A battle royal over the New Hampshire open-heart surgery market has moved into court.
In the latest skirmish, Optima Healthcare in Manchester last week filed suit in state Supreme Court in Concord challenging certificate-of-need approvals granted to Concord (N.H.) Hospital and Columbia/HCA Healthcare Corp.'s Portsmouth (N.H.) Regional Hospital in June.
Optima, which lost its administrative appeal last week, maintains the state's CON board failed to use adequate standards for approving its rivals' applications.
Contrary to its criteria under state law, the CON board made its decision on the "basis of (patient) convenience rather than the basis of need," said Edward Palank, M.D., medical director of Optima's New England Heart Institute located at Catholic Medical Center, Manchester.
The hospital, which is owned by Optima, performs about 1,200 heart-bypass operations each year.
Palank said nine open-heart surgery programs within about an hour's drive from Manchester provide "plenty of competition." He said that opening low-volume centers, such as those planned by Columbia Portsmouth and Concord, puts patients at risk.
The potential newcomers contend Optima's concerns are all about its own bottom line.
"This is about (Optima) protecting a revenue source for themselves," said Michael Green, chief executive officer at Concord Hospital.
"It's clear that they do a nice job of quality," Green said. "It's equally clear their charge structure has been excessive."
Added Frank Fedele, M.D., a cardiologist who practices at Columbia Portsmouth: "Make no mistake about it, this is just about money; they're scared to death Portsmouth's going to put on a great surgery program."
Concord and Columbia Portsmouth have said Optima's bypass rates are too high at $47,000 for typical bypass surgery, according to Columbia. The rival hospitals said they could do just as well for less-about $20,000.
Optima officials disagree.
For bypasses without complications, Optima received $20,922 in 1995 under Medicare, about half of all bypass cases in the three-hospital system, it said.
Rates for managed-care providers are considered confidential. But Julie Eberhart, an Optima official, said "We're commited to being competitive on pricing."
A spokesman for Blue Cross and Blue Shield of New Hampshire said the plan is satisfied with Optima's charges, adding "we've been able to negotiate a competive price vis-a-vis hospitals in Boston."
If Concord and Columbia Portsmouth proceed as planned, they would double open-heart surgery options in the state.
"It will have an impact on our numbers," Palank conceded. "They will come after our market area, and our numbers will go down."
Currently only Optima's New England Heart Institute in Manchester and Dartmouth-Hitchcock Medical Center in Lebanon have open-heart programs in the state.
Maine Medical Center in Portland has joined the Optima suit. Columbia Portsmouth's CON application said it expects to capture 85% of the market in eight Maine towns.
A court decision is not expected before fall.