         Calcium scoring should be reimbursed when performed as part of a contrast enhanced cardiac CT angiography study which is otherwise clinically indicated;

·         The quality of machine and training requirements of those interpreting cardiac CT angiography tests should be further evaluated by the insurers.

Consistent with the TAC Cardiac CT Angiography Report, CTAAB has established as operating policies to:

·         Review all requests for increase in the number of CT scanners.  As part of the analysis of such a proposal, review the ICD-9 or other diagnostic codes to determine if the current and/or projected volume of scans is justified only on the basis of cardiac-related procedures;

·         Permit current CT providers to continue to replace units one-for-one with the level of unit they believe is appropriate.