Storm clouds are gathering to the north as St. Vincent Health applies the last coat of polish to its $19 million Women's Hospital renovation.
The Indianapolis hospital will lose an obstetrician-gynecology group that delivers as many as 1,440 babies a year shortly after it completes its expansion in September.
The 10 doctors of Women's Health Alliance plan to move offices and shift 80 percent of their practice to a new competitor, Clarian North Medical Center, a $285 million project scheduled to open Dec. 1.
In addition to that, the vast majority of obstetrician-gynecologists who practice at St. Vincent Women's will start seeing patients at Clarian North, too, according to Dr. Lynda Smirz of Women's Health Alliance.
St. Vincent officials say the Women's Health Alliance move is something they anticipated before they started the renovations last year. But others say it will take time for the hospital to reclaim the lost business.
"It's not going to shut them down," said Edmund Abel, director of health care services for the Indianapolis-based consulting firm Blue & Co. "It'll still be the biggest OB room in the state, but [Clarian North] will have an impact on the dollars and cents."
King of the hill
St. Vincent Health bought the Women's Hospital in 2003 and, in doing so, created a baby-delivering colossus.
St. Vincent's main Indianapolis hospital on 86th Street and the nearby Women's Hospital combined for 5,659 live births over the past year, the largest number in central Indiana, according to Women's Hospital Administrator Anne Coleman.
Clarian North aims to deliver 2,300 babies the first year it's open. This new competition will affect every hospital on the north side of Indianapolis, said Duane Sobecki, a senior partner with Sobecki & Associates, an Indianapolis-based health care consulting firm.
That includes Community Hospital North, which delivers 2,100 babies a year.
Clarian North is "a brand-new facility, brand-spanking new," Sobecki said. "It's built with the patient in mind, and they got some really top-notch people with a really terrific customer service focus moving in."
Clarian North could hurt St. Vincent Women's from a number of angles.
For starters, St. Vincent could lose almost 20 percent of its annual delivery total if Women's Health Alliance shifts 80 percent of its practice to Clarian North. Doctors in that group deliver 100 to 120 babies a month, according to Susie Kuehr, the group's clinical manager.
Abel said St. Vincent has an excellent reputation and can recruit new physicians "with the best of them." Still, he added, "you don't replace 20 percent overnight."
That loss may climb higher. Smirz said her group's doctors are committed to keeping a presence at St. Vincent Women's because patient preference and insurance require it in some cases.
But Abel said doctors generally prefer to work from one location.
"Once they get busy up north, they're going to spend 100 percent of their time at one location," he predicted.
Aside from losing the doctors and business, St. Vincent also will lose a patientrecruiting tool. Women typically make the health care decisions in a family. If a provider gives good care during birth, that can lead to a lifetime of care for that child or any other family members at that hospital.
Clarian North's Carmel location also puts it in an area rich with patients covered by private insurance, which reimburses at better rates than government programs like Medicare or Medicaid.
St. Vincent Women's already draws a number of patients from that Hamilton County area, making it vulnerable when the new hospital opens, another consultant noted.
Why one group moved
Women's Health Alliance became the first OB-GYN group at Women's Hospital when it moved there from Methodist Hospital in 1984, a year after Women's Hospital opened. The doctors made the decision to move next to Clarian North in 2002, before St. Vincent bought the hospital.
The group plans to sell its 28,000-square-foot office next to the women's hospital and move the week of Thanksgiving. Aside from the doctors, it will move a lab, two nurse practitioners and several employees to an office next to Clarian North.
Smirz, who was named Clarian North chief medical officer in June, called the change an opportunity the doctors could not pass up. A ZIP code analysis told them many of their patients came from Clarian North's market.
Clarian's leadership also impressed doctors, as did the chance to have Riley Hospital for Children as a resource. Riley, which has a national reputation for pediatric care and research, is part of the Clarian Health Partners hospital network.
That also includes Methodist and Indiana University hospitals downtown and Clarian West Medical Center, which opened late last year in Avon.
Women's Health Alliance offers tubal ligations and other forms of birth control. While the group's doctors decided to move before St. Vincent bought the hospital, the Catholic health network's prohibition of such procedures also played a role, Smirz said.
"We want to be able to provide a full continuum of care to our patients, and we felt like we do have a limitation at St. Vincent," she said.
The doctor knows of no other group that plans to move offices from St. Vincent Women's to Clarian North. But she said the vast majority of OB-GYNs practicing at Women's also will work at Clarian North.
"I think everybody realizes they do have to practice at more than one hospital," Smirz said. "Patients dictate where they want their doctors to take care of them."
St. Vincent leaders say they're well prepared for the new competitor.
All is not lost
The Women's Hospital renovation and expansion, which is on target to finish Sept. 6, will boost maternity resources and improve care beyond labor and delivery, Coleman said.
"We're really more than just deliveries here," she said. "We're really building a women's facility for continuum of care for women of all ages."
The hospital will feature 16 labor-anddelivery suites, 26 beds for mothers with high-risk pregnancies, and the largest newborn intensive care unit in the state. St. Vincent will move all its obstetric services from 86th Street to the Women's Hospital.
Outside of obstetrics, Women's Hospital also offers wellness programs, urology, gynecology and breast-surgical oncology care. Future plans call for the possible addition of gynecologic oncology.
Coleman said she wants to establish her hospital as an entry point for all women who seek treatment through the St. Vincent system. Maternity care remains important, and the hospital plans to replace doctors who leave, but the potential loss of business to Clarian North hasn't altered the focus.
"We've really attempted to keep on the focus of specialized, holistic care," she said, "and if we keep our patients and that focus in mind, we believe we will be very, very successful."
Indeed, the hospital's upgrades may draw new patients, according to Jeff Williams, a health care consultant for the Indianapolis office of PricewaterhouseCoopers LLP.
"It wouldn't surprise me if St. Vincent Women's was able to begin attracting business from women's practice groups that may not practice there right now," he said.
Over time, shifts in business tend to even out, he added.
"The facility that wins in the long run typically is the facility that provides the best quality, best working conditions, best staff and patient satisfaction," Williams said.