St. Vincent pediatric claims rile Riley

Riley Hospital for Children officials are upset over how St. Vincent Children's Hospital is promoting a care expansion it recently launched with a renowned Cincinnati medical center.

Riley accuses St. Vincent of stretching the truth by saying its push will improve access to specialized care "currently not available throughout the state of Indiana."

The north-side hospital now treats rheumatology and nephrology patients and added two surgeons who specialize in minimally invasive operations on premature babies.

Riley boasts loads of experience in all those areas, said Dr. Ora Pescovitz, the downtown hospital's CEO.

"What disturbed us was a distortion of the truth, not that we're afraid of competition or the risk of competition," she said. "We don't appreciate untruths being published because the public can't distinguish when something is untrue."

Pescovitz downplayed competitive concerns, even though she helped write a full-page ad that ran in IBJ last month asking whether too much local competition could harm a children's hospital by diluting care.

It suggested that, because the pool of pediatric patients in need of specialty services is small, an oversupply of subspecialists undermines the viability of their practices, "making fewer of these scarce resources available when care is necessary."

That is a real danger in pediatrics, according to several health care consultants. But St. Vincent Children's Administrator Jeff Poltawsky said every move his hospital made answered a definite need in the market.

"We haven't diluted anything," he said. "I think we've added to it.

"Everybody wants choice in health care, and this gives people more options and more choices."

Looking to the Queen City

St. Vincent fired the first salvo in this war of words in June, when it announced an agreement with the 475-bed Cincinnati Children's Hospital Medical Center.

A study St. Vincent conducted last year showed that 60 percent of children undergoing surgery in Indiana were not being operated on by pediatric surgeons at a children's hospital.

Cincinnati Children's helped St. Vincent boost its pediatric surgery by recruiting doctors Denis Bensard and Richard Hendrickson to Indianapolis from Denver. Poltawsky said the pair will help boost treatment at St. Vincent's neonatal intensive care unit, the largest in the state.

Premature babies with low birth weights cannot be moved to another location for surgery, he noted. Having specialists in minimally invasive surgery on site solves that problem.

"I don't think we were distorting the need for minimally invasive surgery," he said. "I think we were speaking to our own demand, what our own patients needed.

"Not all children had access to the … techniques that were necessary to provide the highest level of care."

In addition to those surgeons, two doctors from Cincinnati will make regular trips to Indianapolis to expand St. Vincent Children's treatment into rheumatology and nephrology. Rheumatology includes joint diseases, while nephrology covers kidney problems.

The agreement, which also provides educational opportunities for St. Vincent nurses, puzzled leaders at Riley, which bills itself as one of the 15 largest children's hospitals in the country.

"We were surprised that they chose to align with Cincinnati when they could have partnered with us," Pescovitz said.

The president of the American Society for Pediatric Nephrology, Dr. Sharon Andreoli, practices at Riley. Three pediatric rheumatologists work there as well. In addition, the hospital's doctors have written textbooks on minimally invasive surgery.

St. Vincent did discuss its surgical needs with Clarian, Poltawsky said. But the hospital ultimately found the best fit in terms of vision, goals and care philosophy with Cincinnati's medical center.

"It was the collaboration we were looking for," he said.

The peculiarities of pediatrics

The need for pediatric subspecialties has grown over the years, thanks in part to neonatal care improvements that keep more babies alive. But it can be challenging to find enough patients to keep pediatric specialists busy.

Adults outnumber children in any market, and kids are generally healthier than grown-ups, said Lawrence McAndrews, president and CEO of the Alexandria, Va.-based National Association of Children's Hospitals and Related Institutions.

That means children's hospitals have to cast a wider net to find enough patients to treat.

"A large population is needed for a full range of comprehensive pediatric services," he said. "It's just too hard to do this economically if you haven't got volume."

That also means some specialties can be vulnerable to dilution, which happens when too many specialists confront a dearth of patients in a market.

"There aren't that many kids who need rheumatology, and there aren't that many rheumatologists," said McAndrews, who isn't familiar with the Indianapolis market.

In places where care dilution is a problem, doctors might be unable to pull in enough revenue to support a practice. They also may leave the market to seek more work if they don't see enough cases to stay sharp in their specialty.

Training and research programs also could suffer from care dilution.

"You run the risk of no longer having the ability to deliver the level or quality of care that you need to be the best," Pescovitz said.

Clarian's IBJ ad, which ran about two months after the St. Vincent announcement, noted that "same-market competition" can harm "the pursuit of delivering quality care." The ad never mentions St. Vincent Children's, the only other pediatric hospital serving central Indiana.

However, Pescovitz backed off the notion of care dilution. She said Riley hasn't seen an impact from St. Vincent's expansion. Her main concern was that St. Vincent's announcement "distorted the reality" about availability.

"I just wanted to set the record straight on that," she said. "I don't want to have a battle in the press over something that happened.

"I just want to make it clear that these services are available."

Poltawsky said the surgeons St. Vincent Children's added became "instantly busy" when they started in May.

"I think that certainly there is a need for more specialized care for children in Indiana," he said. "I think there's room for two children's hospitals."

Indeed, both hospitals should find success if they draw well from all corners of the state, said Mike Grubbs, a Barnes & Thornburg health care attorney who doesn't represent either hospital system.

"There's another baby boomlet going on [nationally], and I think that's going to have as much to do with it as anything," he said.

Indianapolis health care consultant Duane Sobecki thinks dilution can be a problem, but he doesn't know when a market reaches that stage.

"I'm saying if St. Vincent thinks that they can make money or make a go of this relationship with Children's Hospital in Cincinnati, let 'em," said Sobecki, senior partner with Sobecki and Associates. "Let's go see who's the best."

Competitors cooperate

Even as St. Vincent and Riley step up competition, they also continue to cooperate on some fronts.

St. Vincent often refers severe trauma, burn patients or transplants to Riley, which is better equipped to handle them.

Doctors associated with Riley also see patients at St. Vincent, and both sides say they want to continue cooperating in the future.

"I think what we need to do is engage in a partnership," Pescovitz said. "We have partnerships all over the state and [they] are intended to provide top-level care to all patients."

On that point, Poltawsky agrees.

"I think it says a lot that we're open to collaborate with many people to deliver the best care for St. Vincent and their families," he said.