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Hospitals are getting treatmentAmanda Kramer
First, it was a cramped emergency room. The busy Fort Atkinson ER, designed to handle about 12,000 visits a year, was getting close to 20,000 visits a year. Then, officials began picking up on other clues - small patient rooms and an inefficient pediatrics unit, for example. "Everything was designed back in 1969," explained Fort Memorial Vice President and Chief Financial Officer Jim Nelson. "The way we care for patients today and the way it was designed is very different." In the nonprivate suites, Nelson said, staff seemed to be using up more and more time trying to match appropriate roommates - boys with boys, girls with girls, diseases with diseases. "There was just a lot of time and energy spent moving patients," he recalled. So, the hospital began an initiative to build a bigger facility - a 96,000-square-foot expansion that would allow it to catch up with the latest technology and offer more patient privacy when it was finished this past December. Fort Memorial is not alone in its concerns, or its actions. In fact, many hospitals in the nine-county Capital Region are finding that improved technology and greater patient demand have left them no option but to start building bigger and better facilities. And some experts say it's a trend that will impact disease diagnosis and health-care economics for some time to come. National boom Nearly a dozen hospitals in cities from Watertown to Baraboo have taken on extensive expansion or renovation projects. According to the Wisconsin Hospital Association, the building boom is happening for several reasons. First, WHA Senior Vice President George Quinn said, there's a projected need for more beds to accommodate Wisconsin's aging population. Second, creating facilities for more outpatient care is becoming critical. Procedures like breast biopsies, heart catheterizations and angioplasties, which once required a several-day hospital stay, can now be done in a one-day or even hourlong visit. Also, Quinn said, the number of emergency room visits has increased over the last five to six years, spurring a need for larger workspaces. "Some of that (visit increases) has to do with the rise of the uninsured," Quinn said. "A lot of it has to do with the fact that ER's are accessible and recognized in the community as available. ER's have become much more sophisticated in being able to provide services." Rick Wade, senior vice president for the American Hospital Association in Washing-ton, D.C., said hospital expansions in this area are representative of what's happening around the country. He explained a large part of the current building boom ties in closely with events that occurred during the World War II era; Congress adopted the Hill-Burton Act in 1946 to help more communities open their own hospitals. A large number were built in communities across the country during the 1940s, and were revamped in the 1970s and '80s. Now, he said, those hospitals are simply wearing out. "For the 2010 world, they're not configured properly anymore," Wade said of many of today's hospitals. "They're tough on the worker and they're tough on our patients." The hospital rooms of yesteryear look nothing like the technologically savvy, single-patient rooms of today, Wade said. Driven by the Health Insurance Portability and Accountability Act (HIPAA), hospitals are making sure rooms stay private. Although the act doesn't mandate private rooms, many administrators feel they are necessary to insure the level of privacy the act requires. The push is allowing for single-patient rooms that accommodate more visitors and family members, which can help patients recover faster. And, Wade said, the growth also makes room for greater diagnostic equipment and computers near the bedside, a plus for nurses who once had to keep running back and forth to the nurses station to read critical test results or monitors. Paying the piper With all the expansion in the Capital Region and across the nation, will there be a significant impact on health-care costs for consumers? The answer is intricate, and both economists and medical professionals have strong opinions. "There is no free lunch," said David Vanness, a UW-Madison assistant professor of population health sciences. "Unless the expansion, additions ... reduce the average cost of care (possibly, but very unlikely), then either hospital reimbursement will remain fixed and hospital profit margins will decrease, or hospitals will demand greater payment from insurers." Vanness said it is unlikely that hospitals would undertake expansions unless they expected profit margins to be maintained or increased. He said if hospitals are successful at increasing payments for their services, then either insurers will pass on those costs to individuals and businesses, or they'll absorb them through lower profits. "In the short run, this depends on competition in the insurance market which is very difficult to predict ... insurers go through 'premium cycles' of alternating attempts to increase premiums and grab profits," Vanness said. "In the long run, however, eventually someone will have to pay for the additional cost of medical care. In the employer-sponsored insurance market, those costs eventually get passed on to workers as higher premium contributions or slower wage growth. In the individual market, long-run average premiums eventually increase." Dr. Carl Getto, senior vice president for medical affairs at UW Hospital, said the cost of much of the building that is occurring is being amortized over 30 and 40 years. And that, he said, makes it less likely that patients are going to see spikes in their health-care costs. Instead, Getto said, the real impetus for higher insurance costs rests with the use of new technology. "Right now the two big drivers are imaging and pharmaceuticals," Getto said. "When you're looking at the cost of building ... that's negligible compared to the pharmaceuticals." Up or out? The view from one of the top floors at Madison's St. Mary's Hospital looking across at the growing UW campus is breathtaking. Quaint neighborhoods, the buzz of Park Street and the waterfront sit right next to an expanse of dirt, trucks and steel that will eventually become St. Mary's latest patient care facility and parking garage. Sharon McCabe has a comfortable view of the work; her house is nestled on Emerald Street between Mills and Orchard streets, close to the action. As a real estate professional, lecturer at UW-Madison and neighborhood resident, McCabe has a vested interest in the growing hospital. So much so that over the past several years, she has been involved with St. Mary's Neighborhood Advisory Committee, a group that was formed in 2002 to discuss the construction project. McCabe said she wasn't too worried about the effect of the massive expansion, which is blocking a significant amount of space along Park Street. However, she listened as her concerns and the concerns of others were incorporated into the hospital's planning process. "My neighborhood was worried about the traffic," she said. "I wasn't too worried about height, but some of the other people were ... St. Mary's needed to expand and the question was were they going to go up or go out? And most people didn't want a mega-story hospital." St. Mary's President Frank Byrne said they've tried to keep others in mind. "We've been conservative," Byrne said. "Everything's been done gradually. Everything's been done responsibly." He said that the expansions in this area have very little to do with competition between the major Madison hospitals: Meriter, St. Mary's and UW. Instead, Byrne said, his hospital is simply "catching up" with demand and changing technology. Some other hospitals, however, tell a different story. James Shulkin, director of planning and marketing development for Fort Memorial, said that hospital did bow to some competition in one area. Obstetrics units, he explained, can be big business. Prospective mothers and fathers now often have the ability to choose among various hospital birth wards. As a result, Shulkin said, Fort Memorial officials listened hard to others when they built their "Great Expectations Birthing Center." "We paid special attention to the design," he said. "The rooms have all the amenities. They're very large, with a private bath." A new mother, like in many newer facilities, now has the chance to stay in the same room for labor, delivery and postpartum recovery at Fort Memorial. And much like a hotel, hospital obstetric facilities in places like Madison and Fort Atkinson have worked hard to create private spaces where family members can spend the night and help new mothers adjust. Stoughton Hospital, a smaller facility that is responding to growing patient demand on the outskirts of Madison, is also adding space to keep up with the changing times. President Terry Brenny explained that the 35-patient licensed facility previously had a mobile MRI station coming several times a week to the hospital. The station would block the ER entrance, creating a problem for incoming visitors. So the hospital has begun construction on an MRI addition to be completed in 2007. The addition will not only improve traffic flow for vehicles that need to come through but also serve more patients who require the diagnostic test. "With our aging population and more astute customers, society expects hospitals to stay abreast of quality," Brenny said. 'Efficiency, safety, privacy' For Mike Wallace, Fort Memorial's new president and CEO, his move from Trinity Medical Center in the Quad Cities, where he was vice president of operations, was a complicated one. But the expansion efforts caught his eye as he was looking at a move to Fort Atkinson. "It spoke volumes about how well this organization performs historically, as well as being mindful and positioning itself for the future," Wallace said. He said the projects undertaken by Capital Region hospitals are by no means "a phenomenon in Wisconsin." "Health care has changed a lot. Look back at pictures of hospitals where people were admitted to a ward," he said. "The technology and advancements have changed. There are different procedures." "I think we've recently tried to accommodate the progression of that," he continued. "Efficiency, safety, privacy is really driving a lot of this; it's a whole different experience now for patients." kramer.news@gmail.com madison.com ©2009 Capital Newspapers. All rights reserved. |
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