When Dr. Gary Roubin emerged from his Lenox Hill Hospital operating room on a recent Thursday morning, his surgical mask dangling from his neck like a St. Bernard’s brandy barrel, his message was all confidence: The patient was going to survive. Both patients, in fact—the stroke victim who had just received a spanking new stent in his carotid artery, as well as the cardiology department that Dr. Roubin had been hired to revive.
“In all my years of being involved in interventional cardiology in this country, I can’t recall a parallel in a major city or institution where there has been the potential for total collapse of a program,” said Dr. Roubin in his affable Aussie brogue as ambulance sirens wailed beneath his office window. “When I came back [to Lenox Hill], we essentially started with no interventional cardiology program. Now we’re 18 months down the road, and we are targeting over seven and a half thousand cases this year. So I think one very interesting question is: How do you go from zero to seven and a half thousand cases in just 18 months?”
Inquiring medical minds certainly do want to know, since the state of Lenox Hill’s interventional cardiology team has almost as much bearing on the future of the hospital as on patients with sky-high cholesterol counts. But the answer to this question may also complicate Dr. Roubin’s rosy prognosis.
“It’s a tough situation, very competitive,” said a cardiologist at a competing hospital. “Dr. Roubin is renowned … but they are nowhere close to what they were.”
Dr. Roubin is the chairman of the interventional cardiology department at Lenox Hill, the granite-sheathed community hospital planted, paradoxically, in the airy upper 70’s, off Park Avenue. A distinguished cardio-jock who invented the first F.D.A.-approved stent, he was summoned from his Wyoming ranch in late 2004 to do some serious suture work on the department after its famed former head, Dr. Jeffrey Moses, left for the northern pastures of New York–Presbyterian Hospital/Columbia University Medical Center. Columbia finally snagged him after promising to build him his own interventional cardiology center in the sky.
The loss of Dr. Moses was a disabling blow to Lenox Hill. During his 17 years as cardiologist in chief, he had built the department into a world-class heart center as well as a lucrative hospital piggy bank. When he left, he not only took the department’s other top physicians—superstar plaque-busters like Dr. Martin Leon and Dr. Gregg Stone, among others—he tore a hole in Lenox Hill’s already weak balance sheet. Dr. Roubin, who had been part of Dr. Moses’ team in the late 90’s and early 00’s, was brought back to try to plug the hemorrhage.
Just how much the hospital is depending on him can be seen in the most recent bond report issued by Moody’s Investors Service. In the report, which upgraded the hospital’s bonds from junk status (where they had been lingering since early October) to not-so-hot status, Moody’s cited cardiology as one of Lenox Hill’s key strategies for beefing up its fiscal health.
“An aggressive 2006 budget has been set to reduce the operating loss to $21 million and is dependent on increases in interventional cardiology and spine cases,” the Moody’s analysts wrote in their March 13 report (emphasis added).
Translated into non-investor-speak: Dr. Roubin is the lucky Atlas responsible for helping to keep the hospital aloft. Or at least from tumbling further into debt.
In the troubled world of hospital finance, interventional cardiology—the 20-year-old discipline of clearing arteries through non-invasive techniques like balloon angioplasty—is one of the most reliably lucrative of all medical fields. The reimbursements are good, the procedures generally safe, and the patients plentiful. And in a city like New York, with its high quotient of Velveeta-raised baby boomers, there’s an almost endless supply of clogged arteries.
Within this world, the polo-playing Dr. Roubin, like his predecessor, is something of a rock star. One of the first stents bears his name—the Gianturco-Roubin stent—and in the mid-1990’s, he pioneered the idea of applying coronary angioplasty and stenting techniques to the carotid artery as a way of preventing strokes (a stent is a miniature mesh device placed in the artery to keep it from collapsing after angioplasty). His most recent innovation, a tiny parasol-like contraption intended to block clots during carotid angioplasty, was approved by the F.D.A. in September 2005.
“It’s been incredibly challenging,” said the 57-year-old M.D. and Ph.D., referring to the process of rebuilding Lenox Hill’s interventional cardiology department. Dr. Roubin was sitting at the large, cherry-stained desk in his ninth-floor office, surrounded by pictures of his four towheaded tots and just enough awards to be impressive without being ostentatious. His blue eyes looked surprisingly rested—a result, perhaps, of the fact that he no longer has to spend three nights a week on-call, as he did when he first took over at Lenox Hill.
“I don’t think that Columbia-Presbyterian expected that Lenox Hill had a rabbit in their hat, and Lenox Hill didn’t know they had a rabbit in their hat,” he said, smiling. “But the rabbit appeared.”
As evidence of this hat trick, Dr. Roubin cited the team of senior physicians he has recruited to Lenox Hill—including Dr. Kirk Garratt from the Mayo Clinic—as well as the 50 or so patients his team sees on high-volume days and the 7,500 they see per year. More than 3,000 of these patients are ultimately admitted for big-bucks reimbursement procedures like angioplasty, he said.
“That’s a fantastic record,” said Dr. Jay Yadav, an interventional cardiologist and neurologist at the Cleveland Clinic, who pioneered the idea of carotid-artery stenting with Dr. Roubin in the mid-1990’s. Recalling those years when Dr. Roubin headed his team at the University of Alabama at Birmingham, he said, “He was a very good leader. I think he led to a lot of growth; [the department] saw a significant increase in patient volume, publications and clinical research.”
But others aren’t prepared to grant him the same bragging rights on his latest undertaking—at least not yet. Some of his peers from New York’s ultra-competitive cardiology club shrugged off his department’s 3,000 interventions a year, noting that this figure still fell short of the more than 4,000 clocked under Dr. Moses. Others clucked that his decision to recruit experienced senior physicians from far-away institutions may make for a talented team, but it doesn’t necessarily make for a bankable one.
“He had a very interesting philosophy: He brought people who are advanced in their years, [but] who have no draw in New York for patients,” said one medical-world insider. “If he wanted to take people who had been in the field for 20 years, he would have done a lot better taking people from New York who have followings.”
Dr. Moses had still-harsher criticism for the department he used to run in the hospital he once called home. (According to medical-world gossip, Dr. Moses and Dr. Roubin had a falling out several years ago, a claim that Dr. Roubin denied, while Dr. Moses acknowledged friction.)
“They seem to think that by approximating our numbers, they’re replicating the program. I think we were about something else,” Dr. Moses said. “It’s hard for me to imagine how even getting angioplasty numbers up to when we left will get Lenox Hill out of debt.”