Competition Ramps Up as Hospitals Ready Cancer Centers

By Cindy Hadish, Reporter

CEDAR RAPIDS, Iowa - Two new technology systems at Cedar Rapids hospitals offer promise to help women in the fight against breast cancer, but one came about with a fight of its own.

Mercy Medical Center this week began using low-dose molecular breast imaging with the LumaGem MBI system, a tool used to detect breast cancer early, particularly for women with dense breast tissue.

Dr. Laura Hemann, medical director of Mercy Women's Center, said the system is not an x-ray-based mammography, so it is easy to detect tumors that show up as hot spots on the image and has fewer false positives than magnetic resonance imaging.

The $539 procedure is covered by Medicare, but not yet by insurance, she said.

Meanwhile, the state Health Facilities Council approved St. Luke's Hospital's certificate of need for a new Intraoperative Radiation Therapy system, marking St. Luke's first foray into radiation treatment.

The two systems perform separate tasks, but illustrate escalating competition as Mercy readies its new Hall-Perrine Cancer Center and St. Luke's plans to consolidate cancer services in Physicians' Clinic of Iowa's forthcoming medical mall.

St. Luke's CEO Ted Townsend said the radiation therapy equipment, which the hospital will acquire in April, will be useful for women who opt for a lumpectomy that typically is followed by six weeks of radiation.

The portable system combines lumpectomy surgery with a concentrated dose of radiation immediately after surgery while the patient is still in the operating room. The treatment may decrease and in some cases, eliminate the need for further radiation therapy, reducing the amount of time and expense involved in follow-up radiation.

"It's a less invasive approach to therapy," Townsend said, citing the difference between a mastectomy – surgical removal of the entire breast – and lumpectomy, which removes the tumor.

Women in rural areas who cannot travel for weeks of radiation treatment will have another option besides a mastectomy, he said.

St. Luke's estimated surgery costs with the new system to be between $15,622 and $37,733, compared to surgery followed by traditional radiation estimated at $51,035.

About 45 to 60 women could use the procedure in its first year, Townsend said.

The state council approved the $1.2 million system last week on a 3-2 vote.

Iowa's certificate of need is designed to prevent costly duplication of medical services.

While under the $1.5 million threshold required to trigger the review, St. Luke's request needed approval because the hospital does not have a certified radiation therapy program.

Mercy's $500,000 MBI system, a diagnostic tool, did not require a certificate of need.

St. Luke's request was opposed by Mercy and Dr. Douglas Duven of the Breast Care Center in Waterloo, who argued against having the technology in a hospital without a radiation oncology department.

Townsend said St. Luke's initially will use doctors from Iowa Health System hospitals in Des Moines or Dubuque and may eventually have its own program.

Dr. Hamed Tewfik of the Iowa City Cancer Treatment Center noted he had introduced Intraoperative Radiation Therapy at University Hospitals and Clinics in the 1980s, but found limited uses.

Mercy cited the health council's 2009 decision against St. Luke's request for approval of a $5.5 million imaging scanner and linear accelerator.

"(T)he Council determined there was not a need for additional radiation therapy equipment in Cedar Rapids," documents filed by Mercy noted. "In fact, the number of radiation therapy treatments provided at Mercy's Hall Radiation Center declined from 2009 to 2010."

Also, Mercy already offers a Mammosite technique that allows women who meet criteria to be treated over five days instead of five to six weeks, the letter said.

"Patients who will be served at St. Luke's will be patients who would otherwise be served at the Hall Radiation Center," which operates at less than 60 percent capacity, Mercy officials noted, adding that the reduction in Mercy patients would increase costs spread over a smaller patient base.

Townsend said the equipment will complement what is already offered in the community and patients would likely go to Mercy for follow-up radiation as needed.

Barb Nervig, administrator of the certificate of need program, said should St. Luke's decide to replace its new system in the future, it could with a linear accelerator, similar to what Mercy already offers.
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