County booming with new hospitals

County booming with new hospitals

Written by Shannon Colletti, Christi Covington and Kara Vaught Monday, 07 January 2008

One of the biggest concerns facing Central Texas healthcare providers is meeting the needs of the region’s rapidly growing population, said Mark Clayton, senior vice president for strategic planning and development with St. David’s HealthCare.

Area healthcare networks are addressing this issue with new hospitals and updated facilities.

Last month, Community Health Systems, Inc., in partnership with the Seton Family of Hospitals, opened Cedar Park Regional Medical Center. In February, Seton will open Seton Medical Center Williamson in Round Rock.

Scott & White also opened a new Round Rock hospital — Scott & White University Medical Campus — in partnership with Texas A&M University last summer.

St. David’s HealthCare is building a women’s facility that, after completion, will double the North Austin Medical Center’s current capacity for women’s and maternity services.

Seton

Seton hospitals are designed to provide comprehensive care for those with routine to complex medical issues.

“Our goal is that very few of our patients would need to go to our other sites for any super specialized care,” said Travis Froehlich, vice president of planning for Seton.

CPRMC, located on the northeast corner of RM 1431 and 183A Toll behind 1890 Ranch, is 280,000 sq. ft. and has 77 private rooms with space for up to 151 rooms.

The emergency room has 18 private treatment bays, and the attached medical office building will house up to 18 physician offices including general surgeons and women’s services providers.

Seton Medical Center Williamson, 201 Seton Parkway in Round Rock, will open Feb. 7 with 365,761 sq. ft. and 181 beds with space for 350 rooms. Additional medical facilities on the campus include 120,000 sq. ft. of medical offices, an ambulatory surgery center, diagnostic and imaging center and oncology center.

“It’s going to bring a level of care and convenience to residents there that they would have had to drive a distance to get before,” Froehlich said. “I hope community health status — not the amount of health care, but how healthy they are because they have access to care — will go up.”

Scott & White

Scott & White University Medical Campus opened with 72 beds on University Boulevard.

The plan is to double the hospital’s capacity in the next three years and grow to 300 beds in the next decade, but it will depend on demand.

“The competitive market has a significant role in what we do,” said Ernie Bovio, University Medical Campus CEO.

The original Scott & White is based in Temple, and Round Rock’s location is the first hospital plant for the network, which emphasizes education and research.

Nursing and medical students from institutions such as the University of Mary Hardin-Baylor and Texas A&M University train at the Temple campus. The University Medical Campus plans to host students from Texas A&M Health Science Center next fall.

St. David’s HealthCare

St. David’s announced last June it would invest $100 million in women’s and neonatal services. This includes the construction of an $82.7 million women’s center at its North Austin Medical Center, located on MoPac just south of Parmer Lane.

The hospital system has five area facilities that deliver about 12,500 babies annually.

“It’s long been a part of our strategic plan to grow women’s services at this facility,” said Don Wilkerson, CEO for the North Austin Medical Center.

When finished, the 377,000 sq. ft., three-story center will boast 37 labor, delivery and recovery rooms, 61 postpartum rooms, six Cesarean surgical suites and 36 neonatal intensive care unit bassinets.

Ground broke last summer and the expected completion is April 2009.

Plans also call for a future ambulatory surgery center for women’s surgical procedures, and the building will be engineered to expand to eight stories as needed. The facility will be the largest women’s center in Central Texas, Wilkerson said.

Funds will also be used for NICU expansion at Round Rock Medical Center, where completion is expected in early March.

St. David’s Medical Center in Austin expanded its NICU and will make renovations in women’s services, which should be finished in June.

Healthcare professionals discuss the business of hospitals

• Dr. David Klein, chief executive officer of Cedar Park Regional Medical Center
• Mark Clayton, senior vice president for strategic planning and development with St. David’s HealthCare
• Ernie Bovio, chief executive officer of Scott & White University Medical Campus

General Information

What is the difference between a medical center and a hospital?

No difference. Hospitals became more commonly known as medical centers when they began to offer both in-patient and out-patient care.

How do you attract and retain staff?

A competitive salary, an attractive work environment and excellent facilities.

What is the difference between a not-for-profit and a for-profit hospital?

A not for profit takes any margins and reinvests them in long term growth or in the community. For profits may do some of that, but they have to provide a return to their shareholders. A public hospital is owned and operated by a public entity. A public hospital can be like a private not for profit, but it is owned and run by a public group. It will try to produce a bottom-line margin, like a not for profit, but has access to government sponsored bonds or taxes to support it.

What is the source for the majority of your revenue?

The revenue is comprised of the different entities that pay the hospital. General categories include the government through Medicaid, commercial insurance and self-pay (or the private individual). Commercial insurance provides the most revenue with government funds coming in second.

What certification or permits are needed for hospitals?

The amount of certification and permits is lengthy. The top three come from:
1. The State of Texas Health Services – The hospital must apply for a license. The state surveys the facility before granting the license.
2. The Centers for Medicare & Medicaid Services – The hospital must be accredited to receive government funding.
3. The Joint Commission – The hospital must be accredited. In a rigorous survey, the commission goes through a lengthy process to determine deficiencies, which must be fixed before the process is complete. It must be renewed every three years.

How do you choose your doctors?

• Klein (Cedar Park Regional Medical Center) - “We don’t employ any physicians. We have an open medical staff, which basically means that any physician can apply to be a member. We really have a stringent application process, which is very highly regulated. But our board of trustees will actually make the final decision based on the physician’s application.”
• Clayton (St. David’s) - “Physicians apply to be members of the medical staff. They go through a process known as credentialing, and a panel of their peers (other physicians) review the applications and make decisions about the qualifications for those individuals to join the medical staff.”
• Bovio (Scott & White) - “In a typical hospital model, many of the doctors have a private practice and apply for a medical staff membership with the hospital to get access to the facilities. Because Scott & White emphasizes education and research, it has its own employees. The [salaried doctors] are more eager to participate in the educational programs.”

How does competition play into the hospital business?

• Klein (Cedar Park Regional Medical Center) - “I think competition is good just like in other industries. When you have competition, it offers the consumers choice.”
• Clayton (St. David’s) - “Competition is good for any business. Our focus is not so much keeping an eye on what another hospital system is doing, although we do that, but I think [it] is trying to meet the community’s needs better than the other guy. If you are able to outserve and outperform, I think the customers will choose the one that is providing the best service, that is doing that in the safest environment and doing that in a way that they feel is best.”
• Bovio (Scott & White) - “We look at the services already offered and the amount offered to see what we can bring. [We] have to take into consideration what our competitors are doing and if we can do it better.” Bovio said Scott & White pushes for a competitive edge with its medical record integration model. If a patient goes to the clinic in Georgetown and then comes to the hospital in Round Rock, the doctors can access the medical files on the computer. “That way they are not carrying papers and X-rays from one doctor to the next.”

How do you get compensated for charity care?

• Klein (Cedar Park Regional Medical Center) - “We have a charity care policy that we will not deny anybody care at this facility based on insurance or inability to pay. The hospital absorbs all the cost of that care. We will not deny anybody care they need.”
• Clayton (St. David’s) - “That area is probably very complicated. What I can comment on is there is a large charity unfunded burden. [About 25 percent of Texans are uninsured.] Much of that population is unfunded totally and, therefore, would be classified by some as charity. Now charity can also be a technical definition. In the case of hospitals, everybody who comes through the door, whether you’re a charity patient or not, unfunded or not, have insurance or not, are part of that equation. [Those with health insurance are] the ones paying the bill. This is what we’re struggling with, and certainly the hospitals bear a disproportionate burden in that regard. The bigger picture answer, in terms of how do we get paid for that is, really that all of us are the ones that are paying for that.”
• Bovio (Scott & White) - “We have a financial counselor on staff who meets with patients and assesses their needs. Those who can’t pay, we work with a group called Hospital Solutions, so they can find the resources they need to get care. We would never turn anyone away.”

Do hospitals get incentive funding? If so, when?

• Klein (Cedar Park Regional Medical Center) - “We had an agreement with the Cedar Park 4A Board where we built the roads and infrastructure and we paid for that and that will be reimbursed over time by them. That was a good incentive.”
• Clayton (St. David’s) - “There are a variety of sources for that. Municipalities can and do provide incentives for different development activities that are in the city’s and a population’s best interest.”
• Bovio (Scott & White) - “Typically hospitals, particularly non-profit hospitals, do not get incentive funding because they do not provide large amounts of tax revenue for the cities.”

Who provides loans and capital investment funds for hospitals?

• Klein (Cedar Park Regional Medical Center) - “The two companies [Seton Family of Hospitals and Community Health Systems] had a funding agreement that invested more than $125 million. This facility is entirely debt free. As we determine that we need to have future capital investments, they will be funded by both parties.”
• Clayton (St. David’s) - “The capital for the finances for any of our projects is generated internally so it would be through our reserves and our internal savings. Before you do that type of project, it requires our board approval and our partnership [Hospital Corporation of America] board approval.”
• Bovio (Scott & White) - “The hospital has to go to Wall Street and the bond market. Sometimes Scott & White in Temple will use the local banks for projects, but typically large amounts must come from bond revenue.”