Matters of the Heart

Roger Desrochers has had three heart attacks and two open-heart surgeries in the last 18 years. But when it came time to schedule his most recent surgery, the 77-year-old New Bedford resident opted not to check in at Mass. General or any other renowned Boston hospital. Instead, the retired textile worker booked his quadruple bypass at the 360-bed Charlton Memorial Hospital in Fall River.

Boston's top cardiac care centers are facing new competition for surgeries like this from suburban hospitals like Charlton. “I wouldn't go to Boston to have another heart surgery,” Desrochers says. “It's too hard to get in and out. My wife is getting older, and it's tough for her to make the drive.” As for the community hospitals themselves, they have a financial incentive for delving into heart surgery: They earn more from Medicare and private health insurers. A coronary bypass is reimbursed by Medicare at about $20,000. Treating an adult with pneumonia, by comparison, brings in only $5,200.

But while a state assessment of the surgery being done by these community hospitals is still pending, some Boston medical leaders question the quality of care. Dr. Thomas O'Donnell Jr., former president and CEO of Tuft's New England Medical Center (NEMC), says community clinics don't have the round-the-clock presence of residents, fellows, and staff of hospitals like NEMC. Should complications develop after surgery, he says, the risk is lower when a patient is being treated in a highly specialized facility. “I like to use the example that if I play golf seven days a week, I'm going to be better than if I play once a month,” says O'Donnell, a practicing vascular surgeon. “The more open-heart procedures you do, generally, the better your survival and complication rates. And in Massachusetts the academic medical centers do the preponderance of open-heart surgery.”

Dr. Ronald Goodspeed, president of Southcoast Hospitals Group, of which Charlton Hospital is a part, responds that his staff has done more than 320 cardiac surgeries since starting the program in April 2002. “In the interest of high quality, we planned we would do 150 total the first year, doing one case a day,” he says. “That way, we devoted all our attention to the process as we honed and sharpened our skills. We're right on target with statewide standards of doing 300 cases a year.”

Who's right — O'Donnell or Goodspeed — will be the subject of a report this spring from the state Department of Public Health (DPH) comparing mortality rates and other factors at all hospitals that perform open-heart procedures. Initial inspections of the new programs appear favorable to the three community hospital groups that have so far received state permission to perform open-heart surgeries — Southcoast Hospitals Group, Cape Cod Hospital, and North Shore Medical Center. They're the first nonteaching hospital groups allowed to perform such surgeries in more than two decades, following the reversal of a statewide ban after a number of deaths at Medford Hospital in the 1970s. Inspectors have so far “reported that the programs all performed satisfactorily,” says Paul Dreyer, associate commissioner of the department's Center for Quality Assurance and Control.
Convenience seems to be the main draw for patients scheduling complex procedures at suburban hospitals. “Having high-quality and convenient cardiac surgical care close to home has been very positively received by people on the Cape,” says Cape Cod Healthcare spokesman David Reilly.

Roger Desrochers couldn't agree more. “The doctors at Charlton kept me and my wife informed throughout the entire process. And they watched me all the time,” he says. “I couldn't even make eyes at the nurse.” B