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Another hospital?

December 9, 2005 12:50 am

Public need will drive decision

NEWS that not one, but two proposals for new Fredericks- burg area hospitals are being floated should have residents smiling. Not that Mary Washington Hospital is deficient--the century-old institution does a yeoman's job of handling the region's acute-care needs. But with the community growing at an exponential rate and traffic congestion slowing ambulance trips, the idea of an alternative is attractive.

MediCorp Health System, the organization that runs MWH, is proposing a 100-bed acute-care facility near Stafford Courthouse which would open around 2009. HCA, which operates 191 hospitals and 82 outpatient facilities in the U.S., England, and Switzerland, would like to open a 130-bed facility near Massaponax around the same time. Should either be built? Both? It'll be more than a flip of the coin that decides.

Since 1973, Virginia has had a "certificate of public need" law that outlines a highly regulated process through which medical facilities--from hospitals and nursing homes right down to individual CT scan machines--are approved by the state. Why? About half the money spent on medical care is paid for by the commonwealth through Medicaid, Medicare, and other programs. So Richmond has a vested interest in keeping costs down while maximizing access to care.

Both MediCorp and HCA, having filed letters of intent to build new hospitals, will have until Jan. 3 to submit applications for a "certificate of public need," required before any facility can be built. After the Virginia Department of Health reviews this initial application and clarifies any remaining questions, a 190-day evaluation process begins. The final call will be made by the commonwealth's commissioner of health.

Along the way, not only will VDH staff review the applications, but the Regional Health Planning Agency in Charlottesville will weigh in, holding public hearings and analyzing the proposals. Should the recommendations of the staff and the regional agency conflict, an administrative law judge will hear all sides and form yet another opinion.

If all this seems like a lot of red tape, it's because it is. But then, adding another hospital to a community is not like building another grocery store. The laws of supply and demand, profit and loss don't work quite the same way when Johnny's leg is broken as they do when one simply needs another cantaloupe. Certain medical services must be provided regardless of the patient's ability to pay. A balance within the community must be maintained between high-profit services and necessary but not- so-profitable care. So while some lawmakers look longingly at deregulation, the reality is that a completely free-market approach to health care may not be in the public's best interest.

Massachusetts, for example, removed the need for state approval for construction of medical facilities around 1990 hoping to encourage competition and therefore cut costs. Within a short time, 20 hospitals closed and the cost of inpatient care escalated at twice the national average. "Hospital deregulation has been a disaster in every respect," noted Alan Sager, Boston University professor of public health.

The Fredericksburg region's need for another hospital is fortunately not critical. With the opening last year of the addition to MWH, the now 412-bed hospital experiences a "comfortable patient census" most days, according to a spokeswoman. However, by 2010 when the population of the area is projected to top 300,000, beds will again be at a premium. Beginning the process now of planning to meet those future needs is wise.

Will the Fredericksburg area get a new hospital? The careful "certificate of public need" process should provide the answer in August.