PROPOSED SURGERY CENTER DEBATED

A new free-standing ambulatory surgery center would make Cape Girardeau's health-care market more competitive with St. Louis and Memphis, said the surgeons who want the state's permission to build it.

A group of at least 19 Cape Girardeau surgeons of varying specialties are investing in the planned $5.6 million Mississippi Valley Surgery Center.

Dr. William Kapp III, an orthopedic surgeon, signed the application for a certificate of need from the state. He serves as president of the investor group's board. The state will review the request at a Sept. 14 hearing in Jefferson City.

The application comes at an inopportune time for Cape Girardeau's two hospitals: The administrators of Southeast Missouri Hospital and St. Francis Medical Center hope to have a decision on a proposed affiliation of their facilities by the beginning of September.

Kapp said neither Cape Girardeau hospital will cut costs enough to compete with larger health-care markets.

"We realize that we've got to be competitive with St. Louis and Memphis, because that's where our competition is," he said.

Local doctors are losing business to St. Louis, because insurance companies get better discounts from hospitals there, Kapp said.

"We're trying to bring back business," he said.

A difference in cost of $100 to $200 between Cape Girardeau and St. Louis "seems to be the mitigating factor to get people to go out of the area," Kapp said.

Dr. August Ritter III, an orthopedic surgeon and Mississippi Valley investor, said the hospitals aren't taking big enough steps to make Cape Girardeau's costs competitive with other markets.

"They're willing to handcuff people from being competitive in a health-care market," Ritter said.

Cape Girardeau's hospital administrators said their charges are comparable with charges at St. Louis hospitals and that is borne out by figures listed in the Missouri Department of Health's Buyers Guides.

Kapp said charges are "irrelevant."

"It's what discounts you're willing to accept" from managed care contracts that count, he said.

Because surgery centers can offer inpatient surgeries less expensively than hospitals, health-care consumers will benefit from lower costs and have more choices available locally for health care, said Kapp.

Kapp and his partners want to build a center with six operating rooms plus areas for rehabilitation and work-hardening.

Cape Girardeau already has three surgery centers with a combined nine operating rooms: Doctors Park Surgery, the Outpatient Surgery Center and HealthSouth Surgery Center of Cape Girardeau.

And the state has given the green light for construction of a fourth surgery center to Silver Springs Surgery Center, LLC, which will specialize in plastic surgery and dental procedures and bring two more operating rooms into the community.

There's room in the market for still more operating rooms, Kapp and his partners said.

The state will determine if there is enough demand for surgical services to warrant building the new surgery center. Mississippi Valley investors said there is.

The basic state formula calls for figuring the need for operating rooms based on the population within a 15-mile radius of the proposed facility. Within that radius, the service population would be 76,528.

But Kapp and his partners used the projected populations for the year 2000 for Cape Girardeau and its surrounding Missouri counties as their extended service area, which brings the service population up to 176,020.

The state said there should be one operating room for every 10,000 people in a service area, which would indicate a need for 17.6 operating rooms in the proposed service area.

Kapp and his partners calculate that with the 11 existing or approved operating rooms -- including the nine already in place at the three surgery centers and the two planned for Silver Springs Surgery Center -- meant there was still a need for 6.6 operating rooms in the area.

Hospital administrators James Sexton of St. Francis Medical Center and James Wente of Southeast Missouri Hospital contended the Mississippi Valley investors' figures were skewed because they didn't include existing operating rooms in the region's hospitals, including 12 at St. Francis and 14 at Southeast.

With those numbers included, Wente and Sexton said, there was a surplus of 21 operating rooms in Cape Girardeau County alone, 20 operating rooms in the 15-mile radius and 23 operating rooms in the extended service area.

Harvey Teitelbaum, a Jefferson City lawyer handling the certificate of need application for Kapp and his partners, said the hospital operating rooms were "irrelevant" because the partners wanted to build a surgery center, not a full-service hospital.

"The state's criterion standards compare apples to apples," Teitelbaum said.

The extra operating rooms would give the community the capacity to handle another 1,500 outpatient surgeries a year, Kapp and his partners said.

In Mississippi Valley's certificate of need application, the partners projected performing 6,032 procedures next year, 6,764 in 2000 and 7,928 in 2001.

Their projected profit over that same time period ranged from $2.7 million next year to nearly $4.1 million in 2001.

The surgery center shouldn't take surgeries away from the two local hospitals, Kapp said, a statement the hospital administrators dispute.

Ritter said the proposed center wouldn't have enough operating rooms to handle all the procedures needed in the region.

"This isn't going to build the capacity to take all the hospitals' volume, either," Ritter said. He planned to spend one day a week operating at each Cape Girardeau hospital if the surgery center opened.

Kapp and his partners said building a surgery center was the most logical option, because none of the existing centers was suitable for the type of surgery they planned to perform, and neither hospital would let them lease blocks of time.

Both hospitals also turned down a chance at joint ownership of the surgery center, Kapp said.

Wente and Sexton said they can't consider an offer to build a surgery center because they were focusing on their proposed merger.

SURGERY CENTER

Mississippi Valley Surgery Center

Projected cost: $5,695,000

Size: 5-acre site, six operating rooms, 24,128 square feet

Services: Outpatient surgery, work-hardening, physical therapy and rehab.

Specialties: Orthopedic; eye; ear, nose and throat; OB/GYN; general surgery

Projected surgeries: 6,032 in 1999; 6,764 in 2000; 7,928 in 2001

Hospital surgeries: St. Francis: 7,739 Southeast: 7,071

Projected profits: $2.7 million in 1999; $4.1 million in 2001

The investors: Bernard Burns, D.O.; Curtis Coonce, M.D.; Tom Critchlow, M.D.; Gordon Eller, M.D.; Marybeth Kapp, M.D.; William Kapp, M.D.; Rickey Lents, M.D.; Todd Lumsden, D.O.; Richard Martin, M.D.; Jacob Pyeatte, M.D.; Nelson Ringer, M.D., August Ritter, M.D.; Raymond Ritter, M.D., Jan Seabaugh, M.D.; William Thorpe, M.D.; Michael Trueblood, M.D.; Ann Behrend Uhls, M.D.; William Wester, M.D.; David Westrich, M.D.