Critical Care

Low crime, good schools, jobs and healthcare all help define a community's quality of life, and when people rank those factors, healthcare typically lands high on the list. But the ability to meet that critical need weighs heavily on the minds of medical officials who must endeavor to keep pace with growth.

As Southwest Florida's population ages and increases, hospital operators, already burdened by reimbursement and indigent-care issues, are aggressively campaigning to improve technology and upgrade services, all the while wondering if they can keep pace.

According to estimates published by the University of Florida Bureau of Economic and Business Research, Lee County's 2005 population of 549,442 will balloon to 648,400 by 2010. Collier's 2005 tally of 317,788 will increase 22 percent to 386,800 in the next five years. And U.S. Census figures show Lee and Collier have larger populations over age 65 than the rest of Florida, with 23.6 percent of Collier's residents and 23.2 percent of Lee's, compared with 16.8 percent for the state as a whole. The region's healthcare facilities, which already face shortages in nurses and other staff, could be overwhelmed by that kind of growing demand.

Local health providers are not sitting on their stethoscopes, however, waiting for a trauma to occur. Here's how the region's healthcare industry plans to address the impending demand.

Lee Memorial Health System

Planning for seniors-and shortages.

"The general public does not seem to be aware of what's coming," says Jim Nathan, CEO of Lee Memorial Health System (LMHS), an 88-year-old, nonprofit organization that employs 6,600 and has 900 physicians at sites throughout Lee County.

"About a quarter of our local population is senior citizens and another quarter is made up of baby boomers who are about to join them. Seniors are the folks who use medical services most," Nathan says.

Not only are the boomers going to swell the ranks of medicine's frequent fliers, they also represent a good portion of the medical professionals who will soon want to retire, Nathan says. "We're going to be seeing severe doctor and nurse shortages," he predicts. "It's going to be a phenomenal challenge."

His strategy, shared by most healthcare executives, is to build new spaces and beef up what already exists. Even with the recent completion of an $88 million, 50 percent expansion at HealthPark Medical Center, LMHS has 19 more projects on the drawing board or in the works. Nathan, who has spent 22 years as LMHS CEO, says none on the list can be rated most important.

"If you're a brain aneurysm patient, Lee Memorial Hospital's new neuroendovascular service that begins in October, which will allow the repair of aneurysms without a craniotomy, is the most important," he explains. But if you're a cancer patient, he says, the Lee Cancer Center that broke ground in June at Colonial Boulevard and I-75 will be critical to you; it will gather numerous treatment services under one roof and be family friendly. And if you're a parent of a preemie who'll need long-term care, you'll appreciate the six additional beds at HealthPark Medical Center's neonatal intensive care unit.

Nathan adds that Cape Coral Hospital is starting an $11 million ER makeover and that Lee Memorial Hospital will be enhanced with the phased construction of a seven-story tower and a new orthopedic center.

Hospital Corporation of America

Expanding facilities and services.

Tennessee-based Hospital Corporation of America (HCA) has launched a $200 million project that will surround, expand and renovate its current Gulf Coast Hospital in Fort Myers and shutter the 22-year-old Southwest Florida Regional Medical Center.

The yet-to-be-named hospital, combined with Gulf Coast, will have 349 beds and offer a 43-bed emergency room, according to Doug Luckett, the HCA Fort Myers market chief operating officer.

The four-story structure, with 420,000 square feet of new construction, will quadruple the size of the existing building. Begun in January, it is slated to open in mid 2008. The new facility will offer pediatrics and obstetrics, kidney transplantation, intensive-care units, comprehensive cardiovascular care and oncology, along with other medical services.

NCH Healthcare System

Alliances and outreach.

NCH Healthcare System CEO Edward A. Morton sees the future of local healthcare best served by forming strategic alliances-with the physicians of the area, with appropriate third parties and with neighboring healthcare providers. Although NCH has been engaged in expanding its facilities, with the Dr. John N. Briggs Wellness Center near downtown Naples and additions at the north Naples campus, Morton predicts that alliances with the local physicians will result in more procedures being performed in outpatient, satellite settings.

"Advances in medical science in some cases have reduced the need for lengthy inpatient stays and are providing opportunities for treatment in environments less intense than acute-care hospitals," he says. He explains that the NCH policy of outreach to other institutions in the medical field has already netted good results and programs of value to the community.

"The relationship [board chairman] Carl Westman helped us cultivate with the University of Miami School of Medicine resulted in the establishment of a Bascom Palmer Eye Institute facility here," he notes. "Bascom Palmer is annually rated among the highest in the nation for ophthalmology care."

The NCH Regional Cancer Institute is a product of a former collaboration with the Duke University Health System.

A new alliance with the Florida State University College of Medicine aims to establish a medical training satellite at the Isabel Collier Read Healthpark in Immokalee. Morton expects the hospital to play a leading role in encouraging more individual responsibility for health management by maintaining wellness centers and providing more services in preventive techniques, such as nutrition. The hospital is also anticipating more preventive capability as advances develop in the fields of proteomic (proteins) and genomic (gene) research, which will predict many diseases before they occur.

More sophisticated CT-scan technology could eliminate some of the need for invasive procedures, especially in the field of cardiac analyses. And DaVinci robotic techniques already in use in prostate treatment have a future in gynecological oncology, Morton adds.

"Although our main campus is pretty much at build-out, there will continue to be reconfigurations here-more private rooms, for example-as healthcare requirements evolve," he explains. "In north Naples, there's room for future expansion, which could provide more operating rooms and the establishment of a geriatric program."

In addition to cultivating strategic relationships, Morton considers the ability to develop and manage information technology efficiently, enhancing effective and efficient communication, an important objective.

HMA

Acquisitions and startups.

Expansion is also planned at smaller hospitals, such as Lehigh Regional Medical Center (LRMC). J. Allen Tyra, LRMC's chief executive officer, says plans are in the works to upgrade the nine-bay emergency room with a 15,000-square-foot expansion that would create a 29-bay facility capable of reducing the average length of stay (from entry through release) from the current two hours and 30 minutes to two hours.

The ER, which serves a five-county area, has been experiencing growth of 6 to 8 percent from year to year, he explains; in 2006, it will handle 30,000 patients. They will all experience the Nurse First program, a protocol established in every Health Management Associates Inc. medical facility that makes a registered nurse the first person a patient sees.

While the Lehigh ER expansion is slated for completion by late spring, the search for additional medical office space-another necessity-is ongoing.

Another enhancement will be the arrival of two hyperbaric oxygen therapy chambers to help treat chronic wounds, such as those complicated by diabetes. The new chambers, expected to be operational in 2007, use pure oxygen to treat wounds. "We take great pride in our existing progressive wound-care program," Tyra says.

The planned capital improvements could cost between $1.2 million and $1.3 million, he says.

All medical care providers are struggling to attract and retain nurses and other hospital personnel. But Tyra believes his facility has an edge. "We've put together good salary/benefit packages, and we've established management that is staff-friendly," he declares. "The work is rewarding, and housing in Lehigh is still affordable. With gas prices what they are, that's an attractive asset."

Another small hospital with big plans is Physicians Regional Medical Center in Naples, formerly the Cleveland Clinic Florida Naples. The name of the 83-bed hospital changed when Naples-based HMA acquired the hospital in May.

CEO Geoff Moebius plans for a total of 18 new beds within 12 months in the medical, surgical and intensive-care units. Under the new ownership, staff is no longer closed but open to physicians in the community who successfully pass the credentials review process. None of the 65 permanent physicians on the roster has left because of the ownership change, Moebius says.

He anticipates expanded medical services. In cardiology, interventional capabilities such as defibrillator and stent implantation will be offered; in the diagnostic sector, electrophysiology, which investigates the heart's electrical problems, will be available.

Expanded stroke-treatment capability will enable severe cases to be treated in-house, and patients will have access to more advanced back surgery. He also stresses the hospital's commitment to research and continuing education programs for physicians.

Along with funding of indigent care, Moebius lists effective integration of information technology among the major challenges.

Even the new kid on the block, not yet up and running, is armed with plans for the future. Michael Mastej, CEO of HMA's Collier Regional Medical Center, says the 104-bed facility slated to open on Collier Boulevard early in the first quarter of 2007 can expand vertically and horizontally and will launch new construction as fast as need demands.