‘The Hospital of the Future’

A major construction project can take years between blueprint and ribbon-cutting, and that poses a problem in the fast-paced world of health care, where technology, patient needs, and treatment techniques can change dramatically in a short time period. That’s why the most crucial element of Baystate Medical Center’s new, $259 million expansion project may be accurately predicting the health care landscape in Western Mass. a decade or more down the road — and it’s also why Baystate has dubbed the project ‘the hospital of the future.’

There was a time in health care, says Mark Tolosky, when a person’s first major hospitalization was often the last. But those days are long gone.

“Today, our medical processes are better, and people are living rather active lives,” said Tolosky, president and CEO of Baystate Medical Center. “Because of that, people can expect to have multiple hospitalizations, not just one.”

With that in mind, and with an eye toward a population that’s aging faster than it’s growing, Baystate has announced its first major expansion since the 1980s, a 599,100-square-foot construction project it’s calling “the hospital of the future.”

The $259 million endeavor will replace some of the hospital’s older facilities with new, state-of-the-art patient-care areas that officials say will directly address the needs of an aging population.

“It’s primarily based on the need to replace our aging East Wing,” said Trish Hannon, the hospital’s COO. That wing is part of the Springfield building, the oldest on the Baystate campus, and no longer reflects the standard of care required by 21st-century health care facilities.

“The East Wing is completely outdated for today’s care — double rooms, small square footage,” Tolosky said. “Even our operating rooms, which were updated in 1986, were probably designed in the early 1980s, so they’re coming up on 25 or 30 years. They just can’t accommodate the staff, technology, and equipment for what we’re doing today.”

In this issue, BusinessWest examines how Baystate’s latest effort strives to meet those current needs — and future concerns as well.

Doing the Math

Considering how much hospital care has changed over the past two decades, projecting what the next 20 or 30 years will bring is a tricky business — but a necessary task nonetheless, Tolosky said.

“We’ve projected out the rate of utilization and the population numbers, and we’re able to foresee this many operative procedures, this many beds, this much imaging, this much cardiac interventional work,” he said. “The modeling is not an absolutely scientific process, but we have to do something.”

Based on those projections, Baystate is looking at a new, multi-story building connected to existing facilities on Springfield Street and Medical Center Drive — one that replaces and expands current medical/surgical, intensive care, and inpatient cardiovascular procedure areas, while relocating critical-care beds currently located in the outdated East Wing. That wing will be converted into administrative and non-clinical support services space.

Hannon said that, although the exact cost breakdown will be determined as part of an ongoing planning process, the health system will likely fund the $259 million project mainly with debt financing, as well as through equity and some fundraising activity. “We anticipate that we’ll finance approximately $180 million to $200 million in 2009 in order for construction to begin,” she said.

Although the numbers are large, Hannon noted that, once they’re adjusted for inflation, the Centennial building project in the 1980s was a comparable undertaking. And it’s noteworthy that Baystate is using the term “phase 1” when discussing the expansion, she said, because large regional hospitals constantly need to look to the future.

“Most institutions of our size have a master planning process that occurs every few years to be sure the facilities that support patient care are sufficient,” she said, noting that the current plan started to take shape in late 2005. “This is the result of our long-term master facilities plan.”

She said Baystate is “stretched to its limits” in its current environment, a situation that has manifested itself in a shortage of beds, an overcrowded Emergency Department, and a lack of procedure and recovery space — all of which create delays in patient care.

Not that Baystate is in uncharted waters. Hannon noted that Baystate’s plans mirror a nationwide need for hospitals to update their facilities, many of which were constructed or last upgraded in the 1950s. It’s a priority that has only been exacerbated by the aging-population trend.

Specifically, it has long been noted in health care that the graying of the Baby Boomers, the first of whom are now entering their 60s, will soon create a need for much more inpatient care, staffing, and technology than many hospitals have the capacity to deliver.

In many ways, analysts say, the medical industry has become a victim of its own success. Advances in medications and equipment have made it possible to live longer with chronic health conditions. Concurrently, with advanced age come increased incidences of cardiovascular disease, cancer, and neurological disease, continuing the cycle of need.

ICUs provide a good snapshot of that trend. Dr. Edward Seferian, a researcher for the Mayo Clinic, recently noted that intensive care can account for as much as 30% to 40% of a hospital’s costs. Of the 18 million ICU days Americans use every year, about half involve care for patients age 65 and older — a population expected to grow by about 50% by 2020 and double from its current number by 2030, drastically increasing the need for ICU care and straining available resources.

Treatment for today’s patients, Tolosky noted, requires new environments and technologies that cannot be properly accommodated in smaller, older procedure rooms — not to mention a nationwide trend to switch to private patient rooms to boost infection control and offer more space for medical equipment and family involvement.

“If you look at the demographics of the Pioneer Valley, you’ll see a stable population, but an aging population, and at the upper end, people are living longer, healthier, more robust lives,” Tolosky said. “But people are also living longer with chronic diseases that require more care.”

On top of that, he said, the middle tier of the population — those Baby Boomers entering retirement — are just beginning to experience serious, recurring medical conditions, even as they want to stay active. “So they require more medical interventions, and we’ve got the technologies to do it.”

Leaving Options Open

The question for many hospitals is where to put those patients, and how to equip outmoded rooms with that modern technology. Baystate’s expansion addresses both issues, but the total increase in licensed beds — from the current 653 to 775 — will not happen all at once when the new building opens in 2012.

“A good part of this is shell space. We can’t afford to do the whole buildout for day one,” said Tolosky, who noted that developing all the interior space would bring the project’s price tag to around $450 million.

“That troubled us initially,” he told BusinessWest, “but then we decided that gives us more flexibility, as each year goes by, to make determinations about what we need. For example, in 2015, do we build out more operating rooms, or another inpatient unit? We can make those decisions on a year-by-year basis. I think that’s great.”

Making any of those decisions — whether thinking in the short term or a decade down the road — means juggling priorities in areas ranging from patient care and the convenience of the location to financial viability and environmental impact, said Jane Albert, Baystate’s vice president of Public Affairs. It also requires the participation of dozens, even hundreds, of stakeholders, running the gamut from cardiovascular services and emergency surgery to inpatient nurses and the Baystate Children’s Hospital.

“Each of these groups came up with guiding principles for the strategic master plan,” said Albert — and the competing demands of each department can easily turn the master plan into something unwieldy if handled carelessly.

“Everything is driven by priorities; nothing is random here. This is how the whole process begins: people coming together and agreeing on the principles we’re going to follow to plan the hospital of the future.”

M. Dale Janes, who chairs Baystate’s Board of Trustees, said the board’s recent vote to endorse the filing of a Determination of Need with the Mass. Department of Public Health — a required step in any capital project — shows its support for the planning process as it has been laid out so far.

“We believe that Baystate’s leaders are continuing on the path of an exceptional journey that was started long ago in our community — dating back approximately 100 years ago when the first additions were made to the Springfield Hospital,” Janes said.

Baystate officials also tout the project’s economic impact on the city and region, noting that more than 200 construction jobs will be generated, while some 550 permanent clinical and physicians positions will be established at the hospital. But Hannon kept coming back to the impact on health care.

“We’re going to create enough capacity to be able to manage patient care demands with newer technologies and treatments,” she said. “As people live longer and need more health care interventions, we’ll be in a position to provide good support and the ability to care for them.”

In a field that moves as quickly as health care, that can be accomplished only by looking to the future — and Baystate is certainly doing that.

Joseph Bednar can be reached at[email protected]