Mercy hopes to add open heart surgery to spectrum of care

CEDAR RAPIDS - Mercy Medical Center has asked the state for permission to start a cardiovascular surgical program, which would allow the hospital to perform open heart surgeries.

But other Eastern Iowa hospitals, including UnityPoint-St. Luke's Hospital and the University of Iowa Hospitals and Clinics - both of which have cardiovascular surgical programs - say Eastern Iowa's need already is being met.

'Mercy's application is based on the increasing need for additional cardiac surgical services and the limited access and capacity for patients to (obtain) cardiac surgery in Cedar Rapids,” the hospital said in a statement to The Gazette. 'Mercy's nationally recognized, award-winning cardiac services provide high quality care and low complication rates. ...

We are pleased about the possibility of taking this next natural step for Mercy's growing heart program and responding to our patients' requests for extending services to open heart patients, as well.”

The hospital will go before the State Health Facilities Council later this year to ask for a certificate of need. That date has yet to be determined.

The Iowa Department of Public Health reviews health care organizations' requests for new services and medical equipment more than $1.5 million.

At the heart of the disagreement between the hospitals are the some 150 patients who have to go outside the Mercy system every year for cardiac surgical services. These patients wait an average of four days before being transferred, and some wait up to nine days, according to Mercy's application for a certificate of need.

'This exceeds national cardiac guidelines that patients should be operated on within 24-48 hours following identification of the need for urgent surgery,” Mercy wrote.

It continued that an aging population and increase in diabetes cases - which is a major risk factor for heart disease - means there's a growing need for cardiac surgical services, while a comprehensive cardiac program would improve continuity of care, reduce costs by shortening the length of stay, eliminate duplication of testing and improve access.

'While Mercy offers high quality comprehensive services to its cardiac patients, a gap exists in those services because Mercy does not offer open heart surgery,” the hospital said. 'This forces patients to go outside Mercy's system for this necessary service.”

However, St. Luke's argues in its letter of opposition that those 150 cases are not enough to establish a program, pointing to a piece of Iowa code that requires a new cardiovascular surgical program to perform at least 200 surgeries per year.

In 2015, St. Luke's performed 328 open heart surgeries, UIHC performed 317 and Mercy Iowa City performed 72, according to Iowa Hospital Association data. If Mercy is granted approval, it is likely that both hospitals in Cedar Rapids will perform this minimum threshold, St. Luke's said.

'We are disappointed by Mercy's decision and will oppose it,” St. Luke's said in a statement provided to The Gazette. 'There are numerous national statistics that have repeatedly proven open-heart surgeries are on a decline as more advanced technologies and procedures are now performed in a heart catheterization lab rather than a surgery suite.”

In St. Luke's letter to the Iowa Department of Public Health, it pointed to data from the Society for Thoracic Surgery that shows there were 3,500 open heart procedures in Iowa in 2000 compared with about 1,700 in 2014.

'Statistics have also shown better patient outcomes are achieved from an open-heart program that has the volumes each year to support such a specialized program,” St. Luke's continued in its statement. 'An open-heart surgical team consists of highly trained medical professionals and specialized equipment. Dividing the volume of open-heart cases jeopardizes the quality of care for our community and will unnecessarily increase cost for these limited numbers of cases.”

'The experience gained from repeating the procedure over and over again is not only important for the surgeon, but that experience is also critical for the entire surgical team, including the nurses, perfusionists, anesthesiologists, cardiologists and other support staff involved,” wrote Dr. Kalyana Sundaram, director of cardiac services at Allen Hospital in Waterloo, in a letter of opposition. 'As the volume of procedures declines, so does the quality of the program.”