a new hospital opens...

JIM MCLAUGHLIN /FLORIDA WEEKLY The new main entrance of Gulf Coast Hospital with direct access off Daniels Parkway.

IN A MOMENT OF MEDICAL choreography worthy of Balanchine, hospital officials are about to shift 200 critically ill patients into the future of medical care, moving them 4.6 miles across Fort Myers to the new, $285 million Gulf Coast Medical Center.

That transportation ballet, on March 8, will begin when special-care teams at the old Southwest Florida Regional Medical Center ease patients onto stretchers for the elevator ride to the street, locking the doors behind them forever.

Lift teams will move the patients into 22 ambulances assembled from EMT squads all over the region. A battalion of police will stand by to escort them to the new hospital, described by one official as "the crown jewel" of the sprawling Lee Memorial Health System, the largest public health system in Florida.

"Our move plan is a hallmark," says Doug Luckett, chief administrative officer of the new hospital. "We're going to use it as a mock disaster drill. We'll get patients embedded in the new beds, then get the rigs back on the road and keep the pace going."

The view of the new atrium from a second-floor patient's room.

Officials tout Gulf Coast Medical Center, located at the intersection of Daniels and Metro Parkways, as peerless in efficiency and technology among hospitals the southwest coast.

None dispute that it will offer patients an unprecedented level of care and comfort, as well as record-keeping efficiency. But how the new hospital will save money for consumers — the troubled heart of the nation's health care dilemma — is more difficult to demonstrate.

Questions of cost create unease or uncertainty in officials.

"I don't want this hospital painted as 'saving money,' I want it painted as improving the quality of care. That's first," says Richard Akin, chairman of LMHS's 10-member board of directors. "Saving money is second."

Fixing the billing system

But saving money is paramount in the national debate, and it depends in part on local or regional health care providers willing to do something different.

JIM MCLAUGHLIN /FLORIDA WEEKLY The new Cysto room set up for urology imaging. The new Gulf Coast Medical Center is more than 10 acres under roof.

Analysts point to two novel business models now being successfully pioneered by a handful of health care systems around the nation.

One, known as "continuum of care," relies on a new use of computers that can put up-to-the-minute records of every patient instantly at the fingertips of every doctor, nurse or caretaker who provides treatment.

Although Gulf Coast Medical Center will offer instant access to patient records for medical personnel within its walls — a continuum of records — the larger Lee Memorial system will only achieve a continuum of care when it can add a single computer system throughout its various hospitals and care centers. And that's probably years away, officials say.

Just as important to affordable health care, according to some analysts and practitioners, is a new official willingness to charge patients fixed fees for certain procedures, rather than making them pay for each service.

JIM MCLAUGHLIN /FLORIDA WEEKLY The new atrium is almost ready to open to the public. The new hospital costs more than $285 million and includes 22 operating rooms and 349 patient rooms.

The pay-for-service model now being used by LMHS and most of the nation's hospitals may ultimately prevent patients from getting the highest quality of care, while costing them a great deal more money. That's because it gives providers an incentive to treat patients; but perversely, not necessarily to keep them well.

Every time a patient has to be readmitted with a complication, or another specialist has to be consulted, or the state-ofthe art new CT scanning machine is used, the hospital is rewarded financially.

"The current payment system is exactly the opposite of what's being designed to keep people healthy," says Jane Jacobs, a spokesperson for the non-profit Mayo Clinic, which uses pay-for-service billing. "The system right now reimburses providers based on episodes of care. It doesn't reimburse providers to keep patients healthy over time."

PHOTOS BY JIM MCLAUGHLIN /FLORIDA WEEKLY A new Siemens Sensation CAT Scanner awaits its first patient at the new Gulf Coast Medical Center. The public is invited to view the facility on Saturday, Feb. 14 from 2 to 5 p.m.

That's why a handful of health care systems in the United States are finding ways to turn the broken billing system inside out, and reward hospitals for getting patients well and keeping them that way.

One is Geisinger Health System, a nonprofit that serves a population of 2.4 million in Pennsylvania, with comprehensive services similar to those offered by LMHS.

Instead of billing patients for each tablet of aspirin, each doctor visit, or each visit from a nurse during open-heart surgery, for instance, they simply offer the entire procedure, from soup to nuts, for a fixed fee of $30,000.

About 30 percent of the medical services the hospital provides are set with fixed fees, says Kevin Brennan, Geisinger's chief financial officer.

"Once we identify that a patient is going to need a cardiac bypass procedure, all the pre-admission care, all the surgeons' bills, all the anesthesiologists, all the cardiologists — everything is paid for," Mr. Brennan explains.

And like any electronics or appliance company worth its salt, Geisinger even includes a warranty on its work.

"We continue the warranty to 90 days post operative," Mr. Brennan says. "So you get a payment that is a full bundle."

Such fixed fees may encourage doctors to provide more precise, efficient medical care; but they also mean the hospital system needs to make up revenue in other ways.

"If you eliminate complications that you used to get paid for, or eliminate readmissions, there's going to be less overall dollars paid to you," Mr. Brennan says. "But it's better for the patient."

LMHS has no plans for a fixed-fee system, in which patients could pay either a monthly fee guaranteeing lifelong care here, or pay set fees for procedures such as heart surgery.

"That would be something to consider down the road," Mr. Akin says, adding that taxes for public health care might also be something to weigh in the future, unpopular as that notion is now. (Lee Memorial is the only major public hospital in Florida that receives no local taxpayer money.)

Continuum of care, real or virtual

Although fixed fees are not in the LMHS plan, "continuum of care" is.

"Continuum of care permeates into a community, when people can travel and have access anywhere they go," says Mr. Luckett, the new hospital's CAO. "We will go for continuum of care, but not in the early stages."

The industry-wide catchphrase is defined on the Lee Memorial Web site this way: "An integrated, client-oriented, cost-efficient system comprised of integrated services patients can enter at any point to receive a spectrum of health care over a lifetime."

Rather than having many private practices working alone, a "continuum of care," as officials see it, aims to bring them all together in one place: the computer record.

That model skirts the edge of nationalized health care and could fit smartly into President Obama's possible health care reforms.

"The Obama administration is touting electronic health records," Mr. Akin says. "We know it's the way to go. You spend the money upfront, but it comes back many times over in the form of improved quality and efficiency."

Even though the new hospital will offer a continuum of care within its walls, it won't be connected to the entire LMHS because it's too costly. After LMHS did less business than expected in 2008, officials said they could not justify spending the $50 to $60 million they estimate as the cost of a single, integrated computer system throughout the Lee hospitals.

"We still have two computer systems, with Lee Memorial (and others) operating on one, and us on another," Mr. Luckett says.

But a virtual continuum already exists throughout the Lee system, suggests Arthur Rubens, an associate professor of management at Florida Gulf Coast University.

An expert in health-care services, Professor Rubens compares medical care in the LMHS to a trip to a superstore or destination mall.

"At the superstore, you can get whever you want. Whatever you need, you go in that superstore," he says. "That originally was a theme behind shopping malls. You go to one location and you get what you want."

When that happens, as it has literally, not just virtually in some other healthcare companies, consumers and providers can both benefit.

A recent New York Times story cited a 2007 study by Hewitt Associates, a health industry analyst, showing that "integrated systems…provide 22 percent greater cost efficiency than competing systems."

Those efficient systems would help anchor the evolving strategy of the Obama administration to reduce health care costs, says Professor Rubens.

The cement-block dilemma in health care — costs that drag down struggling consumers — was highlighted by President Obama's visit to Fort Myers early in the week.

The president focused on the traumatic loss of jobs and homes both nationally and locally, and he has pointed out that health care costs maintain a stranglehold on the American economy, running almost 18 percent of the gross national product and contributing significantly to the recession.

Many of those who have lost jobs or homes in Lee County — along with others who still have jobs and homes — are now uninsured, and will depend on LMHS for care.

A hospital for some, not all

"This hospital is different from hospitals where I've worked in the past by orders of magnitude," says Mr. Luckett, the chief administrative officer. "The way you have to take care of people will be different."

But not all people. Not even just any people.

"We have to make sure somebody is sick enough to be admitted, or has a scheduled or emergency surgery," Mr. Luckett explains. "There is no more waitand see. We can't take people who don't have good stringent needs. We have to make sure their conditions merit our care. So this will be a great surgical hospital."

Other patients with different or lessdemanding needs will continue to find service in the LMHS's other hospitals or care centers, he says.

Some critics see that as the same-old same-old.

"There is no doubt this is a step up," says Dr. Bob Schwartz, director of the Robert Rauschenberg Center for Living in Fort Myers, which treats HIV and AIDS patients, many of them poor.

"But if anyone says they will get more medicine for less money, I say, do they work for Bernie Madoff? Hospitals, in their ever-loving desire to escape the poor — the people who desperately need care — have found better ways to serve the wealthy. Is this just an evasion of responsibility to poor people?"

In each of the 233 private rooms, it's unquestionably an evasion of the sometimes infamous reliance on paper records, as well as an elimination of standard oldmodel discomforts like high beds that are hard for sick people to get into or out of.

Here, each new private bed can be lowered to about knee-high, if necessary. More importantly, a bedside computer will give doctors and nurses up-to-theminute access to records of every single procedure, test, observation or opinion about a patient made within the hospital's walls.

Profit and loss

All of that is massively expensive, of course, which is why — coupled with recession — hospital officials say the system is financially troubled.

The LMHS budget for 2009 will run roughly $1 billion, the same as in 2008. About half of the system's income arrives from Medicare patients, whose insurance only covers about 82 cents on a dollar of care, leaving LMHS to pay down the other 18 cents. And the system loses $11 million alone each year just maintaining the trauma unit, says Mr. Akin.

He estimates that LMHS has to cover the unpaid costs of about $200 million worth of care in a year, for "charity and Medicare."

Meanwhile, officials had to borrow $285 million to build the new hospital.

Still, they managed to eke out $3 million in net revenue for the 2008 fiscal year.

"That's a miniscule revenue when you're looking at a billion in net operating revenue," says John Wiest, chief financial and institutional services officer for LMHS.

And it won't go a long way toward paying down the LMHS debt.

"We have $417 million in cash and investments, but our total debt is $651 million," he explains. "I think a healthy ratio there is one-to-one. Meaning, our cash and investments would be at $651 million, too. We expected this (drop) from the acquisition of the new hospital, and we're trying to rebuild it, but we're in a very difficult environment. We're dealing with completely unprecedented economic times."

But the new Gulf Coast Medical Center won't burden the Lee Memorial system.

Unlike many other hospitals, officials expect the new one to cover its own costs and maybe even serve as a cash cow, helping defray the debt incurred by treating uninsured or underinsured patients who inadvertently put a massive financial strain on the rest of the system.

"This hospital will pay for itself," insists Mr. Akins. "Lee Memorial acquired it in the beginning (in 2006) partly as a defensive move. The previous owners, HCA, were designing a hospital that would take the high-end stuff out of the community. More and more, Lee Memorial was getting hung with all of the no-pays and the uninsured. It was going to put Lee in a situation where they'd have to build more beds to take care of the uninsured, and at the same time not get as much of the paying business to offset big losses."

When the doors open

But officials turned a defensive move into a step forward, one being celebrated far and wide beginning this week on Valentine's Day, Saturday, Feb. 14.

On that special day of the metaphorical heart, which can sometimes be broken, people will tour the new hospital to celebrate the muscular heart, which can often be fixed or replaced, especially at the Gulf Coast Medical Center.

Among many other features, the new hospital has a "full-service cardiac and vascular program featuring the Allura Xper FD20, a sophisticated x-ray system that provides crisp, detailed images during minimally invasive endovascular surgery. There will also be a new cardiac catheterization lab and an openheart surgical suite," according to a press release.

There's more, of course. The transplant center has the shortest wait-list for kidneys in the nation. The hospital includes a childbirth suite, a latestgreatest neurosurgery department, 43 beds in the emergency room along with "a 40-slice CT scanner which provides three-dimensional images," and 233 private bedrooms where no patients ever have to share space with other patients, officials say.

Along the medical parade-route on March 8, therefore, there will be no need for tickertape. The blizzard of public relations applause surrounding the opening of the new, high-tech public hospital is enough.

When they finally turn the key, medical personnel will be cranking up a lean mean efficiency machine, officials say.

The hospital will offer doctors, nurses and patients the most advanced medical equipment and care settings, including information technology that aims to curtail redundancy — unnecessary tests or prescriptions made by doctors who aren't communicating efficiently with each other, for example.

That might ultimately save money for consumers, not to mention improving their chances for robust health.

FGCU Professor Rubens proposes a wait-and-see approach to the benefits of the new Gulf Coast Medical Center and the entire Lee Memorial system.

"Now in Lee County, we see one dominant system," he explains. "It's an opportunity to look at how an integrative system can work: the cost savings and benefits, from the delivery perspective, and also the efficiency — we can see how that will work in the future.

"These next 10 years will be very important. They could set the stage for (LMHS) being one of the forerunners of health care reform."

HOSPITAL FACTS

>>Gulf Coast Medical Center: 436,000 square feet of new construction (more than 10 acres under roof) and 20,000 square feet of renovation. >>Builder: Skanska USA, a Swedish firm. >>Cost: $285 million. >>Materials: 3,119 tons of steel, 5,500 tons of precast, 9.95 miles of concrete piles and 843.72 miles of electrical wire.

>>Beds: 349 total, with 233 private rooms, each equipped with flat-screen televisions and ample room for visitors, along with secure computer terminals for doctors and nurses to view patient records. The wireless system allows access to patient records from any department at any moment in the hospital.

>>Emergency Department: 43 beds, 28 exam rooms, 10 observation units, 33 treatments rooms. >>Surgery Department: 22 operating rooms. >>Other features: a 12-bed stroke unit, the region's only kidney transplant center, a model neurosurgery department, a full-service heart program with the newest diagnostic equipment and an open-heart surgery suite.

>>Lee Memorial Health System: five acutecare hospitals, a rehabilitation hospital, a children's hospital, a skilled nursing facility, a multi-specialty physician group and various subsidiaries and subagencies. About 8,000 employees, including 1,200 physicians who use Lee Memorial.

>>LMHS President and CEO: Jim Nathan. Salary: $554,000, plus benefits and car allowance. >>Gulf Coast Medical Center Chief Administrative Officer: Doug Luckett. Salary: $284,600, plus benefits and car allowance.

Sources: Skanska USA and Lee Memorial Health System

If you go

>>What: Gulf Coast Medical Center Open House >>Where: At the corner of Daniels and Metro parkways in Fort Myers

>>When: Saturday, Feb. 14. The event begins at 2 p.m. with special musical guests and the opening ceremony. Afterwards, guests can tour the new facility. The event ends at 5 p.m. >>Cost: None >>Info: Go to www.leememorial.org