By Phil Galewitz, The Palm Beach Post, Fla. Knight Ridder/Tribune Business News
Jul. 15--Ending months of suspense and many years of feuding among the region's hospitals, Gov. Jeb Bush signed legislation Monday that lets four more Palm Beach County and Treasure Coast hospitals perform open-heart surgery.
The governor's decision doubles to eight the area's open-heart programs -- one of the most profitable medical services -- and gives a big boost to nonprofit hospitals in their battle against richer for-profit competitors.
The nonprofits that gain the service are Boca Raton Community Hospital, Bethesda Memorial Hospital in Boynton Beach, Martin Memorial Medical Center in Stuart and Indian River Community Hospital in Vero Beach. The hospitals are expected to begin treating coronary bypass and other open-heart patients in 2005 and 2006.
'This is the biggest decision for the hospital since the decision to found the hospital,' said Ron Assaf, chairman of the board of Boca Community, which opened in 1967. 'I wish I had the words to describe it.'
The last open-heart program approved in Palm Beach County was at Atlantis-based JFK Medical Center in 1987, when the county's population was about 500,000. Today it is 1.3 million.
Bush's decision is a major blow to HCA Inc.-owned JFK and the other three for-profit hospitals that have enjoyed a regional monopoly on heart care. The others that now offer the service are HCA's Lawnwood Medical Center and Heart Institute in Fort Pierce and Tenet Healthcare Corp.'s Palm Beach Gardens and Delray medical centers.
HCA and Tenet officials say there's no need to expand the service, particularly when the number of open-heart surgeries are declining and experienced doctors and nurses are in short supply. They say reducing the volume of heart patients for each hospital will hurt the ...uality of care because caregivers won't stay proficient.
Bush disagreed.
'Even as Florida's population has increased substantially in all areas of our state over the last decade, the number of heart programs has not kept pace,' he wrote in a letter explaining why he signed the bill. 'This disparity between the growth in population and critical health care procedures has not improved access or provided additional care.'
Bush had recently threatened to veto the legislation because its two key sponsors, Sen. Ron Klein, D-Delray Beach, and Sen. Ken Pruitt, R-Port St. Lucie, are among his biggest adversaries on medical malpractice insurance reform. But Bush said Monday that just as his malpractice insurance bill is about improving access to care, the open-heart bill has the same goal.
Bush noted that state regulators previously approved open-heart surgery at Boca Community, Martin Memorial and Indian River, but the rulings were bogged down for years in regulatory and judicial appeals. The law Bush signed lets the hospitals circumvent the state's review process for major new hospital services.
The nonprofits have stressed their patients will benefit from ...uicker access to open-heart surgery -- instead of facing many hours of delays in getting transferred to another hospital. But nonprofit hospital officials also acknowledge they hope the service gives them a financial windfall.
Heart care is typically the main reason patients are admitted to hospitals.
Open-heart surgery is one of the few hospital services that remains profitable in an era when Medicare and private health insurers are consistently cutting reimbursements. In addition, having state approval to do open-heart surgery also gives them permission to perform angioplasty, the most common surgical treatment for heart disease.
Angioplasty involves threading a catheter into heart vessels via an artery in the groin or arm and then inserting a balloon-like device to clear blockages. The increased success of angioplasty because of better technology has reduced the need for open-heart surgery.
Open-heart surgery and angioplasty are among the most expensive, high-volume procedures hospitals perform. Hospitals typically charge $40,000 to $50,000 for open-heart surgery, which usually involves a five-day hospital stay including a day or two in intensive care.
Hospitals typically charge $10,000 to $15,000 for angioplasty, which usually involves a one-night stay. Last year, the three Palm Beach County hospitals that perform angioplasty rang up $276 million in gross charges for the procedure, more than any single medical service, according to state data compiled by Intellimed International.
Insurers, however, negotiate lower rates. The nonprofit hospitals hope getting open-heart surgery will put them on even playing ground with for-profit competitors.
'This is the biggest decision for the hospital since the decision to found the hospital,' said Ron Assaf, chairman of the board of Boca Community, which opened in 1967. 'I wish I had the words to describe it.'
Martin Memorial has sought an open-heart program since the late 1980s but has been continually thwarted by rival hospitals in the regulatory appeals process.
'I feel great. ... This is huge,' said Dick Harman, chief executive of Martin Memorial since 1989. 'Nothing bigger than this has happened since I've been here.'
His joy was only tempered by the possibility that HCA or Tenet might file a lawsuit to stop the state law from going into effect. HCA and Tenet hospital officials either refused to comment or were not available for comment Monday on the governor's action.
At Bethesda Memorial -- which last month won a victory over JFK to build a new hospital west of Boynton Beach -- administrators were in a celebratory mood.
'This decision and the western satellite hospital are the biggest things to happen to Bethesda since the opening of the hospital in 1959,' said Robert Hill, the hospital's chief executive.
Martin Memorial and Bethesda will start construction in the fall of new open-heart wings; Boca Community and Indian River will do the same next year. The four hospitals each plan to spend between $10 million to $20 million establishing open-heart programs.
Most Indian River residents now travel nearly an hour north to Melbourne or 90 minutes to Orlando for open-heart care. 'We are extremely pleased,' said Carl Martin, Indian River's chief operating officer.
Under Bush's approval, the four hospitals each must perform at least 350 open-heart procedures by the third year of operation or they must 'show cause' why they should be allowed to continue the procedure.
Industry observers say the impact of Bush's decision cannot be underestimated.
'It's huge,' said Doug Cooper, a hospital consultant for Ernst & Young in West Palm Beach. 'It helps protect the long-term viability of the nonprofits.'
With more hospitals offering open-heart surgery, insurers in theory should be able to negotiate lower rates that potentially could lower health costs for individuals and employers, health-care analysts said. But it could also drive up costs because greater availability of health services could increase demand.
The for-profit hospitals have fought to protect their monopoly because they know cardiac care is highly profitable and they do not want others to have it, said Josh Nemzoff, a New Hope, Pa., hospital consultant.
'Whether there is a need for eight (heart) programs will be up to the market to decide,' he said. 'At least the nonprofits can now get out on the field and play.'
To see more of The Palm Beach Post -- including its homes, jobs, cars and other classified listings -- or to subscribe to the newspaper, go to http://www.gopbi.com/partners/pbpost
(c) 2003, The Palm Beach Post, Fla. Distributed by Knight Ridder/Tribune Business News.
THC, HCA,
