Local hospital care at risk if University comes to Aiken

By DR. ANSERMO ARTHUR

Guest columnist

As a current resident and practicing cardiologist in Aiken for the past 13 years, I, like many of you, have read with great interest the ongoing debate concerning University Hospital's foray into the Aiken medical community.

I will summarize what I believe to be the most salient points concerning this issue from a physician's point of view.

Everyone has a story. Whether it is about good or bad service, most everyone can remember and come up with at least one anecdote detailing some experience they may have had in the doctor's office.

I, as well as my partners, see patients from Augusta with similar stories detailing bad experiences they may have had with a doctor or hospital in Augusta. The fact is that all of this is irrelevant to the matter at hand. Just like those individuals who make a conscious decision to cross the river and choose me or any other doctor in Aiken, so too may a person living in Aiken make the choice to go to Augusta for the same purpose. It is about convenience and not choice! Competition notwithstanding, what price will we really be willing to pay in the long run for convenience?

This is about the "bottom line." It should come as no surprise to anyone that University Hospital's push to secure a presence in one of the more affluent areas in Aiken County comes on the heels of their opening a new heart center. Look at the billboards, radio and television ads attesting to this fact. It is not a coincidence either that the location is within earshot of a retirement community where the prevalence of cardiovascular disease is likely to be high and the coffers even larger.

This is not about profit vs. not-for-profit. I am not a hospital administrator and cannot discuss the pros and cons of a for-profit versus a not-for-profit hospital. What I do know about is the practice of cardiology, and it is clear that a community benefits from the services that its local hospital is able to provide. It is irrelevant that Aiken Regional is a for-profit entity.

Take for instance the cardiovascular program that the community fought long and hard to bring to our local hospital. Countless people in Aiken have benefited from having a local open heart and interventional cardiology program, many of whom might not have survived an ambulance ride to Augusta.

Heart programs as a general rule tend to increase the bottom line of most hospitals, so much so that other product lines may improve as well. Aiken Regional Medical Centers has spent millions in capital to improve the hospital and services it provides to the people in this town despite being a for-profit entity.

In addition, the hospital financially supports many outreach programs specifically designed to improve the cardiovascular health of the employees of many industries in this town.

This is not about local hospital to hospital competition.

Competition among local hospitals is great for medicine. Services improve, doctors can request capital investments and hospital administrators usually acquiesce because they know another competing institution across town might be offering better service to attract patients. I define local as a hospital in a particular city, town, county or province. That is not the case here.

Examples of this can be seen in cities like Boston, where five hospitals located within a few miles radius all offer the same very high level of cardiovascular care. It does not matter if the hospital is large or small, all compete on the same playing field.

In the final analysis I believe University is trying to situate itself in a position to garner patients to support its cardiovascular program and other high dollar, procedurally based medical services. With this in mind, it is totally disingenuous for the administrator of University Hospital to say that Aiken Regional Medical Centers and the medical community in this town will benefit from its residents being seen by University physicians whose primary intent will be to send those same persons across the river whenever higher level medical services are needed.

I experienced a similar phenomenon when I lived in the Northeast. A larger hospital that I worked at enlarged its cardiovascular program and set its sights on increasing its patient base to support the endeavor. It did so utilizing the same business model that University Hospital is proposing in Aiken in a small community hospital about 20 miles away.

In my relative naiveté and ignorance I was in favor of the idea, like many of you believing this would stimulate competition and be good for the town and the hospital. It wasn't.

The process was very insidious in the beginning with the larger hospital setting up doctors' offices and then a cardiology practice. When these same patients needed further testing such as cardiac catheterizations, stress tests, etc., they were automatically referred back to the larger hospital. It took about three years but, eventually, the smaller community hospital no longer had enough cases to support doing cardiac catheterizations.

This led to the cardiac catheterization lab closing down in the small community hospital. Other services also declined as a result and, eventually, the hospital was relegated to what I would call an aid station. Any patient needing a higher level of care was transferred to the larger hospital.

The quality of care that the people in the smaller town had come to expect suffered, also. It was not good for the hospital or the town and did nothing for competition.

This scenario has been repeated elsewhere across the country in smaller community hospitals, resulting in an epidemic of hospital closures as the competition for patients drives many larger tertiary care referral centers to adopt aggressive business strategies to garner more patients.

Obviously, many of the circumstances described appear different, but there are some similarities that raise mind-boggling possibilities about the potential for the same process to occur in Aiken if University Hospital is allowed to move forward with its plans.

The writer is an Aiken cardiologist.