In September, the big news at Baltimore Washington Medical Center (BWMC) in Glen Burnie was the $31 million expansion of the operating room.
Now, what a difference three months can make. On the heels of the upgrade to the operating room, the buzz is now about BWMC’s $5.6 million upgrade to its Tate Cancer Center.
The focus is centered on the Trilogy System, a brand new, state-of-the-art technology that can provide various forms of radiation to a broad spectrum of cancer patients.
The two upgrades are indicative of what needs to happen in community hospitals as the neighborhoods they serve steadily grow around them — especially when the facility has been owned for six years by a large concern with the financial clout of the University of Maryland Medical System.
First Things First
For now, it’s back to early fall, when BWMC unveiled three new operating rooms as part of the $31M expansion, raising its total room count from 14 to 17, plus three more empty shells, “so when we need to expand again in the future, we can do so quickly,” said Joyce Myers, director of perioperative services at the hospital. “We can already see that the demand will be there in the future.”
The new rooms address various needs. One is set up specifically for complex spine surgery, with spinal navigation conducted with new 3-D technology that allows the surgeon to see where s/he is placing the hardware. Another room is designed for minimally invasive surgery, such as oncology, urology and thoracic cases; a third serves as a hybrid. It’s also a minimal invasion room, but also can be used for interventional procedures, such as endovascular procedures.
BWMC also added a new, 30-room surgery center where the patients are admitted and where they rest under additional observation before discharge, plus a new waiting area that can accommodate up to 100 people.
Out of the $31 million price tag, $20 million was targeted for the new addition, with the remainder slated for renovation for existing space, like the waiting area.
“Obviously, the expansion is about adding more operating rooms, but it was also done to add space to the number of complex surgical procedures that we increasingly performing here,” said Myers. “For instance, we’re doing more cases of neurosurgery, vascular surgery, orthopedics, joint replacements and robotic surgery using daVinci Robotics.
“Therefore,” she said, “these rooms are larger and can handle the cases and the various equipment that is needed, depending on the type of surgery performed. And the new technology has increased efficiencies for our surgeons since we have opened the new rooms for the case types that we designated.”
Faster Treatments
The keener focus this month at BWMC is, of course, on the Tate Cancer Center, which has steadily grown since opening in 2003.
“The average number of patients treated per day has steadily increased during the past eight years, so in order to continue to serve our community and to be able to continue to provide the most advanced care possible, the time was right to expand,” said Mary Lanham, the hospital’s director of marketing.
The key addition at the center is the Trilogy System, which allows radiation oncologists to administer traditional radiation therapy in small daily doses during a period of weeks. That’s similar to the existing treatment machine at the center, “but it also has capabilities for more advanced, specialized techniques,” said Lanham.
For instance, Trilogy can deliver radiotherapy doses much faster than conventional treatment machines, which can shorten the length of time for each treatment. In addition, with Trilogy, small lesions can be treated using stereotactic radiosurgery, which is delivered in a single treatment, or with stereotactic body radiation therapy, which is delivered during a period of a few days.
“When you are administering radiation to a cancer patient, you want to be sure that it’s very precise. This equipment makes that possible so it’s not adversely affecting the healthy tissue,” said Lanham.
Wave of Upgrades
To view the large infusion of cash invested at BWMC in proper perspective, Paul Parker, acting director of the center for hospital services for the Maryland Health Care Commission, discussed the typical investment cycles in the hospital industry.
“[UMMS and BWMC] were influenced by availability of capital from lenders, the ability to increase prices and increases in service volume,” said Parker. “From 2003 through 2008, [the industry] went through a boom period of investment driven by strong rate and volume (average patient census) increases.’
The state regulates hospital prices through the Health Services Cost Review Commission (HSCRC), which approved healthy price increases during that five-year period, partly to spur needed investment in aging physical facilities. “Coupled with volume increases, this gave hospitals the revenue to build and modernize, and capital spending took off throughout the state.”
Since 2008, however, the HSCRC has been forced to trim rate increases and volume growth has flattened (or even declined) for many hospital services.
The commission is also implementing policies to reduce inpatient demand by eliminating many one-day hospital stays. This has been done by converting those patients to extended observation patients and by reducing readmissions by others who were recently discharged from the hospital (when such readmissions are linked to poor post-hospitalization management of the patients’ care).
“These factors have greatly reduced the ability of hospitals to invest in new capital resources and many have scaled back spending plans,” said Parker. “Hospitals are now challenged to pay for the capital projects initiated during the last decade with reduced patient volumes and have little excess revenue to invest today in new projects.”
Variety of Factors
Gene Ransom, executive director of Med Chi, the state medical society, in Baltimore, said the changes at BWMC “since the merger have meant incredible capital investment and that has been impressive,” referring to the facility and the staff, as well.
That’s been important, since “that market has changed substantially during the past two decades. More people live [within the expanded drawing area] and the insurance mix has increased [with more people insured].”
Those factors, combined with the merger, are behind the investment. And Ransom also gave a shout-out to an icon of BWMC and its predessor, North Arundel Hospital.
“Jim Walker [the long-time president of the hospital who retired in 2008] did some really good things, notably impletmenting the plan to modernize the hospital before he retired. And Karen Olscamp [his predessor] has carried on that legacy.”
Tim Rider, senior vice president of communications for the Elkridge-based Maryland Hospital Association, echoed what Ransom said about demand.
“This is really about meeting community demand,” said Rider. “The communities created these hospitals and they have grown with them. If you look at facilities like BWMC or Doctors Hospital in Lanham, most of these places are due for renovation, since demand is growing and technology is getting more complex.
To allow themselves to offer their communities the services and technology that people need, the hospitals have to expand,” he said. “Even before the Base Realignment and Closure, the area around Glen Burnie was exploding. The Corridor between Baltimore and Washington has become smaller and smaller.”
“[The trend] is kind of a three-headed monster,” said Rider. “Older facilities that were built in the 1950s and ’60s (as was North Arundel Hospital) need an overhaul, demand is greater and the hospitals offer many more services. Then add the 77 million baby boomers across the country that have started to retire.”
Parker expanded on those observations. “Plus more people, especially with federal health care reform, are insured and will need hospital services. That’s good, because not as many will populate the emergency rooms — at least that’s the plan,” he said. “It’s about getting the right care in the right time at the right place.”
