By Tim Bonfield
The Cincinnati Enquirer

DAYTON, Ohio - Patients who need heart surgery in Dayton can pack an overnight bag, drive along a wide, tree-lined boulevard and park right in front of a four-story building that looks like it belongs in an office park.

No hunting for space in garages. No patient towers. No need to follow tunnels, change elevators or use a map to find the right department.

Yet just a few steps beyond the lobby doors is a full-blown hospital offering care as sophisticated as nearly any heart center in America.

This is the Dayton Heart Hospital, a facility that supporters say reflects the future of medicine and one that critics complain threatens the very survival of the traditional community hospital.

The experience of the 4-year-old Dayton Heart Hospital offers a glimpse of what Greater Cincinnati can expect from a $50 million heart hospital proposed for Norwood that could open in early 2005.

It also illustrates what's at stake as state lawmakers debate whether similar for-profit projects should be allowed for orthopedic care, general short-stay surgery or even neurosurgery.

"I think the heart hospital in Cincinnati will be a rousing success," said Dr. David Joffee, one of the founding partners of the Dayton Heart Hospital.

"In every city where this has been done, it has generally been the top people skill-wise ... the innovators ... who have been willing to go out on a limb to do what they feel is in the patient's best interest."

Dayton Heart Hospital is a for-profit venture between MedCath Inc., a national heart hospital chain based in Charlotte, N.C., and members of two of Dayton's largest cardiac physician groups.

It opened Sept. 7, 1999, with 47 beds and a 24-hour emergency department. The hospital provides an array of services - from routine angiograms to multiple bypass operations to installing temporary internal heart pumps called left-ventricular assist devices.

Unlike many hospitals, patients stay in one room, from intensive post-operative care to discharge, much like hospital maternity services that feature combined labor, delivery and recovery rooms.

Since opening, Dayton Heart Hospital has grown to become the second busiest of seven heart programs in Dayton for cardiac catheterization procedures and third for open heart surgeries.

Patients pleased

Many patients praise the care.

"Before the hospital opened, I was against it coming into town. But after finding out the benefits of a specialty hospital, I changed my mind," said Dayton resident Robert Comer, a patient who testified in support of the hospital before a state committee in December.

"My very best care was at the Dayton Heart Hospital. When you press the button to call a nurse, they don't answer you over a speaker system, they come right to your room, now, not a half-hour later."

Dayton Heart Hospital opened amid howls from nonprofit hospital executives who predicted the hospital would grab revenue by cherry-picking the easiest-to-treat, best-insured patients.

Critics make the same arguments in Cincinnati about the Norwood heart hospital.

So far, the facts haven't supported those fears in Dayton.

The two leading Dayton hospital systems - Kettering Medical Center Network and Premier Health Partners - both report rising revenue and higher profits since 1999. The quality of heart care, as measured by heart attack mortality rates, has moved from below state average to above state average.

Rather than cherry-picking patients, Dayton Heart Hospital officials say about 25 percent of their patients come from other area hospitals.

And by the same laws that govern other hospitals, the Dayton Heart Hospital cannot turn away patients who come to its emergency room.

Yet four years of experience has not quieted opposition from nonprofit hospitals about such doctor-owned, for-profit hospitals.

"Our concern is long-term," said Kevin Lang, chief financial officer for the Kettering Medical Center. "Maybe one heart hospital doesn't make that much of a difference. But what if it continues to happen? If you keep on doing this, how will the indigent population get care?"

However, even with the growth of the new heart hospital, Kettering's operating margin grew from a $618,000 loss in 1999 to a $9.4 million gain in 2002.

Dayton's Premier Health Partners, which includes heart programs at the Miami Valley and Good Samaritan hospitals, did register a decline in its heart care business after the Dayton Heart Hospital opened.

But that dip hardly caused red ink to flow. Instead, the system reported a 4.3 percent profit margin from $786 million in overall revenue in 2002, up from a 2.5 percent margin from $598 million in overall revenue in 1999.

"We are still doing well," said Tim Jackson, Premier's chief financial officer. "We have more of a philosophical concern."

The Dayton Heart Hospital hasn't made heart care any cheaper in Dayton. And if the loss of high-profit services causes competing hospitals to charge more for other services to stay afloat, the result will be higher health-care costs for everybody, Jackson said.

"I don't know when it will reach the point that the insurance becomes unaffordable and hospitals will be forced to stop providing services that don't make money," Jackson said. "But that's not the right direction to go."

Cincinnati situation

In Cincinnati, doctors with the Ohio Heart Health Center, the region's largest cardiology group, and the parent company of Deaconess Hospital are proposing a full-service heart hospital in Norwood.

Dr. Dean Kereiakes, the leading physician supporting the Cincinnati heart hospital, said it would function much like the one in Dayton but would have a different ownership structure.

The Cincinnati group has insisted on sharing ownership with local hospitals and has rejected splitting revenue with an out-of-town chain.

"That hospital involvement is important because this has never been about hurting other hospitals. It has been about providing the best possible cardiac care," Kereiakes said.

From his perspective in Dayton, Joffee predicts that Cincinnati's hospital system won't be hurt by the competition. Instead, care probably will get better.

"As patients, we think that our doctors have the most control over care. Right now, hospitals control medicine and hospital administrators think they do it best. It shouldn't be that way," Joffee said. "We're here because patients see a difference. We firmly believe we can do it better."

About the Dayton Heart Hospital

Location: Edwin C. Moses Blvd., south of downtown Dayton.

Opened: September, 1999

Size: 47 beds, all equipped to offer intensive-care level service.

Features: a 24-hour emergency room, four cardiac catheterization labs, three operating rooms, a day-patient treatment and recovery area, a variety of specialty cardiac equipment, and a single-room approach to post-operative recovery.

Ownership: 56 Dayton-area doctors and MedCath Inc., a publicly traded company based in Charlotte, N.C., that was founded in 1988. Since 1996, MedCath has built 10 cardiac specialty hospitals in Arizona, Arkansas, California, Louisiana, New Mexico, Ohio, South Dakota and Texas. Another original partner - Dayton's Franciscan Medical Center - went out of business in 2000.

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E-mail tbonfield@enquirer.com