The Maryland Health Care Commission sent recommendations Wednesday to the General Assembly on stepping up oversight of coronary stent placements.
They come amid accusations that three doctors were performing unnecessary procedures, but the recommendations were meant to deal more generally with the state's outdated review process for hospitals offering angioplasty and cardiac surgery.
Authorities had given some hospitals waivers to offer angioplasty when a patient was having a heart attack, even though the facilities did not have on-site cardiac surgical backup, because research showed it was safe. Officials also had begun allowing elective angioplasty, where stents were placed in clogged arteries to prevent heart attacks.
After several years, larger hospitals that conducted most angioplasties had less oversight than waiver hospitals, said Paul Parker, acting director of the commission's Center of Hospital Services. He said the new recommendations would offer greater standardization and monitoring of all 23 Maryland hospitals where the procedures are performed.
The commission recommended making angioplasty a separate category from cardiac surgery so regulators have authority over it and streamlining the process for establishing need in those waiver hospitals.
It recommended creating standards of review for angioplasty and cardiac surgery, and banning the procedures at hospitals that don't meet performance thresholds.
"There wouldn't be an open-ended approval to provide [angioplasty]," Parker said. "They'll have to show they are maintaining certain standards."
The recommendations would allow the commission to receive and share data with other state agencies for investigation.
The commission based its recommendations on a report issued by an advisory panel two weeks ago. Lawmakers are expected to vote on the new rules during the session that begins in January.
Professional cardiology groups had criticized the panel's report for not calling for outside peer review of physicians.
The American College of Cardiology and the Society for Cardiovascular Angiography and Interventions had wanted mandatory accreditation that included the external review. But officials said they needed more time to assess the best review methods.
"An element of that ongoing monitoring will be accomplished via a peer review process," said Ben Steffen, the commission's acting executive director. If legislation passes, the commission "believes that development of the peer review process will be accomplished [later] through regulations."