Many Hospitals Are Expanding, But Some Critics Ask Why

By David Darman on Monday, August 4, 2008.

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Nearly twenty hospitals in New Hampshire are undertaking multi-million dollar additions or renovations.

In a few cases, the construction is the first modernization in decades.

But in most instances, the renovations are directed at making changes in patient care and to handle a growing number of patient visits.

Still, as New Hampshire Public Radio’s David Darman reports, some analysts say there’s a kind of profit motive behind the construction.

No matter whether the hospital is big or small, the reasons for a multi-million dollar addition or renovation are typically very similar.

Here’s Joe Shields of Frisbie Memorial Hospital in Rochester, which has mostly completed its 42 million dollar project.

The last major expansion at the hospital was 25 years ago and that was at a time when most of the services we provided were done on at an inpatient basis. Today, most of our services are provided on an outpatient basis, so we needed to update the facility to reflect that change.

Valley Regional Hospital in Claremont is working on a 22 million dollar expansion.

It’s their first project in more than a century.

And Eliot Hospital in Manchester plans to construct a new clinic to handle thousands more patients.

But work at the site of the old Jac Pac Plant in downtown Manchester hasn’t yet started.

SOUND UP: Concrete truck

Work is progressing on schedule at New London Hospital, in New London.

Here, a big truck pours concrete to create a walkway outside the new 21 million dollar, 46,000 foot add ition.

Spokeswoman Lori Manor Underwood stands at the hospital’s yet unfinished new entranceway to explain where patients will go when the doorway is finished.

…and then you’ll be directed to go either left down this hallway, which will connect you to the hospital, radiology or lab services or to the medical services unit. Along the left we’ll have a new giftshop here it’s currently in our other lobby. And then you can see its all starting to be framed out so you can see what it’s starting to look like.

The revamped services in New London mirror the kinds that are being offered at other hospitals around the state.

Officials at these hospitals say they need to expand and renovate to keep up with changes in the healthcare world.

But Dr. Elliott Fisher of Dartmouth Medical School doesn’t agree.

I think there’s every reason to be skeptical about the need for this construction.

Dr. Fisher sees other motives in hospitals expanding and modernizing.

My guess is if you look carefully at the applications, the services that are being expanded have the highest profit margins…imaging services, orthopedic surgery, cardiac procedures where there is little evidence that there’s a shortage that patients are being undertreated and there is good reason to be skeptical about the motivations about what’s happening.

Fisher’s skepticism rises from a recent report from the Medicare Payment Advisory Commission.

It found that hospitals with expanded capacities did not lead to healthier patients on average than hospitals that had not expanded.

Fisher and other critics say that means all the new construction will lead to higher health care costs, without necessarily producing better outcomes.

New Hampshire’s Health Services Planning and Review Board is responsible for approving any hospital construction in the state that exceeds 2.7 million dollars.

Board chair Nick Vailis says he’s heard the reports saying some construction could have been avoided.

But Vailas says the board can’t deny construction just on those grounds.

Every hospital that comes before us is working within the framework of the law and the statute to do what they’re doing. And with that, we pretty much have to approve what they’re doing because …they’re meeting all the requirements necessary to determine that yes, there is a need for what they do.

Since 2003, the planning board has approved projects worth 668 million dollars.

But the board is seeing fewer new requests coming in.

For one thing, most hospital officials who wanted renovations have already undertaken them.

For another, the nation’s credit crisis and economic slump have taken a toll on projects that might have come forward.