Friday, July 27, 2007

Building Plans

A press release we issued yesterday follows. Story by Jeff Krasner in the Boston Globe today offers more context and details. See my post on May 29 for related commentary.

BETH ISRAEL DEACONESS MEDICAL CENTER UNVEILS
BLUEPRINT FOR GROWTH
Focus is on increased capacity on main campus
and proposed new ambulatory care center to support growing patient needs

BOSTON – Beth Israel Deaconess Medical Center (BIDMC) has begun its long-term plan for growth that envisions increased clinical capacity at its main Longwood Medical Area (LMA) campus and enhanced convenience and access for patients at a new ambulatory care center at a yet-to-be-determined suburban location.

This conceptual blueprint for growth, approved last month by the BIDMC Board of Directors, calls for more private rooms, more operating rooms, new technology and more rational use of space on BIDMC’s main campus in the LMA. The projects, to be carried out over the next 10 to 15 years, will create an estimated 500-700 construction jobs in Boston and ultimately add more than 550,000 square feet of space for patient care.

Over the next year, BIDMC staff will launch more detailed programming, planning and architectural efforts in cooperation with the Boston Redevelopment Authority officials and neighborhood leaders to turn its conceptual blueprint into a specific plan.

Services in the proposed 100,000-150,000 square foot suburban ambulatory care center will likely include primary care and specialist physicians, ambulatory surgery and ancillary services like radiology. BIDMC is about to issue a request for proposal to launch the planning and design process, with a target opening date in 2011. Pending site selection, approvals and permitting, construction of the off-site ambulatory center will begin within the next two years.

This long-term facilities plan reflects BIDMC’s success in recent years in turning around its finances and increasing its volume in the highly competitive Boston health care arena.

"To provide the best care for our patients and our community, we always need to be looking ahead," said Lois Silverman, chair of the BIDMC board. "We are planning for both volume growth and changing patient needs, as well as for advances in technology and clinical practices."

"Our goal is to maximize the limited space available on our campus to create a more rational and convenient medical center for our patients," said Paul Levy, BIDMC’s President and CEO. "We intend to be a model for how care is organized, both physically and clinically."

"The Shapiro Clinic Center will continue to be a vibrant, busy, multi-specialty center of ambulatory care," added Eric Buehrens, BIDMC’s Executive Vice President and Chief Operating Officer. "But we also want to do our part to reduce the traffic and parking burden in the LMA by providing convenient, accessible care for patients living and working in the suburbs."

BIDMC will partner with its physicians’ group, Harvard Medical Faculty Physicians at Beth Israel Deaconess Medical Center, in the development of the suburban ambulatory center.

"Upgrading our facilities is critical to the mission of providing the best care and service to our patients, including convenient access to ambulatory services," said Stuart Rosenberg, MD, HMFP’s President and CEO. "To that end, HMFP has committed to support the jointly developed facilities plan."

The new blueprint analyzed volume trends, assessed existing facilities and analyzed various alternatives for adding the estimated 700,000 square feet of additional space needed for patient care.

Some key features in the plan:

Growth on the west campus will include expansion of the West Clinical Center located at One Deaconess Road and construction of a new building at the site of the current Libby and Deaconess buildings on Pilgrim Road;

BIDMC will continue to concentrate the majority of inpatient beds on the west campus, eventually including maternity services, to improve both operations and access to inpatient services for emergency department patients;

At the same time, the east campus will increasingly house most outpatient and ambulatory services, administrative offices and research labs;

Over time, the medical center will add approximately 130 beds, with an emphasis on creating more private rooms and greater intensive care capacity, reflecting the trend toward caring for sicker patients;

Capacity will be expanded in several other clinical areas, such as in operating rooms and radiology suites. New operating rooms will be larger and capable of handling the increasingly sophisticated technology, including minimally invasive surgical instruments and additional imaging equipment;

The total cost of the 10-15 year plan is expected to be $1 billion.

Projects already underway will not be affected. For example, BIDMC will lease approximately 50 percent of the space after the opening of the Center for Life Sciences, a new research building currently under construction by private developers in the LMA. Also, Beth Israel Deaconess Hospital-Needham, a community hospital affiliated with BIDMC, is currently planning to expand its emergency department, add inpatient rooms and enhance its radiology services.

Beth Israel Deaconess Medical Center is a patient care, teaching and research affiliate of Harvard Medical School, and ranks third in National Institutes of Health funding among independent hospitals nationwide. BIDMC is clinically affiliated with the Joslin Diabetes Center and is a research partner of Dana-Farber/Harvard Cancer Center. BIDMC is the official hospital of the Boston Red Sox. For more information, visit www.bidmc.harvard.edu.

9 comments:

Patient Dave said...

Huzzah. Sign me up to be a loud participating voice on the project's Patient Advisory Board, which I'm sure is a key part of the plan!

(Not kidding, btw... this is something worth doing for the next 10-15 years.)

Paul Levy said...

Noted!

Anonymous said...

Paul;

Congrats, although watch out for NIMBY with your suburban center. This caused our hospital, in its suburban site since 1907, to file papers to move away entirely.

This gives me a chance to ask a question - virtually all of the booming new hospital constructiion nationally has involved private rooms. CEO's say "patients demand them." People like Maggie Mahar the health journalist say insurance companies shouldn't pay for them. Of course, the patients aren't paying. Other than infection control, a marginal "excuse", what reaction are you seeing from the insurers when they are told everything will be private rooms?

Gus S. said...

Be great to see a farmers market in there!

Matt said...

Congratulations on the expansion. How many beds will that be total?

I've recently gotten a crash course in growth planning. So much goes into it, it's amazing. Blueprints and building seem like the easiest of all the steps. Increase in beds trickles down into all service areas, and every department has to justify and say how many new FTE's they will need. I've helped our respiratory department with theirs.

Our facility is growing from 200 to 300 beds, building a new ambulatory surgery center too. We are land locked, so have to build up 2 more floors.

Makes for a truly exciting, and stressful, time at any facility. I'm sure it also puts a mix of new pressures on the CEO as well.

How did you justify the new expansions? Population studies? Capacity issues you've already had?

Barry Carol said...

Given the high cost and capital intensity of any hospital expansion of this type, I wonder what impact it will have on BIDMC's overall cost position and how it squares with your long term strategy to be a low cost provider, at least among AMC's. Are there any meaningful cost savings associated with private rooms besides (hopefully) lower infection rates? Also, if the long term trend in end of life care is likely to be toward more and earlier use of hospice and palliative care, doesn't that suggest there might be less need for ICU beds in the future rather than more?

Anonymous said...

I bet that in a few years I won't be able to recognize the Hospital were I spent the best time of my life (I was a research fellow in Surgery during 1996-1997) and were my second child was born.

¡Felicidades!

Julio M. Mayol MD PhD
juliomayol@gmail.com

Paul Levy said...

Matt, we have 600 beds now, including OB and babies. About 460 med/surg and ICU.

Barry, there is a growth imperative that requires the addition of beds, as noted in my earlier posting. Our business plan shows marginal revenues exceeding marginal costs, hence a good proposition. On an average cost basis, we will still try to be low-cost relative to others.

Private rooms are more flexible in that doubles have (1) a problem when a patient has certain infections (anon 9:00, not a marginal excuse at all) and (2) precludes roommates of opposite gender -- both of which leave bed capcity unavailable. I'm not sure that regulatory requirements yet mandate them for new construction, but they soon will.

We see no dimunition in use of ICU rooms for the types of services we provide, i.e, high acuity tertiary and quarternary care. Hospice beds in our reimbursement environment are not practical.

Y Julio,
muchas gracias!

Anonymous said...

Paul;

Thank you for educating me on the matter of private rooms. Not that I didn't believe you or anything, (: but I googled the issue and discovered that, indeed, the American Institute of Architects, if I am quoting their name correctly, has made private rooms a "standard" in their official guidelines for hospital construction. (see link below)
In addition to the points you made, they cite HIPPA (privacy) concerns, and the decreased potential for medical errors due to patient misidentification. Having witnessed in my area a patient death due to a phlebotomist drawing for the blood bank by bed number rather than actual patient ID (the patients had switched beds so one could have the window); this resonated with me immediately.
Barry, guess we can learn from this. I'll put it on the Health Care Blog so Maggie can learn too.

Interestingly, of all the google citations, not one mentioned cost. Paul, how much more does it cost to contruct private rooms than semiprivate? Presumably these costs are recovered by the advantages cited above.

http://www.aamc.org/newsroom/reporter/june06/patients.htm