Sunday, September 14, 2003

Cardiac programs multiply

Norwood hospital plan isn't only one in works

By Tim Bonfield
The Cincinnati Enquirer

At least three more open-heart surgery centers are being considered for Greater Cincinnati, even as debate continues over a proposed specialty heart hospital in Norwood.

• Mercy Health Partners is considering open-heart programs for its hospitals in Anderson Township and Mount Airy.

• A for-profit hospital company has approached doctors about building a heart hospital in Anderson Township.

• Middletown Regional Hospital is considering launching open-heart surgery services as part of its hospital rebuilding project.

Intense interest continues even though the region in the last five years added two programs to the six it already had - at Bethesda North in 1998 and at Mercy Fairfield in 2001.

And the number of open-heart surgeries performed in Greater Cincinnati has fallen 13 percent in the past five years - to 3,117 cases last year - and is expected to continue declining.

The apparent contradiction between more programs and fewer cases reflects a combination of forces, including evolvingtechnology, state regulations, and a battle for control of one of the most profitable sectors of health care.

As cardiac care evolves, the changes have people asking questions about the long-term fate of the hospital industry.

"These are very challenging times for hospitals," said Lynn Olman, president of the Greater Cincinnati Health Council. "On one hand, specialty services can provide more convenience for consumers. On the other hand, there are big risks involved. If these trends continue, and more profitable services are taken out of hospitals, how are hospitals going to provide the services that don't make any money?"

Sparking new debate about specialty hospitals is a heart hospital proposal announced last month.

The 60-bed, $50 million facility could open in Norwood as soon as early 2005. It is a joint venture of Ohio Heart Health Center, the area's largest cardiac physician group, and Deaconess Associations Inc., parent company of Deaconess Hospital.

Proponents say that because the hospital would be run by doctors and solely focused on cardiac care, it could become a regional center for treatment and research. Community hospital officials fear doctor-owned hospitals will create a potential conflict of interest.

Norwood City Council is expected to consider the hospital proposal in more detail in October. But other cardiac care concepts are being discussed. Anderson Township has been viewed as a potential site for a heart hospital, either free-standing or part of Mercy Hospital Anderson.

Dr. Russell Vester, a leading partner in Cardiovascular & Thoracic Surgeons Inc., said enough people with heart problems already are coming to Mercy Anderson for emergency care and diagnostic services to justify launching a cardiac surgery program.

Vester's group, with 14 physicians, has been involved in launching heart surgery programs at Bethesda North and Mercy Fairfield and would consider a similar project in Anderson Township.

"We've talked with Mercy. In the future, should they decide to do something, we'd like to be involved," Vester said.

In the past five years,Vester's group also has been approached by three for-profit companies that proposed building a for-profit heart hospital in Anderson Township.

The doctors have turned away the proposals, mostly because they would prefer a local hospital as a partner, Vester said. But interest from the for-profit companies remains, he said.

Across town, Mercy Health Partners sees similar demand for heart surgery emerging at its Mount Airy campus, where many West Side residents already seek cardiac diagnostic services.

"Open-heart surgery is a natural progression of an array of cardiac services we already offer," said Tom Urban, president and chief executive of Mercy Health Partners.

Unlike the Norwood proposal, there are no formal plans or timelines for open-heart surgery in Anderson Township or Mount Airy.

In Middletown, the opportunity to build a new hospital by 2008 has officials studying all sorts of new technology, including expanding cardiac services with open-heart surgery. But so far, nothing has been decided, said Lawrence James, vice president and chief marketing officer at Middletown Regional.

"It all depends on where technology goes between now and 2008," James said.

Open-heart surgery numbers in the region fell from 3,587 cases in 1998 to 3,117 cases last year because of advances in heart care, doctors and administrators said.

Balloon angioplasty procedures, often using stents to prop open clogged arteries from the inside, have eliminated the need for many cardiac bypass operations. Better drugs to control cholesterol and blood pressure also may be moderating demand for heart surgery, although rising rates of obesity are increasing the risk of heart disease.

But many hospitals and other organizations seeking open-heart surgery capability aren't hoping to perform bypass operations.

Instead, they want to provide far more common angioplasty treatments, such as placing stents. Thousands of angioplasty treatments are concentrated at a few hospitals in town because in Ohio, like many states, regulations require hospitals that do angioplasty to have open-heart surgery capability as a back-up. Again, improved technology might change the picture.

If studies - going on now in some centers nationwide - can demonstrate the safety of free-standing angioplasty programs, then regulations restricting them might be eased, James said.

Then hospitals and others would be free to launch angioplasty treatment programs in convenient suburban locations, James said. And that would slash much of the interest in launching more open-heart surgery programs.


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