By MICHAEL MOORE of the Missoulian | Posted: Saturday, October 10, 2009 11:30 pm
Lately, it's been just about impossible to thumb through the newspaper without seeing advertisements targeting women from Missoula's two hospitals.
Both hospitals now have centers that cater to women. But there's more than just a desire to better serve women beneath those ads.
"It's pretty simple," said Jeff Fee, chief executive officer of St. Patrick Hospital. "Women are the chief decision-makers when it comes to health care. They are more prone to seek medical care, and their decision seems to guide the rest of the family's choices where health care is concerned."
It follows, then, that St. Pat's and Community Medical Center are going to compete for women's health care business.
"I would think you'll continue to see an effort on both hospitals' part to capture the majority of that market," said Gregg Davis, director of health care industry research at the Bureau of Business and Economic Research at the University of Montana. "This is the part of the business where choice is critical, so if you bring the women in the door, you bring the men and children along at the same time."
Steve Carlson, CEO at Community, simply termed care for women as "one of the places where you are going to see the hospitals compete. I think that's good for the community in this particular area. I think it serves the consumer."
But does competition between the hospitals always serve the community?
Not really. Which is part of why the hospitals collaborate in some areas and compete in others.
"It's a fine line on competition," said Davis. "Sometimes competition brings a better level of service at a better price. But sometimes, particularly in a market like Missoula, competition doesn't serve anyone. It doesn't help the hospitals financially and it hurts the consumer because the level of service declines."
NASCAR driver Darrell Waltrip is often given credit for coining the term "coopitition," but these days it's mostly the province of marketing.
Coopitition is exactly what it sounds like - a combination of cooperation and competition.
And it's the perfect description of the way Fee and Carlson view the relationship between Missoula's hospitals.
"Obviously, we don't share ownership, so there are areas where we have to compete and that's just fine," said Carlson. "There are areas where competition can lead to better service."
In Missoula, two high-profile health care arenas highlight how the exact opposite could be true: open-heart surgery and babies.
The first is the province of St. Pat's, the second the domain of Community.
Although Community does cardiology, St. Pat's is really known for its work on hearts. It houses the International Heart Institute, which has earned the hospital both national and international acclaim.
Open-heart surgery is a highly specialized field, one that requires both past and ongoing experience for doctors to stay at the top performance level.
But the number of open-heart surgeries required in western Montana only totals about 300 per year. If the hospitals split those cases, it's likely that both service and outcomes would suffer.
"You have to have a certain level of infrastructure to support an open-heart program," Carlson said. "You also have to have surgeons doing enough work so that they stay sharp. If you split this pie, we'd dilute the pool of patients, and more importantly, we'd probably dilute the skill level of doctors because they wouldn't have enough cases."
Fee says it also becomes difficult to recruit surgeons if their practices aren't going to be sufficiently robust.
"We want the best people here, and if we have a program that doesn't keep them at the top of their games, they won't come here," he said.
A similar dynamic is at work in obstetrics, the business of delivering babies and taking care of mothers.
When Fee came to Missoula in August 2006, St. Pat's was on the verge of opening an obstetrics program.
But as Fee started looking at the proposed program, it didn't really make sense. For one thing, the population of women of child-bearing age was barely growing.
"That meant it would have been a purely competitive play," Fee said. "We were also hearing from the community that people wanted the hospitals to work more closely together."
Fee also found little support among doctors for the move. He also felt that if it added obstetrics, St. Pat's also would need a neonatal intensive care unit, which Community already had.
"In the case of docs who deal with high-risk babies, you can make the case that they won't be as proficient if they aren't seeing a reasonable number of cases," Fee said. "You don't want to over-saturate the market with that kind of doctor."
In the end, St. Pat's backed away from its plan, a move that pleased Carlson.
"Both programs would be marginalized if both hospitals did a NICU," Carlson said. "That would have been bad for us, obviously, but it would have also been bad for western Montana, and that's probably an even more important reason."
There's probably no more recognizable symbol of St. Patrick Hospital than the Life Flight Helicopter. It's been around since 1981.
"I think that the helicopter is something people think about when they think of St. Pat's," Fee said.
In 2005, Community started its own helicopter service, and officials then noted it was part of the hospital's long-term plans for growth.
Carlson, who wasn't in Missoula at the time, said the hospital also needed a helicopter to transport the isolettes used to ferry children bound for the hospital's NICU.
"At the time, St. Pat's helicopter couldn't carry those," Carlson said.
The helicopters are now dispatched on a rotating basis for 9-1-1 calls, and Fee said the Community chopper has definitely cut into Life Flight's role.
Now, however, Carlson said the Community helicopter barely pencils out financially, and he'd be willing to look at a flight program that worked for both hospitals.
"We would be open to a discussion about a third-party flight operator who could work for both hospitals," Carlson said. "We just need a way to make sure we have our patients transported in the best possible way."
Fee isn't interested in a third-party chopper system.
"If you look at what the patient pays for a third-party system, it's more expensive," he said. "Having a combined air program might be the right thing, but third-party is not the right way to pay for it."
Besides, Fee said, Life Flight is too symbolic.
"It's part of who we are," he said. "To give that up, I don't see it happening. It's just too central to our mission."
Gregg Davis said competition will likely always be a force in the relationship between St. Pat's and Community.
"There have been some studies that suggested the competition has led to a sort of medical arms race, with everyone trying to be everything to all people," Davis said. "But the preponderance of the evidence shows competition to mostly be a good thing. For the most part, it results in better availability, better prices and better services."
Still, Davis said, for a market like Missoula, some services are probably best left to one hospital or the other. And the hospitals are also better off looking at ways they can collaborate in some areas.
The two hospitals currently have a joint home-health program, and they've also recently merged their laundry services.
"Steve and I talked about that and we figured if we couldn't come up with a way to do laundry together, we were probably going to have a hard time agreeing on anything else," Fee said with a laugh. "So we figured it out, and now we're doing all the laundry at our facility."
Fee and Carlson try to sit down at least once a month for breakfast and a chat.
They always find agreement, even when it's just agreeing to disagree.
"There are going to be areas where we need to compete, and that's just the nature of the business," said Carlson. "I do think Jeff and I try to do what's right for the community in additional to doing what's right for our institutions."
At an economic forum last week, Larry Swanson, director of the O'Connor Center for the Rocky Mountain West, said Missoula was blessed to have two hospitals as highly skilled and qualified as St. Pat's and Community.
Fee and Carlson understand that, and know part of that quality is buoyed by competition, while another part comes with collaboration.
That's "coopitition," and Missoula seems destined for it where its hospitals are concerned.
"I think that's a workable strategy for both hospitals, but we need to be working on economic development issues here in Missoula, because there are some threats to our client base out there now," said Fee. "That's a competition that's not St. Pat's and Community. That's Missoula versus the rest of the region."
For both hospitals, about 50 percent of patients come from outside Missoula County. Now, as hospitals in Kalispell, Whitefish and Hamilton better market themselves, that flow of business to Missoula could slow.
"What we're likely to find through that is that the pool may get smaller," said Fee. "And that means we really need to sell Missoula. If we don't grow, you'll likely see more competition instead of less."
Reporter Michael Moore can be reached at 523-5252 or by e-mail at mmoore@missoulian.com.