HOSPITAL REVIEW

In another example of how the law of unintended consequences plays out, St. Francis Medical Center might find itself again in front of Missouri's Health Facilities Review Committee trying to justify its need to own a magnetic resonance imaging system.

The review committee is intended to be a panel that reviews hospitals' major equipment purchases. The idea is for the state to play a role in preventing costly duplication of services in cities that have more than one hospital and to prohibit hospitals from making expensive but unnecessary equipment purchases whose cost would be passed on to consumers. In other words, the panel is set up to help keep health costs down for hospitals and, ultimately, for consumers.

But a committee charged with making such decisions must work within certain guidelines. In the case of the Health Facilities Review Committee, those guidelines often seem arbitrary. In the past, capital requests that seemed to be obvious examples of expensive duplication of services were approved without a hitch. At the same time, the committee denied requests for equipment that seemed reasonable and necessary -- such as St. Francis' request last year for a new MRI system to replace its leased model.

After the request was denied, St. Francis officials exercised its purchase option on the leased system, which they believed was allowed under the certificate of need granted the hospital by the review committee in 1990. Now the director of the committee says the panel needs to take a closer look at the purchase.

Regardless of what the committee finally comes up with, a few things are clear. It will cost more over time for St. Francis to purchase the leased MRI system than if the hospital last year would have been permitted to buy a new one, with lower maintenance and operation costs.

The standards for approving such purchases have changed and might change again soon, making it difficult for hospitals to plan for capital improvements and equipment purchases needed to ensure a consistent level of quality care.

It begs the question: How is the health-care consumer helped by micromanagement that only raises costs and dilutes service? Hospitals constantly have to think of improving services and technology for the people in their service area. A state regulatory agency needs to have a good reason before it prevents that from happening.

It remains to be seen whether further scrutiny of St. Francis' MRI system purchase is justified.