Fancy Cardio-Care Finally Comes to N.Y.’s Hospitals

In a city like New York, where hospital administration often seems like a kind of competitive sport, there is perhaps no such thing as a low-impact hospital ceremony. But the groundbreaking for New York–Presbyterian’s new Vivian and Seymour Milstein Family Heart Center last Thursday was an eye-popper even by these standards. There were doctors and donors, women in spring bonnets, a white canopied wedding tent and, yes, even a former President.

“I am particularly honored to be here for this official groundbreaking today,” said Bill Clinton, looking trim, if a bit orange, as he stood in a gussied-up lounge at the hospital’s Columbia University Medical Center campus. Mr. Clinton became the hospital’s most famous heart patient in 2004, when he underwent a quadruple bypass there, and he is now the honorary chair of the heart center’s steering committee.

“I’m always reluctant to come back, however,” he said, “for fear that I would somehow miss one of the items on [Dr.] Schwartz’s checklist and be dragooned into feeling guilty. I confess I ate a bran muffin this morning, but it was low-fat.”

The audience erupted into eager laughter, while the hospital’s president and C.E.O., Dr. Herbert Pardes, looked on with arm-folded satisfaction.

Dr. Pardes had lots of reasons to look pleased. Throughout the past few years, New York–Presbyterian has been working to transform its cardiology program from a major local center with some national appeal into a medical “destination.” (The poaching of Lenox Hill Hospital’s star interventional-cardiology team in September 2004 is widely viewed as the hospital’s first big push in this direction.)

Now, within the space of a few hours, Dr. Pardes had broken ground on a $200 million cardiology palace designed by I.M. Pei’s architecture firm, announced a $50 million donation from the Milstein clan to build it, and watched the former President of the United States endorse the project. In the life of a hospital president, this a bit like hitting the Trifecta, the kind of image-burnishing jackpot that would make most medical-department chiefs and administrator types weep with envy.

And perhaps some of them did.

In recent months and years, some of the city’s top medical institutions have begun embarking on institutes, centers, wings and departments, all dedicated to cardiology, ushering in a “new era in medicine,” as Mr. Pardes called it. At New York University, plans are already taking shape for a new cardiovascular institute that will be completed in the next four to seven years. And on May 5, Mount Sinai Hospital will inaugurate Mount Sinai Heart, a semi-autonomous institute that will feature new doctors, clinical initiatives and research programs—as well as Oscar de la Renta uniforms for the whole staff. (But no new building.)

“I have been carrying this in my blood since I left [the] Mayo [Clinic] years ago,” said Dr. Valentin Fuster, the director of Mount Sinai’s Cardiovascular Institute and its Center for Cardiovascular Health. “I have now the possibility to develop something very unique in New York City. Our goal is to really be one of the five in the world, and maybe one of two or three in this country.”

As an added bonus, Dr. Fuster said, Mount Sinai Heart will be “an economic center”—a fact that cannot help but appeal to cash-strapped Mount Sinai.

The reason for all these grand cardiology plans is a matter of some debate. Certainly, one of the enduring mysteries of New York medical life is that, while the city is home to some brilliant doctors and a surplus of ailing hearts, it has not managed to cultivate the kind of world-class heart program that has made, say, the Cleveland Clinic a household name (at least among hypochondriacs). But some wonder whether the designer buildings and glittering new centers will really turn New York into a cardio-destination, or whether these big plans are just a case of bluster and competition gone berserk.

To listen to the doctors, the current cardio-boom is a legitimate undertaking, an altruistic phenomenon born of that old Hippocratic desire to save lives and heal the sick.

“Our intention is very simple: We want all the people in New York to have the best care,” said Dr. Pardes, speaking to The Observer several days after the groundbreaking. “You [shouldn’t] have to go to Cleveland, Rochester, Minn., Boston or Baltimore. You should be able to get it here …. Why shouldn’t New York have health-care centers every bit as good as those of the best in the country?”

At the same time, the medical landscape has changed. While “cardiologist” used to be a catch-all phrase for a physician who worked with the heart, the profession is now full of rigorously specialized professionals—interventional cardiologists, cardiothoracic surgeons, nuclear cardiologists and so on—who must somehow be merged into a functioning whole.

“I think that the institutions that don’t think along these lines,” said N.Y.U.’s chairman of cardiothoracic surgery, Dr. Stephen Colvin, referring to the creation of integrated cardiology centers, “are gradually lagging behind a bit.”

But not everyone is convinced. For all the cheerleaders, there are also skeptics who wonder whether de la Renta duds and landmark buildings are really essential to sound cardio-care—or whether the current cardio-boom is actually about status, reimbursement rates and the desire to bolster one of medicine’s few money-making disciplines.

“It is an arms race, or the hospital version of an arms race, and it has nothing to do with the profession,” said a hospital-world insider who asked not to be identified. “It’s a good selling point to major donors, and it supposedly concentrates your faculty and your professional staff in one location. It adds some positive value, but you could do that on two or three floors of a facility—you don’t need a freestanding building.”

A number of doctors and administrators pshawed this idea of competition gone awry. Instead, when asked, they insisted that they don’t look over their shoulders—or rather, if they do, it is only to engage in the kind of “healthy” competition that “makes the whole field stronger.”

“There’s natural competition,” said Dr. Pardes. “But you know, there’s 20 million people who live in this area. So unfortunately, there’s a lot of activity for all of us.”

Still, the endorsement of a former President doesn’t hurt.