"Hospital not skipping a beat"

Danville Register & Bee
Saturday, March 1, 2008
Five years ago this month, Danville Regional Medical Center was proud to announce the first open-heart surgery at the recently completed Heart Center of the Piedmont - a $9 million surgical facility operated jointly with the Duke Private Diagnostic Clinic.About 600 procedures have been completed since then. But last summer, it was clear that patient load was dropping and quality of care was being questioned, and it seemed that Duke wasn’t so sure it wanted its name on the door anymore.Upon the recent completion of a comprehensive assessment, Duke Heart Center faculty and staff and LifePoint Hospitals Inc., Danville Regional’s parent company, agreed that the collaboration was successful and beneficial to both entities and will continue through 2010.“Duke Heart Center faculty will continue to provide uninterrupted, on-site cardiovascular surgical services and on-call coverage for the residents of Danville and the Dan River Region,” said Dr. Peter Smith, chief of cardiac thoracic surgery at Duke University Medical Center.Jerel Humphrey, the new president and chief executive officer of Danville Regional, seems pleased with the decision.“It’s a win-win-win,” he said, “for the hospital, for Duke and the community.”
Uncertainty about the futureA number of factors over the past few years called continuation of the program into question, including administrative changes and community perceptions of the hospital.In 2005, LifePoint Hospitals Inc. bought Danville Regional, bringing a series of operational shifts.“The hospital historically (had) been run as a nonprofit organization,” Dr. Syed Ahmed, a cardiologist who has been with the hospital for 25 years, said. “Suddenly, it became for-profit and changes were brought into the system.“Some of the changes were shocking, but inevitable, (and) some of the problems we saw were inherent to changes taking place on a larger scale - ownership, a different corporate structure, different psychology.”Issues with the cardiovascular surgical program were “something between the administration of Danville Regional and the (administration at Duke)…and the contractual agreement they had,” Ahmed said, noting the issues had nothing to do with the physicians.“…Problems with the sale of the hospital and administrative changes” also may have contributed to community attitudes about Danville Regional, Ahmed said, which in turn partially contributed to lower patient volumes in the cardiovascular surgery program, as well as in the hospital overall.Another possible cause of lower numbers of cardiovascular surgical patients was a study published in June by the Centers for Medicare and Medicaid Services, a division of the Health Human Services, that ranked Danville as one of the seven worst hospitals for heart attack mortality rates. Although that study did not concern the cardiovascular surgery program, cardiologist Dr. Bosh Zakhary said in August that it influenced the community.That same month, Dr. Lee McCann, Duke’s cardiothoracic surgeon responsible for all surgical procedures at the Heart Center, announced his resignation citing low patient volume and financial troubles.The “service line assessment” of the program was announced at the same time.
All clear“The good news is that they were very positive with what they found and wanted to continue,” Humphrey said. “Their assessment to me is an independent seal of approval of where the hospital is … they don’t associate with programs that aren’t high quality.”Humphrey acknowledged that canceling the program was an option as Duke was “evaluating the status of the relationship.”Duke wants to “restore the hospital to its position as a trusted provider,” Smith said.“It’s been a problem,” he said. “The community deserves first class hospital-based care and that’s our objective. … Duke and Duke physicians have taken care of citizens in (the) county forever. We have a vested interest in the health of your community members.“We are very interested in maintaining that and improving it.”Last week, officials were still putting finishing touches on the agreement between Duke and LifePoint.“We’re still negotiating and working with LifePoint to establish a relationship that is going to enhance the hospital’s reputation and ability to deliver health care,” Smith said. “…This is a joint venture. Duke can’t do it alone; LifePoint has to show they’re committing.”Smith, however, is confident that the relationship will last.“Each step we take, and this is the first one, is an indication that Duke believes we can establish the conditions for success,” he said.
The staffDr. Richard Embry, a “very experienced cardiothoracic surgeon,” currently in Springfield, Ill., is expected to be the permanent cardiothoracic surgeon with the program, Smith said.Embry will operate full time in Danville, though technically will be an employee of Duke.“I think he’s going to be a very good addition to the community,” Ahmed said. “He should be able to carry the cardiovascular surgical program forward.”In addition to Embry, Duke and LifePoint are actively recruiting a permanent cardiovascular surgeon to add to the team.After McCann’s departure at the end of this month, Humphrey said Duke will be rotating and sending surgeons on an “as needed basis” for interim support, which he expects to last about two months.“Continuation of the program is key,” Humphrey said. “No interruptions.”Smith said 13 Duke faculty members also will be present to help with surgeries, evaluate and perform physician activities.Danville Regional has six full-time cardiologists on its staff as well. Optimism abounds“Stay tuned,” Humphrey said about advances in the program.“Duke is going to continue to be the provider of cardiac surgery service and we’ve established conditions to provide the same level of care (that one gets) at Duke,” Smith said. “LifePoint has made a commitment to enhance cardiovascular services in general … a critical fist step to overall improvement to the community’s hospitals.”Ahmed sees hope in improving the image of the hospital with the community. “Mr. Humphrey is taking a proactive role in terms of restoring the confidence of the general public,” Ahmed said. “And certainly the re-establishment of the relationship with Duke is going to have a positive impact in terms of cardiovascular programs in particular and the hospital in general.”