Good medicine or good money?: More Pasco hospitals offer lucrative cardiac services

Interventional cardiologist Christos Pitarys, right, watches the monitor as he checks pressure within the heart and for blockage in an 85-year-old patient Friday at Morton Plant North Bay Hospital’s catheterization lab. At left is registered cardiovascular invasive specialist Syed Mujeebuddin.

BRENDAN FITTERER | Times

Interventional cardiologist Christos Pitarys, right, watches the monitor as he checks pressure within the heart and for blockage in an 85-year-old patient Friday at Morton Plant North Bay Hospital’s catheterization lab. At left is registered cardiovascular invasive specialist Syed Mujeebuddin.

Thomas Babbino credits an angioplasty with saving his life. "The pain went away the minute (the balloon) cleared the blockage," said the 67-year-old Delta Air Lines retiree. He was rushed 7 miles from his Trinity home to Morton Plant North Bay Hospital when he had a heart attack on Feb. 9.

"They're calling me the miracle patient," Babbino said of the hospital, which recently began offering angioplasty, a procedure in which a balloon is inserted up through the groin and into the arteries, which are cleared and then propped open with stents. "I say they are the miracle."

Until this decade, Babbino's options in Pasco County were limited to Regional Medical Center Bayonet Point, which opened its heart institute in 1989.

Then in 2006 Florida Hospital Zephyrhills got into the game on the east side, opening a heart institute where patients can get everything but a heart transplant. The institute, which has already served 8,000 patients, this year received an award of excellence in coronary intervention from HealthGrades, an independent health care ratings organization.

Last year, Community Hospital, a sister hospital of Bayonet Point in New Port Richey, announced it was offering angioplasty.

The latest hospital to beef up cardiac services is Morton Plant North Bay. That makes Pasco Regional Medical Center in Dade City the only hospital that doesn't perform them, though it does offer the procedure for vascular problems not related to the heart or brain.

"This is an important step for a community-based medical center," said John Couris, North Bay's chief operating officer and administrator. He uses the word "journey'' frequently when discussing the hospital expansions and new programs.

"We've been doing diagnostic (catheterization) work for as long as we've owned the hospital, about the beginning of 2001. We've done pacemaker work and other types of work with the idea and intention to move to angioplasty," he said.

The recent hospital expansion made it a good time to begin. On Jan. 25, Morton Plant began performing emergency angioplasties, adding elective ones for hospitalized patients last month. This month, it began offering them to patients referred by their cardiologists. A minimum one-night stay is required afterward.

Couris said he thinks there's enough business to go around.

"Competition is a good thing," he said. "It pushes people to focus on quality, safety and outcomes, providing the best service they can to the community."

So what's driving this fast foray into heart health?

A couple of things.

First, demands of an aging population, evidenced in the 75 million baby boomers entering the golden years. The state also makes getting into the business easy; the only requirements are to have an established cath lab and meet quality standards. The fact that the competitor across the street is also offering them doesn't matter.

Also, cardiac services tend to be cash cows, say critics who question the need for so many medical procedures.

"It's made our list of treatment traps in the past," said Dr. John Santa, an internal medicine specialist and director of Consumer Reports magazine's new health ratings center, an independent service that offers customers access to analysis and ratings for health care services, devices and drugs. Santa also served as administrator for the state office of health policy and research in Oregon for three years. "There have been articles in peer reviewed literature expressing concerns about the numbers of unnecessary angioplasties being done."

Santa said emergency procedures for heart attack victims and angioplasties for people not responding to medication are worthwhile, but other people probably don't need them. "They would do just as well on very aggressive medical and lifestyle treatment, medications such as statins or beta blockers."

But Santa says it "takes a pretty courageous patient to say no" when a doctor says he or she sees a partial blockage and can do an angioplasty while the person is on the table.

Also, Santa says, Medicare pays higher reimbursement rates for procedures and state regulatory agencies are loath to refuse a request to start a program, which makes it attractive to hospitals.

"It's very difficult for government to say no to a business," he said. "When hospitals are the top employers and very important to the economic health and well being of a community, it's very hard to say, 'You get to do it and you don't; you can't hire a cardiologist and you can.' "

While the state has rules to prevent too many new hospitals from opening in one area, it has no real limits on who can offer angioplasty.

"They don't have to get permission the way they once would have," said Jeff Gregg, chief of the bureau of health facility regulation for the state Agency for Health Care Administration.

All hospitals have to do is attest that they have a large enough catheterization lab and a reasonably functioning cardiology department. Most new hospitals today are built with sophisticated cath labs.

"In most urban and suburban areas, angioplasty and stent insertion is becoming a fairly common procedure," Gregg said. "It's progressing to the point where we shouldn't be surprised to see it performed on an outpatient basis."

Dr. Sunil Gupta, a cardiologist who has performed angioplasty for 10 years, and his partner, Dr. Ketul Chauhan, say the technology has improved to the point that the procedure is low risk and more effective than drugs in many cases in making people feel better faster.

"Medication can take months," Gupta said.

Unlike their predecessors, stents today are coated with medication that help keep the vessels open.

The doctors say patients who adopt healthy habits in conjunction with angioplasty might not have to have another procedure.

As for Thomas Babbino, he wouldn't hesitate to have one if it meant avoiding a heart attack.

He said his first heart attack 13 years ago came shortly after a stress test showed no problems.

"If they offered me the chance to go take a look inside and check it out, I'd take it," he said.

Researcher Shirl Kennedy contributed to this report.

Good medicine or good money?: More Pasco hospitals offer lucrative cardiac services 03/27/10 [Last modified: Monday, March 29, 2010 3:27pm]

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