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State should side with Providence St. Peter

THE OLYMPIAN | • Published June 28, 2009

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Longtime South Sound residents will remember the community controversy in the mid 1980s about whether Olympia should have one hospital or two.

Providence St. Peter Hospital on Lilly Road had a monopoly on care and vigorously opposed the construction of a second hospital on Olympia’s west side. St. Peter lost that war and today the community is served by two hospitals — St. Peter and Capital Medical Center.

The one- versus two-hospital battle bitterly divided this community, but since the dust settled, leaders of the two hospitals have forged strong working relationships that have served this community and patients in the broader, five-county southwest Washington region, very well.

That relationship is being tested today.

Capital Medical Center and Providence St. Peter Hospital have staked out sharply conflicting positions on a state Department of Health process to determine whether Capital should be allowed to offer angioplasty and stents as elective heart procedures.

Cardiologists perform those procedures to open up clogged arteries and restore blood flow to the heart.

Capital Medical can, and does, provide the heart procedures on an emergency basis. But the elective procedures, about 1,000 a year, are performed at St. Peter Hospital, where the two heart surgeons who practice in Thurston County are available to perform emergency heart surgery if the elective angioplasty or stent procedure goes wrong.

Officials at both hospitals and local cardiologists say that the need for such emergency heart surgeries occurs very rarely — something less than one-quarter of 1 percent of the time.

MAKING THEIR CASE

Capital Medical Center offered the heart procedures on an elective basis before there was a change in state law requiring they be done only with heart surgeons available as backup.

Because the incidence of acute complications is so rare, the Legislature and the Department of Health have changed the rules and are now allowing elective procedures without surgical backup.

Capital Medical Center seeks to take advantage of the new rules and has applied for a Certificate of Need through the Department of Health. St. Peter Hospital administrators have challenged Capital’s application, and state regulators have set a public hearing for July 17. A decision is expected by Oct. 1.

The Olympian’s editorial board has met with cardiologists and administrators from both hospitals.

Capital Medical Center offers many arguments in support of its application, the strongest of which boils down to one word — choice. Capital representatives argue that patients should have a choice of where to get their heart procedures done and not be forced to go to St. Peter. It’s an argument that will resonate well with many South Sound residents and what ultimately led to the creation of a second hospital.

Other arguments:

 • The Department of Health has determined that there are enough patients needing heart procedures to warrant a second provider somewhere in Region 6, which includes Thurston, Lewis, Grays Harbor, Mason and Pacific counties.

 • Addition of the elective program will strengthen Capital’s emergency program.

 • Capital already has a catheterization lab in place and trained nursing staff so there are no additional infrastructure costs.

 • Capital did provide the service until the rules changed requiring surgical backup.

St. Peter administrators make the case against Capital’s request, saying:

 • Providing the service at Capital will not increase access to the heart procedures. A second program five miles away from St. Peter Hospital won’t improve access to the quarter million residents in the other four counties.

 • Approving Capital’s application will not improve quality. Study after study shows a link between volume and quality of angioplasty and stent procedures. St. Peters has the volume to maintain top quality. St. Peter has four cath labs and an excellent record providing the elective procedures with surgical backup just 50-yards away. St. Peter has the capacity and trained staff to meet the region’s expected growth in elective procedures.

 • A second center at Capital Medical Center is an unnecessary and expensive duplication at a time when efforts are being made to cut health care costs.

 • Granting Capital’s application will undermine St. Peter Hospital’s ability to maintain unfunded services and provide charity care.

CONFLICTING ARGUMENTS

Sift through all the conflicting arguments and data — as members of The Olympian’s editorial board have done — and there’s no denying that money is a central issue.

At about $16,000 each, elective heart procedures are money makers for hospitals. The revenue helps offset the costs of other hospital services that lose money.

From what the two CEOs state, between $1.5 million and $2 million is at stake.

Capital Medical Center CEO Mike Motte said his hospital will make an additional $1.5 million a year if it receives permission to proceed.

Jim Leonard, CEO of Providence St. Peter Hospital, said his hospital could lose up to $2 million from the bottom line. “It’s a grave number for me,” Leonard said.

It’s that financial effect that’s pivotal to the editorial board’s deliberation and ultimate opinion.

Transferring $2 million from the bottom line of St. Peter — a nonprofit hospital — to Capital Medical Center — a for-profit hospital — would harm this community.

It would harm this community because it would force St. Peter Hospital to cut its costs and reassess the amount of charity care it is able to provide.

Consider this:

According to reports filed with the state Department of Health, in 2007 Providence St. Peter Hospital provided $30.5 million in charity care. Capital Medical Center provided $453,058.

St. Peter ranks sixth in the state when charity care is measured as a percentage of gross patient revenue (3.4 percent). Capital Medical Center ranked 92 out of 93 reporting hospitals (one-quarter of 1 percent).

BACK INTO THE COMMUNITY

The money St. Peter Hospital makes on elective heart procedures goes right back into the community in the form of charity care for uninsured and underinsured patients. It also supports other key hospital programs including the sexual assault clinic, mental health services, chemical dependency and St. Peter Family Medicine Residency Program, which serves the basic health care needs of many South Sound’s Medicaid patients.

Some of the money Capital Medical Center would make from the elective heart procedures would go into the pockets of investors in the form of stock dividends.

That’s a huge difference and the reason The Olympian’s editorial board recommends that Department of Health officials support St. Peter Hospital’s position on Capital Medical Center’s Certificate of Need application.