A month after approving a multimillion-dollar investment in a new radiosurgery program, Erlanger hospital's board of trustees is expected to consider allocating more than $4 million to upgrade another piece of radiation-therapy equipment.
The moves are part of a concerted effort at Erlanger to bolster its cancer program, expand treatment options for patients and reclaim lost market share in the region, board members and physicians say.
"Erlanger needs to improve its image and expand its referral base," said Dr. John McCravey, medical oncologist.
UNIQUE IN THE REGIONThe CyberKnife radiosurgery program at Erlanger will be the only one of its kind within a 100-mile radius of Chattanooga, officials said. Other medical centers in Tennessee with this technology are in Nashville, Knoxville, Memphis and Bristol. That means growth in Erlanger's patient volume from these treatments likely will come either from outside the region or from patients who previously weren't getting treated, said Joe Winick, senior vice president of strategic planning.
A few weeks ago, the hospital agreed to buy the CyberKnife robotic radiosurgery equipment, a noninvasive treatment that can be used for cancers of the body and brain and treat complex tumors previously considered inoperable, cancer specialists said.
In February, Erlanger's board is expected to consider a resolution calling for an investment of more than $4 million in an upgrade of the hospital's linear accelerator, the conventional means of administering radiation for cancer treatments and a key component of the cancer program.
Erlanger officials are hoping that, by expanding their cancer programs, the hospital can increase the number of cancer patients it treats.
In recent years, Erlanger has ceded market share for cancer services to Memorial Hospital, a number of specialists said.
According to statistics that hospitals are required to report annually to the state, in 2008 Erlanger diagnosed and provided the first round of cancer treatments to 548 patients, compared to 1,560 patients diagnosed and treated initially at Memorial Hospital.
The number of patients diagnosed elsewhere who came to Erlanger decreased from 236 in 2007 to 187 last year. At Memorial, the number increased from 220 to 334 last year.
The recent and planned purchases at Erlanger represent a "substantial commitment" to the hospital's cancer program, said board Chairman Dan Quarles.
"We are doing our best to do what we can do to make these programs premier in the region," he said.
board aware
Erlanger trustees said hospital leaders have shared market share statistics with them, but officials said those statistics are considered part of strategic planning and are confidential.
"The board has been aware of this somewhat loss in market share," said Jim Worthington, Erlanger trustee. "While that's not our main mission (growing market share), it is a factor that needs to be considered because we have to find a way to make the income meet the needs" of the hospital.
More than two years ago, the hospital also started a robotic surgery program for minimally invasive surgery.
"Everything we're doing, from our robotics program in urology to upgrading our technology to adding the CyberKnife ... is about us having a first-class cancer program to serve the community," said Joe Winick, senior vice president of strategic planning.
PERCEPTION ISSUE
Losses in market share have nothing to do with the quality of care provided at Erlanger, some doctors said, but rather are rooted in "inappropriate perceptions" among some patients and some physicians.
As the area's safety net hospital, Erlanger treats a disproportionate number of patients who can't pay for their care and absorbs deep losses because of it, Dr. McCravey said. Ironically, that service to the community adversely can affect its image, he said.
"It's easy to say, 'That's where all the poor people go,'" he said. "The community looks at Erlanger as (purely) an indigent hospital, which is not the truth."
Combating that image while coping with financial constraints is a challenge, said Dr. Frank Kimsey, radiation oncologist.
"We don't spend as much of our dollars marketing our program (as other hospitals). We spend our money taking care of folks," he said. "We're working on a shoestring most of the time because of our patient load, and we don't have hundreds of thousands of dollars" to devote to marketing.
The CyberKnife robotic radiosurgery equipment will cost $7.3 million, an expense shared between Erlanger and its project partner Community Care Inc., an ambulatory surgical center development company.
Last month Dr. Kimsey told hospital budget committee members considering the resolution to buy the equipment.
"I think it's going to launch Erlanger into the No. 1 cancer (center) position here in the community," he said.
The equipment features a robotic arm that administers a targeted, high-dose radiation beam to a tumor, while compensating for almost indiscernible motions such as the patient's breathing to stay on target.
In a CyberKnife treatment session, radiation beams are directed at the tumor from various angles to avoid any extended exposure to the tissue surrounding the tumor.
Conventional radiation therapy delivers low-dose radiation over a more generalized area in 30 to 45 treatments over a period of weeks or months.
The CyberKnife's high-dose radiation treatments can be effective in just one to five treatments, Dr. Kimsey said. That means patients usually will be done with radiation treatments within a week and have minimal side effects, he said.
"From a quality-of-life standpoint, anything we're able to do avoid toxicity in cancer treatment is critically important," he said.