Renowned Doctor Is at Heart of Battle for Patients : Health: The recruitment of Dr. Taro Yokoyama is considered a boon for a Burbank hospital as competition for lucrative cardiac cases increases.
The decision by renowned cardiologist Taro Yokoyama, the so-called King of Hearts, to extend his practice into the San Fernando Valley adds heat to an intensifying battle among medical institutions.
St. Joseph Medical Center’s promise to spend $5 million to build new cardiac facilities for Yokoyama and his team demonstrates the fierce competition for lucrative heart patients, sources said.
The immediate effect of Yokoyama’s decision to branch out into the Valley from his base at St. Vincent Hospital near downtown Los Angeles, which for many years has been recognized as a top-flight cardiac center, is expected to be a boon for the Burbank hospital. Yokoyama and his team of 10 physicians began practicing at St. Joseph on Sept. 10, marking the first time a nationally significant cardiac team has operated in the Valley.
Exuberant administrators at St. Joseph heralded the move as the first step in creating a “center of excellence” in the elite field of cardiac surgery, and expressed the goal that once its multimillion-dollar cardiac surgery expansion is complete, the Burbank institution will become one of the nation’s top 10 cardiac centers.
St. Joseph administrator James Sauer said plans are under way for new and renovated operating rooms, a pediatric intensive care unit, new and retrained staff members and state-of-the-art equipment to support Yokoyama’s team.
Many sources in the medical community said the recruitment of Yokoyama makes sense, especially when an estimated 53% of the state’s hospitals are losing money. Last year, St. Joseph lost $3,844,000 on its Medi-Cal services, and closed its trauma center after further losses. Net income equaled $3,481,000. St. Vincent, in the year ended in June, 1990, lost $5,899,771 on its Medi-Cal contract and had net income of $2,393,000 for the year ended in June, 1989.
One expert familiar with state medical income figures said that even among hospitals that are making money, the average net income is just 2% of revenues.
The new program at St. Joseph will almost certainly boost the hospital’s bottom line, particularly if the number of heart operations doubles or triples from the 142 done in 1989, as some hospital officials suggest.
As opposed to emergency room patients, many of whom are poor and uninsured, cardiac patients are “very lucrative,” said one medical community expert. “These are highly paying, insured patients. They have long recuperative stays. What hospitals try to do is recruit teams like this. I’m not surprised Jim Sauer went after these guys,” this expert said of St. Joseph’s administrator.
The cost for cardiac surgery can range from $8,700 for a simple procedure to $40,000 and more for open-heart surgery.
A number of medical experts said Yokoyama’s move comes at a time when competition for these patients continues to grow. At one time, most cases went to St. Vincent or a few other well-known heart centers, according to a former Los Angeles heart surgeon who asked not to be identified. “But now,” said the doctor, “every 100-bed facility has a heart unit and a surgical team.
“Cardiology and cardiac surgery has become one of the major ways for hospitals to survive,” he said.
The medical rumor mill in Southern California has been palpitating uncontrollably since Yokoyama announced his intention to take his instruments into the Valley. Instead of severing his ties at St. Vincent, Yokoyama announced that he would work at both hospitals. Some cardiac surgeons said that arrangement will be difficult for him.
It is “difficult to see why Dr. Yokoyama would want to be at two hospitals, knowing all the problems it creates” in terms of dividing the attention and resources of the highly specialized surgical teams who perform open-heart operations, said Dr. Gregory Kay, a cardiac surgeon at the Hospital of the Good Samaritan.
Although Yokoyama said he has “no intention” of leaving St. Vincent at this time, Kay and others said they think Yokoyama may cut ties to his base at St. Vincent after the new facilities at St. Joseph are completed.
That would be a coup for the Valley hospital but a serious blow to the proud, 134-year-old Catholic institution in Los Angeles, which only four years ago lost what was then considered the pre-eminent heart surgery team in California, in a dispute over the direction the medical program was taking. Sensitivity over Yokoyama’s move has grown so strong that top officials at St. Joseph declined to discuss the matter. Yokoyama himself canceled one interview.
Several weeks ago when he was asked if he would eventually leave St. Vincent for St. Joseph, Yokoyama said, “We are speculating too much.”
The facilities at St. Joseph do not yet meet his standards, he said, adding that many things could happen in the next two years while improvements are being made. “In medicine, there are so many factors that can’t be predicted,” he said.
Yokoyama said St. Vincent had done nothing to displease him. “I noticed that many of my referrals came from the San Fernando Valley,” he said. “I simply wanted to expand to the south end of the Valley.”
The decision to create a world-class cardiology center at St. Joseph involved a detailed search for a top-flight surgeon that went beyond Yokoyama. At least two other teams were contacted, including Robert Kass, a respected physician at Cedars-Sinai Medical Center, and the group at Good Samaritan headed by Kay’s father, Jerome.
“We were contacted about whether we would be interested, and we said we were not,” said Gregory Kay, who said the team at Good Samaritan performs more cardiac surgeries than any other group in the state.
Jerome Kay’s highly regarded team operated at St. Vincent until 1986, when it departed amid complaints that St. Vincent was not willing to invest more money in research. Yokoyama was put in charge of the cardiac unit at that time.
Some have suggested that Yokoyama, as a top surgeon, was in the driver’s seat during the negotiations with St. Joseph. One medical administrator in the Valley, who asked not to be identified, said Yokoyama was “offered the moon” by St. Joseph, a remark that hospital officials declined to comment upon.
But one source said the mere fact that St. Joseph was conducting a search could have put pressure on Yokoyama. This is because the 20 cardiologists who have staff privileges at St. Joseph refer a large number of patients to Yokoyama’s team at St. Vincent for coronary bypass surgery, heart valve repair or replacement, or, in infants and children, repair of congenital heart defects.
Once St. Joseph’s heart center is operational, St. Vincent and Yokoyama could have lost those extra patients. That would have been an extra inducement for Yokoyama to come to the Valley. Since he started operating in the Valley, he has performed 26 surgeries. St. Vincent officials said they have not noticed a precipitous drop in their patient load.
Some speculated that Yokoyama wanted to branch out for more work. Yokoyama’s surgical team performed 724 heart surgeries last year at St. Vincent, compared to 1,202 in 1986. Even the smaller number is considered impressive, but one surgeon, who asked not to be identified, said big surgical groups “are so volume-driven they have to work all day long. They have an inability to sit still.”
According to the surgeon, who claimed to have a good channel into St. Vincent, Yokoyama has expressed frustration over the amount of work. “He was not busy enough by his own report,” he said.
That still doesn’t answer the question of whether Yokoyama intends to leave St. Vincent altogether. St. Vincent President Vincent F. Guinan said he and fellow administrators “don’t anticipate any significant impact from Dr. Yokoyama’s networking into the Valley.”
But when Guinan was asked whether Yokoyama’s move had the blessings of St. Vincent’s policy-makers, he refused to answer.
“I don’t think it’s a good question,” he said.
Some sources suggested that there are sensitivities within the medical staff at St. Joseph over the move as well, since it comes on the heels of the decision to close the hospital trauma center. “It’s interesting that they closed the trauma center and instead put millions and millions into heart surgery,” a medical industry expert said. “This is a way to ace out poor people and get more paying patients.”
An emergency room physician at St. Joseph, however, said he had heard no hard feelings expressed over the heart center. Closing the trauma center, which was costing the hospital a lot of money, “was probably the right thing to do,” he said.
