It started, more or less, with a cup of coffee after a movie, but quickly grew into a project that will mean a $15 million building project and 120 additional staff members for Sinai Hospital.
Dr. Jerome Reichmister, Sinai's chief of orthopedic surgery, chatted over coffee with Dr. Dror Paley, an orthopedic surgeon specializing in the exotic field of limb lengthening, after both had seen "American Beauty."
More conversations followed, with Paley and his co-director, Dr. John E. Herzenberg, eventually agreeing to move their Maryland Center for Limb Lengthening and Reconstruction to Sinai from Kernan Hospital, part of the University of Maryland Medical System.
Dr. Michael Mont, a joint replacement and preservation specialist from Good Samaritan Hospital, joined Sinai as well, and he, Paley and Herzenberg will lead Sinai's new Institute of Advanced Orthopedics.
To house the institute, construction was started recently on a four-story addition to the hospital, which will include five operating rooms, 18 private patient rooms - including two "VIP suites" - and a therapy pool. It is scheduled to be finished in July, when Paley and Herzenberg arrive. Sinai, which has about 3,000 employees, expects to add 120 nurses, physical therapists, receptionists and others to staff the expanded program.
The project shows how orthopedics - the medicine of bones and joints - has become an area of keen competition among hospitals. As the population ages and as technology changes, orthopedic procedures are increasing. For example, the number of total knee replacements nationally doubled, from 129,000 in 1990 to 266,000 in 1998, according to the American Academy of Orthopaedic Surgeons. About three-quarters of those knee replacements occurred on patients older than 65.
"Orthopedics is as competitive as any other major area of health in the Baltimore market, such as cardiology and oncology," said Laurence M. Merlis, president and chief executive officer of Greater Baltimore Medical Center, which did 438 joint replacement surgeries in the fiscal year ending in June. "Hospitals are trying to grow their business and differentiate themselves in the market."
At a time when HMOs continue to push many types of care to outpatient settings, orthopedics "is inpatient-oriented," and "it's important to keep the beds full," said Warren Green, chief executive officer of LifeBridge Health, Sinai's parent. "If I had every dermatologist in Maryland in my medical office building, it wouldn't fill a single bed."
Sinai decided about five years ago to beef up its orthopedic program. "What we did is define the components of an orthopedic product line, and look at what we needed to fill in," said Neil M. Meltzer, president of Sinai.
Also, the hospital considered "how we could create something that was different from other hospitals," Reichmister said. "We were looking not only to take care of bread and butter orthopedics. We wanted to emphasize joint replacement, sports medicine and pediatric orthopedics."
Said Green: "We're interested in becoming a center of excellence." When the opportunity came to recruit Dr. Paley, he said, Sinai accelerated its plans to develop the program and to construct the new wing. "What we're building is in part for him, but only in part," he said.
The more high-level orthopedists Sinai has, the more it can attract. "We do have our eyes and ears open," Reichmister said. "There are some other people talking to us. They like the new facility, and what's been happening over the past five years."
Paley and his colleagues correct twisted or stunted limbs, often breaking bones and fitting limbs with scaffolding-like devices that allow them to be stretched gradually. He and Hertzenberg have published enough papers, presented enough lectures and conducted enough seminars that each has a resume running to about 60 pages.
Paley said he and his associates had been quite happy with Kernan and the University of Maryland system. "We didn't want to go anywhere," he said. "Sinai, to their credit, approached us and created an opportunity that was hard to turn down, a chance to work in an environment we could design and create from the ground up."
Also appealing about Sinai, he said, was the opportunity to continue teaching and research. "Universities typically have been the place for that to get done," Paley said, "but we are no less academic because we will no longer be based at a university."
For Sinai, it certainly doesn't hurt to have doctors producing the type of research usually done at universities. "I wouldn't say it's changing the image of Sinai, but it's contributing to setting us apart," Green said, to showing that Sinai has "university sophistication."
Green said Sinai will be doing some marketing of its expanded services, but not so much of the kind of direct-to-consumer advertising on television and other media that Sinai used, successfully, to boost its market share for its new emergency room. Rather, he said, efforts would be directed more at getting the word out to doctors who refer patients for orthopedic surgery.
"The more esoteric the surgery, the more professionally directed the marketing," Green said. "You're not going to see any billboards for limb-lengthening."
