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Adventist HealthCare and Holy Cross Hospital have filed their final applications to build scaled-back hospitals in the upcounty. Adventist reduced its proposed number of beds while Holy Cross reduced the size of its facility.

The health care providers each filed a modified application for their respective proposed hospitals with the Maryland Health Care Commission last week, clearing the way for the final stages of the review process to begin, said Pamela Barclay, director of the commission's Center for Hospital Services.

Holy Cross announced in August 2008 a plan to build a 93-bed hospital on the Montgomery College campus in Germantown. Adventist HealthCare announced in April a plan to build a hospital as part of a health care campus in Clarksburg. The state requires new hospitals to receive a certificate of need before they are built and is unlikely to approve both proposals.

Adventist made some minor changes to its proposal, which has been in the works for several years and has many of the required land-use approvals from the county, said Robert Jepson, vice president of government relations and public policy for Adventist HealthCare of Rockville. Proposed hospital beds were reduced from 100 to 86 after looking at projections for need, he said. The hospital's expected cost decreased from about $202 million to roughly $177 million due to softening of the construction market.

"We feel very confident that we have a good project in the fastest growing part of the county," Jepson said. "We think it's the right project in the right place at the right time."

Holy Cross' modified application states that changes to its initial application arose from a change in the proposed facility's design, reductions in expected capital costs, additional analysis required for comparative reviews and new bed need analysis.

The proposed Germantown hospital's size was reduced by 40,000 square feet by eliminating space designed for future expansion and combining the bed tower and diagnostic and treatment center into one building, according to Holy Cross spokeswoman Yolanda Gaskins. The proposed number of beds did not change.

The hospital will be designed with a six-level diagnostic and treatment wing with private rooms and a separate three-level clinical support wing, according to an application excerpt provided by the commission.

"[A]pproving Holy Cross' proposed new hospital in Germantown project is a better way to meet the needs of upcounty residents for hospital-based care than approving AHC's proposal to construct a new hospital in Clarksburg," Holy Cross' application states. "The proposed Germantown hospital offers greater financial feasibility, less impact on other providers, approved geographic accessibility, more environmental benefits, a more significant contribution to the training of future health care workers and a stronger track record for operational performance."

A public comment period of 10 business days will begin after the modified applications are reviewed for completeness and posted on the commission's Web site in the next several days, Barclay said. The reviewer will then determine whether a hearing is needed to address unresolved issues before the reviewer takes a comparative look at which hospital, if either, should be built.

A decision could be made as early as the spring, Barclay said. During the review process, the commission considers conformance with the state health plan, need, availability of more cost-effective alternatives, viability of the proposal, compliance with conditions of previous Certificates of Need and impact on existing providers.

Eleven state legislators wrote that they support Adventist's proposal in a Sept. 21 letter to the commission because of the level of community involvement in developing the project, existing land use approvals and its location near Interstate 270 within a proposed comprehensive medical campus. All representatives in Districts 15, 17 and 39 except for Del. Saqib Ali (D-Dist. 39) of Gaithersburg signed the letter, which also expressed concerns about the impact a Germantown hospital could have on the Germantown Emergency Center.

"I represent Germantown, I don't represent Clarksburg, so if possible I think a hospital in my district would be a great thing, but I would like to see the process play out," said Ali, adding that he is not supporting either proposal. "I think the experts need to decide this, not the politicians."

Holy Cross' application states that its hospital would not impact existing health care facilities because 40 percent of its patients would be upcounty residents currently receiving treatment at its Silver Spring hospital while the remaining capacity would serve the growing aging population in the proposed Germantown hospital's service area. Jepson said Adventist disputes Holy Cross' assessment that the emergency center would not be affected.

Sen. Jennie M. Forehand (D-Dist. 17) of Rockville, Sen. Nancy J. King (D-Dist. 39) of Montgomery Village and Del. Craig L. Rice (D-Dist. 15) of Germantown said the changes to Adventist's application did not affect their support for the project.

"I liked the way Adventist has gone about doing the project," King said. "They've brought in the public and kept everybody informed all the way through."