UnityPoint battles over proposed new lab
One of Iowa’s largest health care providers is going to court in an effort to block the creation of two new cardiac catheterization labs it says are unnecessary.
UnityPoint Health-Des Moines, which owns and operates Iowa Methodist Medical Center, Blank Children’s Hospital, Iowa Lutheran Hospital and Methodist West Hospital, is challenging efforts by the Iowa Clinic Surgery and Endoscopy Center to establish the two new labs.
Last summer, The Iowa Clinic filed an application with the state for a “certificate of need” for two new, state-of-the-art cardiac catheterization labs that would be used to help diagnose and treat heart disease within the existing surgery center.
Certificates of need are issued by the Iowa Department of Public Health and State Health Facilities Council as a part of a regulatory review process that requires prospective health care providers to obtain state approval before developing a new or expanded institutional health service. The applications for certificates are reviewed by IDPH staff and the council to ensure that an existing medical need in the community will be met by the proposed project.
Although hospital-based cardiac catheterization is currently offered in Des Moines at MercyOne, Iowa Methodist Medical Center and the Iowa Lutheran hospitals, The Iowa Clinic argued that cardiac catheterization performed at the clinic or a similar surgical center rather than at a hospital would serve patients more effectively and at a lower cost.
National Medicare data indicates the average cost of a cardiac catheterization in a surgical center is $1,682, as opposed to $3,157 in a hospital. After Medicare pays its share, the surgical-center patients pay an average of $335, compared to $952 paid by hospital patients. One reason for the big difference in costs: Hospitals are more likely to take the higher-risk cases that result in complications and hospitalization.
UnityPoint–Des Moines has opposed the project, citing a recent decline in case volume; an existing excess capacity for providing the service; the prospect of the new labs taking business away from labs that are already underutilized; and revenue shifting from nonprofit hospitals to a for-profit enterprise. Attorneys for UnityPoint have also argued it is “likely that UnityPoint Health-Des Moines will be forced to consolidate its cardiac catheterization labs resulting in the closure of one or more labs” if the project moves forward. They have noted that UnityPoint currently operates at least five cardiac catheterization labs, all operating below capacity.
Iowa’s administrative code states that cardiac catheterization laboratories should be projected to operate at a minimum of 300 catheterizations per year. The Iowa Clinic has projected that each of the catheterization labs it is proposing will perform 397 catheterizations per year.
In December, the council voted 3-1 to approve surgical center’s application, noting that the Centers for Medicare and Medicaid Services has recognized that low-risk cardiac catheterization procedures can be performed safely in an ambulatory surgery center, resulting in lower costs and improved patient convenience.
The council’s approval appeared to clear the way for The Iowa Clinic to become the first ambulatory surgical center in Iowa to offer cardiac catheterization. But within weeks, UnityPoint asked for a rehearing. That request was rejected by the council in February.
UnityPoint Health-Des Moines is now suing IDPH and the council, seeking not only judicial review of the council’s rehearing denial, but a ruling that states the certificate of need should never have been issued. IDPH and the council have yet to file a response to the lawsuit.
The Iowa Clinic is the largest physician-owned, multispecialty group in central Iowa with more than 250 doctors and health care providers practicing in more than 40 specialties and handling an average of 650,000 patient visits per year. The physicians of The Iowa Clinic have privileges at both central Iowa hospital system, UnityPoint Health and MercyOne.
The primary service area for the lab project is an 11-county area in central Iowa. In 2019, The Iowa Clinic had over 54,000 patient visits resulting in cardiology services.