Gwinnett Medical faces fight

Gwinnett Medical Center’s bid to perform open-heart surgery has set up a tooth-and-nail fight with Emory and Piedmont hospitals, which already perform the life-saving procedures.

Gwinnett Medical would be the first to offer open-heart surgery in that county. The conflict centers on Gwinnett’s arguments for convenience versus the other hospitals’ assertion that another heart center will flood the metro market, driving up costs and driving down the quality of care.

Both sides maintain their position represents the best interests of health care for metro Atlanta. The great majority of the eight metro hospitals that already offer open-heart surgery are located in Atlanta, but pressure has grown in recent years to bring the service into suburban counties.

WellStar Kennestone Hospital was the first to bring such services outside the Perimeter, but it had to fight Piedmont and St. Joseph’s — over some of the same issues — before performing its first open-heart surgery in 2004.

These hospital vs. hospital fights have occurred across the nation and here in metro Atlanta. Open-heart surgery is among the most lucrative procedures for hospitals, and Georgia and other states have set up reviews to ensure the market remains balanced, experts say.

The amount of open- heart surgeries is trending down nationally, as more people can be helped through drugs or less invasive procedures, making it even more important for hospitals to hold on to such business, said Peggy Cella, a health care consultant for 20 years in metro Atlanta. Gwinnett is actually seeing an increase in such procedures, which can cost $100,000.

Gwinnett Medical officials said that the open- heart program will save precious time for people in need of the procedure, and it won’t damage the marketplace.

Clyde Strickland, a longtime Gwinnett resident, said he knows the cost of Gwinnett’s distance from open-heart centers, especially considering the growing metro traffic. He had a friend who he feels might have lived through a heart attack if he could have received treatment closer to home at Gwinnett Medical.

When his brother failed a heart stress test, he was taken to Gwinnett Medical and then shipped to St. Joseph’s in Atlanta for the open-heart procedure the next day.

“It’s about being able to save lives, and the quality of lives,” Strickland said.

Strickland, the 70-year-old owner of a major waterproofing company in the Southeast, has donated $1 million dollars to help build the $32 million open- heart addition to the hospital’s Lawrenceville facility.

Emory and Piedmont have fought the Gwinnett proposal for more than a year through three state reviews. Even after the state health commissioner granted final approval, Emory and Piedmont filed lawsuits about a week ago in Fulton Superior Court to overturn the state’s decision.

Emory and Piedmont say metro Atlanta doesn’t need another open-heart center, and that adding another will dilute the number of surgeons and surgeries needed to control costs and keep the work at a level of excellence.

Moreover, they assert Gwinnett residents already have adequate access to these procedures, and that the great majority of people having a heart attack don’t require immediate open-heart surgery.

For Strickland, the bottom line seems simple: Emory and Piedmont don’t want to lose business.

“Just because of money,” Strickland said. “Greed and money.”

Emory and Piedmont say they are not being selfish, and that, if anything, the unnecessary duplication of this service could drive up costs.

Several metro health care experts, however, say that while these hospitals are engaging in a turf battle, the issue extends beyond just cash concerns. But cash is part of the mix.

“The issue is predominantly a business decision. ... If Gwinnett opens up, it means less cases for other hospitals, less business and less revenue,” said Michael Rovinsky of Integrity Consulting Group, a health care consultant for some 25 years.

But there’s also a quality of care issue, Rovinsky said. Studies show, he said, that the more open-heart procedures a hospital performs, the higher the quality of care.

Emory has asserted that a Gwinnett open-heart center would hurt Emory’s cardiovascular teaching programs by decreasing the number of surgeries available for instruction.

Piedmont said the new program would dilute the limited pool of the highly skilled open-heart professionals and “be detrimental to existing quality programs and all Georgia residents.”

Gwinnett counters that it expects to perform 348 open-heart procedures a year within about three years of opening the center. Emory performs about 1,700 a year. Most of Gwinnett’s cases would constitute ones that would otherwise have gone to St. Joseph’s Hospital in Atlanta. Then again, St. Joe’s is partnering with Gwinnett on the new three-story open heart addition.

Emory and Piedmont also challenge Gwinnett’s assertion that county residents need a heart center closer to home.

Less than 2 percent of heart attack cases require immediate open-heart surgery, said Emory spokesman Lance Skelly. Many of these cases can be treated with drugs or emergency procedures such as angioplasty, in which a balloon is inserted to open a clogged heart artery.

Gwinnett Medical recently received state approval to start an angioplasty program. With this approval, Gwinnett Medical is not justified in its request for an open-heart surgery service, said Piedmont spokeswoman Diana Lewis.

The complexity of the issues is reflected in the state’s own struggle to reach a final decision. When Gwinnett Medical filed the application in early 2008, the state Department of Community Health initially approved it, agreeing that Gwinnett residents faced a barrier to open-heart care.

But after Emory and Piedmont filed objections, a state appeals panel reversed that decision and denied the Gwinnett application by saying the residents faced no such barrier.

The final decision came down to DCH Commissioner Dr. Rhonda Medows. She concluded in her written approval of the plan that “open-heart surgery is more than very rarely performed on an emergency basis.”

Strickland, who has been in Gwinnett for more than half his life, believes a facility closer to home will save lives. He doesn’t want to bet on the odds that, should he have a heart attack, he won’t need emergency open-heart surgery. He wants all heart services close to home.

Gwinnett Medical’s push for open-heart surgery has become a rallying issue in the county, with proclamations of support from the County Commission, the chamber of commerce, elected officials and the school board.

Until a few years ago, virtually all the open-heart centers in metro Atlanta were in Atlanta. WellStar’s Kennestone Hospital in Cobb broke that mold five years ago.

But even after the state granted the approval, it took Kennestone nearly three years in court to fend off challenges from some of its competitors.

Gwinnett Medical hopes to open the heart center in 2011, but hospital officials acknowledge the court challenges could stretch out the start.