‘‘We reviewed what it was going to take to provide the kind of care for this community that it deserved in the next 100 years and concluded that we didn’t have enough space where we were,” he said. ‘‘This community deserves better access than we could create at that particular location.”
Discussions are ongoing about what will become of the Takoma Park campus, with possibilities that include retaining it as a medical facility, Robertson said. The decision to move has sparked concerns from area centers. Last year, the chief executives of Holy Cross Hospital in Silver Spring, Suburban Hospital in Bethesda and Montgomery General Hospital in Olney wrote in a letter to the county that moving Washington Adventist ‘‘will disrupt current care patterns and put key elements of our local safety net at risk.”
In a recent letter to the County Council, Robertson said that rather than focusing on Washington Adventist, the council should conduct a ‘‘county-wide review of health care services.”
One room, one patient
One of the reasons behind the hospitals’ expansions is to convert rooms from semi-private to private ones. Private rooms not only help allay patients’ concerns over privacy but can control the spread of increasingly complex infections, said Neal McKelvey, a senior vice president at Holy Cross. He oversaw that center’s $90 million expansion, completed in 2005.
The private rooms can also improve the use of beds, he said.
‘‘If we have a male patient who needs a bed, but the only beds open are those in semi-private rooms with female patients, then those unused beds continue to go unused since we can’t put a male patient in the same room with a female patient,” McKelvey said. ‘‘If we have all private rooms, that is not an issue.”
Montgomery General Hospital in Olney is in the midst of a $30 million project to transform its rooms into all private ones and add to its emergency center. Shady Grove’s $99 million expansion also includes privatizing rooms and expanding its emergency department.
Suburban Hospital in Bethesda plans to file for a large renovation and expansion project with the county later this summer that will include privatizing rooms.
The new Washington Adventist campus in the White Oak area of Silver Spring — near a planned 2.3 million-square-foot U.S. Food and Drug Administration complex and a proposed 115-acre science and technology office park — is likely to have all private rooms, Robertson said.
Executives at Montgomery General, which has been independent since 1918, also have been speaking with their counterparts at Holy Cross and MedStar Health in Columbia about possibly joining one of those networks. The main reason the 144-bed hospital seeks to merge is so it can become more financially stable and expand in the years ahead, as the community grows, changes and ages, said Lynne Myers, vice president for corporate strategy and professional services.
The hospital’s board should decide by this fall whether to merge or remain independent, Myers said.
Further to go for ERs?
Emergency rooms are often considered the front line of health care systems, where cracks can turn up first.
Montgomery County’s emergency departments saw more patients last year than in 2001, but they have actually become less crowded since treatment capacity has expanded, state figures show.
Still, the county’s emergency rooms have not improved as rapidly as the situation has statewide.
In fact, in a key measurement of emergency room traffic, Montgomery’s annual emergency visits per bed in the five hospitals — 1,358 — was above the statewide average of 1,343 last year, according to state figures. In 2001, Montgomery’s visits per bed — 1,492 — was well below the state average of 1,751.
The county’s hospitals added 43 emergency treatment beds between 2001 and 2006, a 28 percent increase. Meanwhile, emergency rooms statewide added almost 600 beds, a 52 percent jump.
The addition of Adventist HealthCare’s $7.5 million, 21-bed freestanding emergency facility in Germantown a year ago has already helped make Shady Grove’s emergency room less crowded, Robertson said.
The Germantown facility is up to about 2,000 visits monthly after about 1,500 monthly in the first few months. ‘‘It is working the way we thought it would,” Robertson said.
Shady Grove saw the second most emergency room visits last year among Maryland’s 47 general hospitals, behind only Franklin Square Hospital Center in Baltimore. In 2001, Shady Grove ranked fourth in the state; the Rockville center has seen its emergency visits grow by 19 percent since then — higher than the statewide growth.
In emergency visits per bed, Washington Adventist is more crowded — with only 26 beds — than Shady Grove and its 55 beds. It’s clear that more needs to be done, Robertson said.
‘‘We continue to see an increase in uncompensated care,” he said. ‘‘More people need health insurance. We also need to build up the clinic infrastructure so that more people get care in clinics and not the emergency departments.”
Suburban Hospital in Bethesda plans to improve access to the emergency department as part of a proposed expansion, spokeswoman Ronna Borenstein-Levy said.
Suburban gets more than its share of complex cases since it is the county’s primary trauma center, as well as a primary stroke center with a top cardiac program, she said.
Some 26 percent of emergency patients at Suburban last year were admitted to the hospital, well above the statewide average of 18 percent. Suburban’s rate was the highest in Montgomery and fourth highest among hospitals in Maryland.
‘‘We’re seeing more outpatient cases, but the people getting admitted are much sicker,” Borenstein-Levy said.
Bob Deans, a Bethesda resident, said he recently found the wait time and charges better at Shady Grove’s freestanding emergency center in Germantown than at the hospital emergency rooms he has visited.
‘‘I’d like to see us have a freestanding emergency center downcounty,” Deans said.
Dealing with nursing shortage
Nursing and staffing shortages put a different kind of pressure on hospitals. Throughout Maryland, the shortage of nurses is about 6,000 this year and could reach more than 17,000 by 2012 if efforts to reduce those numbers fail, according to state figures. The shortage is sparked by an increase in the elderly who need care, dissatisfaction over salaries and working conditions by nurses who leave the profession and a lack of qualified instructors, experts say.
‘‘There is a great need for more faculty to teach nursing in colleges,” said Nancy Fiedler, senior vice president for communications with the Maryland Hospital Association. ‘‘We’re trying to attract more people from hospitals and other sources to teach.”
Many hospitals also want to increase beds to address a lower-than-average bed ratio, but make compromises with state regulators to reduce the number of beds on a project to obtain the needed state approval, Fiedler said. The state process is designed to make sure that expansions and new hospitals are the most cost-effective approach, she said.
In 1975, the national average was 4.5 hospital beds per 1,000 people, but that declined to 2.7 beds by 2005. The ratio is even lower throughout Maryland and in Montgomery and adjacent counties, according to the Kaiser Family Foundation, a Washington research organization.
Maryland’s bed ratio — 1.8 beds per 1,000 people — is below the national average due largely to strict state regulations, Fiedler said. ‘‘The thinking of regulators is they want to control costs so that there is not a greater capacity than demand,” she said. ‘‘But there appears to be a need to be a little more flexible, especially in high-growth areas.”
Most suburban counties have fairly low bed-to-population ratios, while urban counties have higher ones due to historical trends, patient demand and proximity to medical schools, said Donna Sickler, a research associate with Urgent Matters, a health policy program at George Washington University in Washington.
Fairfax County, Va., Prince George’s County and Frederick County have slightly lower ratios than Montgomery, while Baltimore city and Washington’s ratios are about twice the national average.
‘‘I am not necessarily sure that residents of Montgomery County should be concerned about the relatively low bed-per-capita rate,” Sickler said. ‘‘I think that geographic distribution of these beds is an important issue to focus on.”
Geography also plays a role in Montgomery since the faster-growth areas in the northern portion are farther away from acute-care hospitals.
The bed issue is important in terms of hospitals being able to accommodate a sudden patient increase during emergencies such as major hurricanes, Adventist HealthCare’s Robertson said.
‘‘I would like to see us have enough hospital capacity to handle those emergencies,” he said.
