By Tim Bonfield
The Cincinnati Enquirer

By early 2005, Greater Cincinnati residents could have a new heart hospital that its developers say will transform the way cardiac services are provided across the region.

Initial plans for the Cincinnati Heart and Vascular Hospital call for building a $50 million to $60 million facility - possibly in Norwood - that would employ about 250 people. The hospital would include 24-hour emergency services, a helipad, operating rooms, special labs for angioplasty services, a separate physician office building and 60 intensive-care beds for people to recover from open-heart surgery and other procedures.

HEART PROGRAMS

Greater Cincinnati has eight hospitals that offer open-heart surgery - seven in Ohio and one in Northern Kentucky. Hospital Open-heart procedures* Christ 989 St. Elizabeth 816 Bethesda North 341 Good Samaritan 323 Mercy Fairfield** N.A. Jewish 250 Deaconess 204 University 159 *Includes elective and emergency coronary bypass operations, valve replacements and repairs performed in 2001 (the most recent statewide data available) **Opened in December 2001. Officials predict performing about 300 open-heart procedures in 2003. Source: Ohio Department of Health, Enquirer research

KEY PLAYERS

Ohio Heart Health Center, a group of 35 physicians with 21 offices in Ohio and Indiana that performs more than 700 open-heart surgeries and 2,500 angioplasties a year. Deaconess Associations Inc., which operates Deaconess Hospital, Scarlet Oaks and Cottingham retirement communities in Greater Cincinnati along with home care and long-term care facilities in 12 other states.

NORWOOD SITE

The most-talked about location for the proposed heart hospital is Norwood - specifically a 10-acre slice of a 22-acre parcel just west of Carthage Avenue near where Montgomery Road crosses the Norwood Lateral. The site, now controlled by the developer Al Neyer Inc., used to be part of the sprawling General Motors plant in Norwood. Public meetings have yet to be held to discuss noise from helicopter flights and ambulance runs and whether the heart hospital would fit with other ideas for the site. Norwood isn't the only site the hospital proponents are considering, but officials would not discuss any other location.

The project is a joint venture of the Ohio Heart Health Center, the Tristate's biggest group of heart specialists, and Deaconess Associations Inc., the parent company of Deaconess Hospital. The developers also are negotiating with other hospitals and doctors who might join the project as investors.

Supporters - including financier Carl Lindner - say the new heart hospital could become a "center of excellence" for heart care in Greater Cincinnati. Such a facility could provide quick access to highly regarded specialists, offer the latest equipment, and participate in a wider array of experimental treatments than most other heart programs in town.

But the concept faces several challenges, including critics who say Cincinnati already has too many heart programs, and a proposed state law - backed by the Ohio Hospital Association - that would prohibit doctors from referring patients to hospitals where they have an ownership stake.

The proposed hospital already has intensified a long-running debate among doctors, hospital administrators, business leaders and others about how health services should be provided in years to come.

"If we were satisfied with the status quo, we wouldn't be talking about this," said Dr. Dean Kereiakes, chief executive of the Ohio Heart Health Center and the main proponent of the new hospital. "I think change is tough. But the call for more regionalization is everywhere. So who's going to put things into play?"

Much is at stake in this proposal, from the potential effects on Christ Hospital, where a $77 million cardiac wing is expected to open in November, to the economic development of Norwood.

Heart disease is the No. 1 cause of death in Cincinnati and nationwide. Not only are heart services crucial to community health, the hundreds of millions of dollars in revenue involved are the target of intense competition.

Some say care will be improved by consolidating services among a few large heart centers. Others say patients are better served by opening smaller services closer to growing parts of the community.

Some question whether it is ethical for doctors to own hospital services.

"Our vision is one of inclusivity," Kereiakes said. "We invite the partnership of all area hospitals, including the rural, community-based providers, to truly integrate efforts into a focused-care model."

Several hospital executives are adamantly opposed to the concept.

"Not only is it totally unnecessary, but it is going to hurt the quality of care of the other programs in the area," said Joseph Gross, president and CEO of St. Elizabeth Medical Center, which runs the area's second busiest open-heart program at its South campus in Edgewood, Ky.

The 35 doctors of the Ohio Heart group practice at many local hospitals, but they do much of their work at Christ Hospital. Ohio Heart officials say their doctors account for more than 80 percent of the surgeries and other heart procedures done there.

While a new program threatens to cut into the number of patients served at Christ, officials with the Health Alliance of Greater Cincinnati would not discuss how much.

In a statement issued Tuesday, Health Alliance chief executive Ken Hanover said: "We are concerned about the concept of a for-profit specialty hospital with physician investors. If a physician who controls referrals to a specialty hospital also has an investment interest in that hospital, there is an inherent conflict of interest."

Beyond ethical issues, a doctor-controlled heart hospital could hurt more than just Christ Hospital, Hanover said.

"Profitable services, like heart, which are carved out of the full-service community hospital, will leave it with insufficient resources to meet the needs of the community for services like emergency, transplant and dialysis," Hanover said.

But Kereiakes and other supporters say the new heart hospital would not be the same as other for-profit, doctor-owned hospitals because the plan calls for sharing revenue with participating hospitals. The new heart hospital also plans to accept complex cases some heart programs reject and to provide charity care at levels that at least match what Christ Hospital provides today.

On Tuesday, Lindner told the Enquirer that he supports the proposed heart hospital and praised Kereiakes and Dr. Charles Abbottsmith - another key member of the Ohio Heart group - as two of the finest doctors in Cincinnati.

"I will be financially involved with this. I'd do anything to get these guys going," Lindner said.

Too many already?

Cincinnati has eight hospitals equipped to perform open-heart surgery: Christ, Good Samaritan, Deaconess, and University, all near the University of Cincinnati; Jewish Hospital in Kenwood; Bethesda North in Montgomery; Mercy Hospital in Fairfield, and St. Elizabeth Medical Center South in Edgewood, Ky.

The proposed heart hospital envisions absorbing the existing program at Deaconess, so its supporters say it would not expand the number of programs.

But several hospital chief executives and insurance executives said the proposed heart hospital would not change a widely shared view that Cincinnati already has too many heart programs.

John Prout, chief executive of the TriHealth hospital group, which includes open-heart programs at Good Samaritan and Bethesda North, said, "We don't believe the community needs another heart program."

Larry Savage, president and CEO of Humana Health Plan of Ohio Inc., said the community needs no more than three or four heart programs.

He would support the idea of a new heart hospital - but only if it leads to real consolidation.

"If this is a real collaborative effort and truly a center of excellence, it could be a good thing for the community," he said.

Any effort to encourage fewer, bigger heart centers would clash directly with the philosophy at work at Mercy Health Partners, which opened a new program at Mercy Fairfield in conjunction with a group of local doctors in December 2001.

Since opening, the program at Fairfield has grown steadily. It expects to perform 300 open-heart surgeries this year, and has a record of good outcomes.

"Our program has been very successful in terms of volume and quality," said Tom Urban, president and CEO of Mercy Health Partners. "We think patients appreciate being seen and cared for right in their own community."

The success in Fairfield has the system considering opening similar programs for the group's hospitals in Anderson Township and Mount Airy.

The Mercy group isn't interested in joining the proposed heart hospital venture. "At this time, we'd rather support our own model of care," Urban said.

Political battle

Beyond the local turf battles, the heart hospital proposal brings home a statewide debate about the impact of specialty hospitals.

State and federal laws already restrict doctors from referring patients to laboratories, diagnostic centers and outpatient surgery centers they co-own. However, laws have allowed doctors to make referrals to full-blown hospitals, even if they have an ownership stake.

That exception gives the doctors of Ohio Heart - and any other doctors who might join - the ability to own a share of the proposed heart hospital, said Mark McDonald, chief operating officer at Ohio Heart.

However, there are efforts at the state and federal levels to eliminate that exception.

In Ohio, the Ohio Hospital Association is backing House Bill 71, which would prohibit doctors from making referrals to hospitals they co-own. The bill is scheduled for a committee vote Sept. 3. If it passes as currently written, it would kill the Cincinnati heart hospital.

"Our concern is that physician-owners and other investors will be taking revenue out of the (non-profit) community hospital system that would otherwise be available for charity care," said Mary Yost, a spokeswoman for the Ohio Hospital Association.

But proponents of the heart hospital plan to fight the bill.

"There's an old saying, 'If you can't compete, legislate.' Our philosophy is that House Bill 71 is fundamentally anticompetitive," McDonald said.

E-mail tbonfield@enquirer.com