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Artery fix: Patients benefit, hospital suffers
By JASON BODNAR AND ANNA NGUYEN
Burlington County Times
She's an avid golfer, but a clogged artery was causing trouble just a week ago for Helen Kenuk. She had difficulty walking and found herself short of breath.
If it had happened 10 years ago, the 77-year-old Hainesport resident
might have needed open-heart surgery, which involves opening the chest
cavity. Weeks of recovery follow.
Kenuk was on an operating table for 20 minutes Monday, home Tuesday, and feeling fine Wednesday.
That's great for her, but it marks a trend not so great for the bottom line at Deborah Heart and Lung Center in Pemberton Township where she had the procedure.
Deborah charges about $41,300 for every open-heart surgery, but $17,500 for angioplasties, according to John Ernst, executive vice president.
Kenuk is far from alone in being able to choose angioplasty over open-heart surgery. In 1998, Deborah performed 1,002 angioplasties and 1,114 open-heart surgeries. This year, the hospital is on pace for 1,851 angioplasties and 684 open-heart surgeries.
That cut profits at Deborah from $3.7 million in 2002 to $1.9 million in 2003. So far this year, the hospital is operating at a loss of $5.5 million, Ernst said.
"Angioplasties are a significant part of why the bottom line has changed," Ernst said, "and if the tendency is to continue to do more angioplasties than open-heart surgeries, our losses can only continue to increase."
Cutbacks and fiscal belt-tightening have followed. Since the beginning of the year, the hospital has trimmed its staff of 1,280 by attrition, as 38 positions became vacant due to retirements and resignations and weren't filled.
Ernst said the hospital has also cut costs in other areas. For example, renegotiating deals with major suppliers saved more than $1.2 million.
"In order to weather the storm, we're going to have to do more in the
next year or two," Ernst said.
"It's a national trend to shy away from open-heart surgery," said Dr. Daniel Shindler, a cardiologist at the University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School in New Brunswick.
In New Jersey, the number of angioplasties rose 65 percent and the number of open-heart surgeries dropped 8 percent from 1998 to 2003, according to the New Jersey Department of Health.
That's primarily because angioplasties have rapidly become more effective.
During an angioplasty, doctors insert a balloon-tipped catheter into a patient's plaque-blocked artery, then inflate the balloon, pushing the plaque to the sides of the artery and opening a pathway for blood to flow.
In the past, 30 percent of patients experienced renarrowing of the artery, according to Dr. Muhamed Saric, director of echocardiography at University of Medicine and Dentistry of New Jersey in Newark, Essex County.
The advent of stents a decade ago cut that percentage in half. During most angioplasties now, doctors insert a stent, which looks like the coil inside a pen, into the artery where the balloon was. The stent acts like a scaffold, holding the artery open.
In the past year, many doctors have been able to use a drug-eluting version of the stent. Drug-eluting stents further help to prevent reclogging by slowly releasing a drug that prevents scar tissue from forming.
Kenuk got one of those Monday, so chances are, she won't be back for
"You don't have to be a rocket scientist to know that angioplasty is far less traumatic to a person than open-heart surgery," said Dr. Charles DeBerardinis, assistant director of the catherization laboratory at Deborah.
From a medical perspective, Deborah welcomes these changes, which lead to more efficient care and fewer follow-up procedures, but it doesn't take a mathematician to see the trend toward angioplasties and away from open-heart surgeries hurts bottom lines.
It hurts Deborah more than other hospitals in New Jersey that perform heart surgeries because Deborah specializes. It is not a general hospital like all the others.
"Other institutions can fall back on new-baby birth rate, neurosurgery, orthopedic surgery," Ernst said. "In our case, there's no alternative."
The drop in cardiac surgery could eventually affect more than just the business side of things. Dozens of studies have shown the more often a doctor or hospital performs open-heart surgery, the better they become at it.
Doctors and hospitals in New Jersey are doing fewer open-heart surgeries, especially after three new cardiac-surgery programs opened in the state since 1998, spreading around the surgeries even more.
The state requires hospitals to perform at least 350 open-heart surgeries a year, but four of the 17 hospitals with cardiac-surgery departments fell below that benchmark in 2003.
Still, due to some technological advances in open-heart surgery, the success rate for cardiac surgery in the state has risen, according to data from 1994 to 1999, the most recent available.
"We (the state) have a formal and elaborate system of evaluating the
performance of hospitals and surgeons," said Dr. Clifton Lacy, the New
Jersey commissioner of health and senior services.
Hospital officials also monitor the volume of operations and outcomes, said Valerie Sellers, senior vice president of health planning and research for the New Jersey Hospital Association in Princeton, Mercer County.
But Dr. Lynn McGrath, chief of surgery at Deborah, worries that with a
continued decline in the frequency of cardiac surgery, that may not be
enough to prevent an eventual decline in quality.
Kenuk today is among many patients who have benefited from the expanded list of choices for treatment.
Her concerns aren't about the experience levels of open-heart surgeons or a decrease in revenue. She's just happy she's able to get back to her husband of 58 years, her seven grandchildren, and, of course, her golf clubs.
"My doctor tells me I'll be able to golf in a few weeks," Kenuk
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