Doctors and UnityPoint face off in court over revenue and patient care

A group of central Iowa physicians and one of Iowa’s largest health care providers are facing off in court and accusing each other of being motivated more by money than by patient care.

For the past 25 years, the physicians who make up The Iowa Clinic and the hospital network known as UnityPoint Health-Des Moines have enjoyed a partnership that has resulted The Iowa Clinic’s cardiologists practicing at UnityPoint facilities, including Iowa Methodist Medical Center, Iowa Lutheran Hospital and Methodist West.

Now, the physicians and UnityPoint are at war over a proposed set of cardiac catheterization labs, with each side claiming the other will be putting patients at risk for the sake of their bottom line.

The battle lines were drawn last summer, when The Iowa Clinic filed an application with the state for a “certificate of need” for two new, state-of-the-art cardiac catheterization labs that would be used to help diagnose and treat heart disease within the clinic’s existing ambulatory surgical center, or ASC.

Certificates of need are issued by the Iowa Department of Public Health and State Health Facilities Council as a part of a regulatory review process that requires prospective health care providers to obtain state approval before developing a new or expanded institutional health service. The applications for certificates are reviewed by IDPH staff and the council to ensure that an existing medical need in the community will be met by the proposed project.

Although hospital-based cardiac catheterization is currently offered in Des Moines at MercyOne, Iowa Methodist Medical Center and the Iowa Lutheran hospitals, the doctors at The Iowa Clinic argued that cardiac catheterization performed at their West Des Moines clinic or a similar surgical center, rather than a hospital,  would serve patients more effectively and at a lower cost.

UnityPoint-Des Moines opposed the project, citing a recent decline in case volume, an excess capacity for providing cardiac catheterization services, as well as the expected revenue shift from nonprofit hospitals to a for-profit enterprise owned by the physicians.

Last December, the council voted 3-1 to approve surgical center’s application, noting that the Centers for Medicare and Medicaid Services has recognized that low-risk cardiac catheterization procedures can be performed safely in an ambulatory surgery center, resulting in lower costs and improved patient convenience.

Lawsuit challenges state’s decision to allow new labs

The council then denied UnityPoint’s request for a rehearing. UnityPoint is now suing the Iowa Department of Public Health and the council, seeking not only judicial review of the council’s rehearing denial, but a ruling that states the certificate of need should never have been issued.

In recently filed court papers, lawyers for UnityPoint took issue with The Iowa Clinic’s motives, stating the doctors’ decision to build the new labs “to perform the same procedures on the same patients but in their own facility (was made) so they can reap the benefits.”

UnityPoint also raised questions of safety, arguing that lab patients “in the midst of a cardiac emergency would have care transferred to an entirely new care team” at a separate medical facility, adding “unnecessary time and delays to access to treatment.”

Lawyers for The Iowa Clinic’s physicians then accused UnityPoint of “attempting to shock by suggesting The Iowa Clinic’s project puts patients at risk. This offensive notion obscures (UnityPoint’s) obvious focus on its bottom line rather than what is best for patients … The council recognized The Iowa Clinic’s project would permit Iowa to get with the times rather than wait for years to pass, depriving patients of an ambulatory surgical center option for no good reason.”

Lawyers for UnityPoint countered that the proposed facility would be the first in Iowa “to perform these procedures outside of a hospital facility and thus lacking 24-hour, 7-days-per-week availability. These emergency services are necessary because complications can arise in these procedures, even when a patient is closely screened for an outpatient procedure.”

Lawyers for the state have also weighed in, arguing that the proposed cardiac catheterization procedures will be “scheduled in advance and performed on lower-risk patients.” IDPH lawyers say that “while UnityPoint attempts to question the safety of these procedures, it is undisputed that the Centers for Medicare and Medicaid Services, Wellmark, other insurance providers, and the American College of Cardiology, have uniformly concluded that these procedures may be safely performed in an ASC setting.”

The state, UnityPoint and The Iowa Clinic have each submitted their arguments to a Polk County judge who has yet to rule in the case.

The Iowa Clinic is the largest physician-owned, multispecialty group in central Iowa with more than 250 doctors and health care providers practicing in more than 40 specialties and handling an average of 650,000 patient visits per year. The physicians of The Iowa Clinic have privileges at both central Iowa hospital system, UnityPoint Health and MercyOne.

The primary service area for the lab project is an 11-county area in central Iowa. In 2019, The Iowa Clinic had over 54,000 patient visits resulting in cardiology services.