Health Related

CVPH plans to end cardiac surgeries

Would move program to Fletcher Allen Health Care if state approves

By: By ASHLEIGH LIVINGSTON

PLATTSBURGH — The days of cardiac surgeries offered at CVPH Medical Center could be numbered.

The hospital’s Board of Directors has approved a plan that, if also OK’d by the State Department of Health, would move CVPH’s cardiac-surgery program to Burlington’s Fletcher Allen Health Care, which has served as CVPH’s mentor institution for those surgeries since 2011.

The Plattsburgh hospital would instead focus its cardiac efforts on intervention procedures, which include percutaneous coronary interventions, or angioplasties; stents; and cardiac electrophysiology procedures.

CHANGING NUMBERS

The change is inspired by a decrease in the number of heart surgeries taking place at CVPH, coupled with an increase in intervention procedures conducted there, according to Debra Donahue, senior vice president and chief operating officer of CVPH.

These fluctuations, she noted, are also occurring nationally.

“Research will tell you that they anticipate about a 3 percent decrease in surgical volumes (nationally),” Donahue said.

“We’ve also seen, at the same time, an increase in our interventional stents volume because they’ve been able to utilize stenting more than they had in the past, so people do the less invasive thing first.”

Historically, she noted, Fletcher Allen and CVPH competed for Northern New York’s cardiac population, with some sent to Burlington for the same intervention procedures offered in Plattsburgh.

However, Donahue said, “it doesn’t make sense to bypass a hospital that can do those procedures to go to Fletcher Allen.”

INTEGRATED FACILITIES

And, in 2012, when CVPH became part of Fletcher Allen Partners, which also includes Elizabethtown Community Hospital, Central Vermont Medical Center and Fletcher Allen Health Care, the facilities began working as an integrated system, rather than in competition.

In an effort to get the most value out of that system, Donahue noted, Fletcher Allen Partners contracted a study of its cardiovascular services, which suggested it is best and keeps cost down when patients can receive high-quality care close to home.

“So to establish CVPH as a Northern New York site for cardiac interventions will bring those patients that had bypassed us to CVPH for those procedures,” she said.

ACADEMIC HOSPITAL

Moving Plattsburgh’s cardiac surgeries to Fletcher Allen also makes sense, Donahue said, because Fletcher Allen is an academic medical center, so the surgeries are performed there more frequently.

“If we’re not doing it all the time, if we don’t have the volumes, then we can’t be at the highest quality,” she said.

TOP-RANKED PROGRAM

“The interventional is something we’re very good at,” added Michele Powers, director of communications and marketing at CVPH.

In fact, the hospital’s angioplasty program has ranked among the top 5 percent in the nation for the past three years and among the top 10 percent for the past seven years.

CVPH performed an average of 1,200 angioplasty and cardiac electrophysiology procedures per year between 2009 and 2012, according to Powers, and is on track to meet or surpass that number by the end of 2013.

And under the proposed arrangement, Donahue expects CVPH would receive an additional 150 to 200 angioplasty cases annually.

FEWER HEART SURGERIES

However, Powers noted, over the last four years, CVPH has performed an average of 125 cardiac surgeries per year, with the high during that time being 138 in one year.

This year, she said, will be the low.

“The Department of Health likes to see that you at least do 100 surgeries, and it’s going to be very difficult for us to reach 100 this year,” Donahue said.

ALICE HYDE SUPPORTIVE

At Alice Hyde Medical Center in Malone, medical staff will continue to determine where to send cardiac patients based on what facility can best meet their needs on an immediate basis, according to CEO Doug DiVello.

However, he noted, his institution supports CVPH’s plan and feels it makes sense for the Plattsburgh hospital to position itself to perform more interventional procedures, as doing so will improve quality.

“The strategy makes sense to us, and we will benefit because our patients will get better care if they’re successful in this integration strategy,” DiVello said.

In addition, he noted, it’s a much shorter trip for patients to transfer from Alice Hyde to CVPH than to Fletcher Allen, “so clearly that’s a benefit, as well.”

TRAVEL COSTS

Of course, the consolidation would also require Plattsburgh-area patients who may have previously been able to receive cardiac surgery at CVPH to travel to Vermont.

These transfers could potentially result in additional travel and lodging expenses for families.

“There is some added expense, I guess, if you look at it that way,” Donahue said. “But more importantly, I think, is to be able to demonstrate to the community that this surgery needs to be done in a place where they’re doing it every day.”

Even now, CVPH sends patients in need of more complex heart surgeries to Fletcher Allen, so doing so, she noted, “is a well-greased, very seamless” process.

“As a regional community hospital, we cannot do all the things an academic medical center (can do),” Donahue said. “Our mission is different, so there is need for other patients to travel or to be transferred out to an academic medical center.

“We’re very fortunate that we have one within an hour’s distance.”

APPROVAL NEEDED

Dr. Joel Wolkowicz, director of cardiology at CVPH and president of the hospital’s medical staff, said that since CVPH’s surgical program, like others across the country, is getting smaller due to decreasing volumes, he too feels it best to consolidate. 

“We don’t want to become a very small program that doesn’t do a very good job,” he said. 

As of now, the cardiac-surgery program at CVPH continues; though, it is unclear for how long.

Donahue said the hospital would like to make the changes as quickly as possible but must go through the proper approval process with the Department of Health, which she suspects will take a matter of months.

“I don’t know how many months, but it won’t be years,” she said.

STAFF UNCERTAINTIES

It is also unclear what will become of the CVPH program’s staff.

Some will definitely stay here and work in general, non-cardiac surgical procedures or take on other positions in the hospital, according Wolkowicz.

Others are looking to see if they can get positions at Fletcher Allen, he said, and some of the physicians could potentially leave the area.

The hospital’s cardio-thoracic surgeon, Dr. Anne Cahill, said she is very proud of the work she and her team have done at CVPH.

She said her goal is to continue to provide service to the community. 

“My family has appreciated great friendships and community support,” she told the Press-Republican on Thursday. “We will reside in this community. 

“I’m in negotiation with CVPH on how I can best continue to provide education, wellness and clinical service.”

Email Ashleigh Livingston:alivingston@pressrepublican.com

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