On Monday, as he's done 1,500 times before, neurosurgeon Michael Horowitz treated an intracranial aneurysm -- threading a wire through a femoral artery, north through the patient's trunk and neck, then into the brain, stopping at the arterial bulge and leaving behind tiny platinum coils that restrict blood flow and prevent rupture.
So what's makes this surgery special? It was performed in Butler, not in Pittsburgh.
That was partly a matter of contract law. Dr. Horowitz, a recent recruit to Highmark Inc., is barred from practicing in Allegheny County by the non-compete clause enforced by his former employer, UPMC, where he worked for most of two decades. He and two colleagues, Richard Spiro and Pedro Aguilar, came to Highmark's provider wing this year from UPMC to create the Pennsylvania Brain and Spine Institute. All are bound by a non-compete clause.
But the surgery was also a matter of Highmark making good on its promise to keep care in community hospitals when possible -- in this case, at Butler Memorial Hospital.
Highmark Inc., now in the health care business by way of its new Allegheny Health Network and its purchase of West Penn Allegheny Health System, is walking a fine line -- trying to drum up business for its ailing flagship network, while also hoping to maintain friendly relations with suburban and independent hospitals.
Community hospital administrators worry that more patients at WPAHS will mean fewer patients for everyone else, at a time when admissions are dropping universally. It's such a grave concern that the state Department of Insurance, which approved the Highmark-WPAHS affiliation last month, is requiring Highmark to monitor patient levels at community hospitals and take "corrective action" if admissions dip by 10 percent or more in a given year.
Dr. Horowitz says Monday's surgery, the first time it has ever been performed at Butler Memorial, is an indicator that Highmark can prop up WPAHS while keeping care in the community, where it's cheaper.
"It's not a problem doing it [at] a community hospital," he said of the minimally invasive surgical procedure. "If they are elective cases like this one, it's nice being treated near home."
And in emergencies -- such as a burst aneurysm -- having brain services in the community means "they [won't] have to travel by ambulance or helicopter ... Not only does it save a lot of money [on transport,] but you also get treatment faster."
For the swift treatment, JoAnn Galbreath was grateful. Mrs. Galbreath, 63, was admitted to Butler Memorial last week following a dizzy spell and a fall. Doctors initially suspected vertigo, but brain scans soon revealed two aneurysms, the larger of which was treated on Monday by Dr. Horowitz. By the next morning, she was discharged.
"I would always prefer to have it done at home," said the Penn Township woman, who lives about seven miles from the hospital. "It was nice to see the facilities and the procedures done right here in Butler."
In the three months since he switched employers, Dr. Horowitz said he has been impressed with Highmark's build-out of the new brain and spine practice, putting offices in Mars, Butler and McMurray, with surgeries taking place at Butler Memorial and WPAHS's Canonsburg General Hospital.
While those suburban offices are necessitated by the non-compete clause, Dr. Horowitz said he expects that the care will stay close to home even after West Penn Hospital in Bloomfield finishes work on its neurosurgery unit and the doctors are able to practice in Allegheny County again.
The recruitment of some of UPMC's most productive brain and spine surgeons -- Dr. Horowitz was the head of vascular neurosurgery, chief of neurosurgery at UPMC Presbyterian and co-director of UPMC's Center for Endovascular Therapy, while Dr. Spiro was the chief of neurological spine surgery at UPMC and one of the network's highest-paid surgeons, and Dr. Aguilar led the functional pain surgery program at UPMC Passavant -- was a strategically important one for Highmark's health network.
But it was also psychologically important, a small milestone for the upstart health network.
Despite UPMC's massive advantage in terms of employed physicians -- 3,400 or so at last count -- Highmark's recruitment of this trio helps dispel, to whatever small degree, the notion that UPMC is always the first choice.
Or, as a UPMC spokesman said recently, that UPMC "can pick and choose and successfully recruit pretty much any West Penn physician. ... Almost all of UPMC's [physicians] continue to find the concept of leaving one of the nation's top 10 medical institutions to join a corrupt and perpetually mismanaged West Penn Allegheny nonsensical."
Asked what he thought of those remarks, Dr. Horowitz wouldn't take the bait, saying only that he was comfortable with his new employer. "We liked the direction that neurosurgery was going at Highmark," he said. "We're going to be able focus more on patient care ... I've been nothing but impressed."
The Pennsylvania Brain and Spine Institute is housed under Highmark's physician employment wing, now known as the Allegheny Clinic.
Bill Toland: firstname.lastname@example.org or 412-263-2625.