Hospital set to introduce cardiac care.

Byline: Tim Christie The Register-Guard

CORRECTION (ran 2/17/04): A story Sunday about McKenzie-Willamette Medical Center's plans to open a cardiac catheterization laboratory misspelled the name of Seattle health consultant Fred Tobis of Tobis Health Care Associates.

SPRINGFIELD - McKenzie-Willamette Medical Center plans to open a cardiac catheterization laboratory sometime this year, the first step toward providing open heart surgeries - and a sure way to bring in more revenue.

Cardiac cath labs have been around for decades, but their numbers have increased in recent years, fueled by new techniques and devices that allow for less invasive treatments of heart disease - and by the desire of hospitals and doctors to capture market share in a lucrative area of medicine.

"The reality is, the way cardiac procedures are reimbursed, it tends to be a profitable venture," said Dr. Fred Tobin, a former practicing cardiologist who now runs a health-care consulting firm, Tobin Health Care Associates in Seattle. "This is a revenue enhancer. It brings in money."

Doctors have been talking for 10 years about providing cardiac services at McKenzie-Willamette, said Dr. Dennis Gory, a local cardiologist and member of the McKenzie-Willamette board.

Now that McKenzie-Willamette has the financial backing of its new partner, Texas-based Triad Hospitals, the nation's third-biggest for-profit hospital system, it made sense to push ahead with a cath lab, he said.

In a cath lab, doctors insert a long skinny tube - the catheter - into an artery or vein in the arm or leg, and slide it into the heart or the coronary arteries. Doctors can use it to run diagnostic tests, such as measuring blood pressure, oxygen and the heart's pumping ability and to look for blockages.

Catheters also can be used to treat heart disease by inserting stents or balloons into clogged arteries, procedures known as interventions.

Heart disease is the No. 1 killer in the United States, accounting for some 950,000 deaths each year and for 40 percent of all deaths. About 61 million Americans - almost one-fourth of the population - have some form of cardiovascular disease, according to the Centers for Disease Control and Prevention.

The number of heart surgeries has declined dramatically in the last two years because of the effectiveness of new cardiac stents, Gory said.

A heart stent is a mesh, stainless steel tube. It acts like a cross between scaffolding and a culvert, holding open the part of the artery widened by balloon angioplasty. In the last year, doctors have been using stents coated with an antibiotic that stops cell growth and keeps arteries from renarrowing.

For hospitals and doctors, cardiac care is a profitable specialty service. Cardiologists might be paid $500 for a simple procedure or several thousand for a session where they do several procedures, according to health insurers.

Cath lab facility fees can range from $3,500 for a simple procedure to $15,000 or more for a more complex intervention procedure.

Both for-profit and nonprofit hospitals are forced to focus more on money-making specialities to pay for the more routine types of care on which they lose money, he said.

"The reality is, if they don't do things like that, they're going to close," he said. "The issue is, what are they going to do with the money: Pay off shareholders or do good things for the community?"

Gory said McKenzie-Willamette's cath lab would start out by performing diagnostic services first. Catheter interventions and heart surgery would be added simultaneously at a later date, he said.

"We are not planning on doing interventions without surgical back-up," Gory said.

It's a controversial issue: The American College of Cardiology and the American Heart Association recommend that hospitals not do catheter interventions unless they have back-up surgery capability.

McKenzie-Willamette spokeswoman Rosie Pryor said consumers will benefit when both local hospitals are competing to treat heart ailments. Health insurance and cardiac experts say the competition question can cut both ways.

Dr. Steven Marks, medical director for PacificSource, a Springfield health insurer, said if both hospitals have cath labs, consumers will have more access to cardiac services. But too much investment in technology can lead to unnecessary treatments, he said.

"There's always a concern on the part of those of us in insurance world that the more you have of a particular technology, the more there's a tendency to induce demand and drive costs up," he said.

Dr. David Williams, a medical professor at Brown University in Rhode Island, chairs the cardiac catheter and intervention committee of the American College of Cardiology. He said a competing cath lab means consumers might get better service if they live in an underserved area, or if the only facility that provides the service doesn't do a good job. But consumers are ill-served if labs proliferate. Then, he said, "you get mediocrity at best."

That's because doctors and hospitals that perform more procedures lead to fewer complications, and conversely, those that do fewer procedures have more complications.

In this market, "there's enough volume to justify" a second cath lab, Gory said. He expects the McKenzie-Willamette lab to do 300 to 400 procedures a year. The cardiologists who do the procedures will practice at both hospitals, he said.

PeaceHealth officials said they're not surprised that McKenzie-Willamette plans to open a cath lab. Sacred Heart Medical Center did its first cardiac catheterization in 1969 and its first heart surgery in 1971, spokesman Brian Terrett said.

"The way the technology is going ... you'll see more cardiac cath lab interventions and less surgeries," said Marilyn Klug, PeaceHealth's vice president for business development.

Klug declined to say how many cardiac cath procedures are performed each year at Sacred Heart, saying the information was proprietary. But state records show the Sacred Heart cath lab did 1,706 procedures in 2001 and 1,823 in 2002.

McKenzie-Willamette officials said they plan to open the cath lab sometime this year, but no date has been set.