by Marjolijn Bijlefeld and Robert Burke
When the first young patients walk into the new Inova Fairfax Children’s Hospital in 2016, they will know they’re in a building designed just for them. From the brightly colored, kid-friendly entrance to the child-size beds and medical equipment, this new hospital won’t look anything like hospitals built for adults.
The new facility will occupy the first three floors of a new 12-story, $400 million project that broke ground in September. The 665,000-square-foot building is the second phase of an $850 million expansion project at the Inova Fairfax campus, which includes a 12-story patient tower, set to open in January. “What we want to be able to offer is 100 percent private rooms with the newest and best technology,” says Heather Russell, administrator for Inova Fairfax Hospital for Children.
Joining the Inova expansion as one of the biggest new projects in Virginia is the $168 million Children’s Pavilion in Richmond, a 640,000-square-foot outpatient center, which also broke ground in September. It will be part of the Children’s Hospital of Richmond at VCU, and is scheduled to open in 2015 at a site next to VCU Medical Center on Broad Street in downtown Richmond.
There is also a major expansion under way at the University of Virginia Health System, where in June construction began on the $141 million, seven-story Battle Building at U.Va.’s Children’s Hospital.
These buildings represent a major increase in hospital services and facilities for children around the commonwealth. Driven largely by the need to upgrade aging buildings and equipment, and to keep up with a growing population, the projects are taking place despite the funding challenges that pediatric care faces in the age of tight government budgets impacting Medicare and Medicaid funding. While the new facilities are a big step up, some physicians would like to see the creation of more freestanding children’s hospitals in Virginia.
The U.Va. project is furthest along among the new pediatric centers. It is scheduled to open in the spring or summer of 2014. Sheila Smith, associate chief for U.Va.’s Children’s Hospital, says the construction “was both an opportunity and a necessity. We have a lot of specialty clinics in various buildings across Charlottesville” and it was difficult for patients to travel from one specialist to another. Plus, “a lot were in older buildings that can’t support the care” needed, she says.
The new building “was an opportunity to bring together all the subspecialists in one building that is child- and family-friendly,” Smith says. The new facility will have 75 exam rooms and bring together 36 specialty clinics, along with providing 12 new outpatient operating rooms. “It gets specialists in close proximity to each other for those who need a lot of care, and … it puts them closer to the hospital, where the core services are readily available.”
In Richmond, the VCU project is also a consolidation of services in one location. The Children’s Pavilion project is the latest move by VCU Health Systems to strengthen its position as a leading provider of pediatric care in the region. In 2010 it joined with Children’s Hospital of Richmond to create the Children’s Hospital of Richmond at VCU. Since then it has opened the region’s only pediatric emergency room and attracted new pediatric specialists. The new pavilion will have 72 exam rooms, two operating rooms and space for diagnostic testing, imaging and laboratory services, according to a VCU news release.
A group of Richmond-area pediatricians, however, is pushing for a freestanding children’s hospital. Called PACkids, the pediatricians’ group has been talking to leaders of the region’s major health systems in hopes of building support. In a recent edition of the Richmond Times-Dispatch, PACkids published a petition signed by more than 200 Richmond-area physicians, including some from VCU, saying they were “fully committed” to making a new children’s hospital a reality.
Dr. Keith Derco, a co-founder of the group, says there has been talk of building a true children’s hospital in the region for decades. “From the kids’ standpoint, we have a very fragmented system” divided between the major health-care providers, Derco says. “Each system is competing for the same talent, and it sort of waters down our ability to provide superstar practitioners to take care of kids in Richmond,” he says. “What we have is very good doctors working in systems that compete.”
The new VCU project, Derco says, doesn’t close the door on the freestanding hospital that his group advocates. PACkids, in fact, supports the new VCU pavilion, but Derco believes the region can improve its quality of care even more with the infusion of talent a children’s hospital can attract. Plus, the hospital would be an economic driver for the region, he says, in the health-related development that would grow around it and in marketing the region to businesses looking to expand or relocate. A study by the consulting firm Kurt Salmon for PACkids said a 200-bed children’s hospital in Richmond would cost about $500 million. The study said the project would need about $150 million in donations, with the rest of the cost financed through debt.
In fact, only 43 true children’s hospitals exist in the U.S., and Virginia has just one — the Children’s Hospital of the King’s Daughters in Norfolk. James Dahling, the hospital’s CEO, says there are some big differences in the level of care that a children’s hospital can provide, compared with the pediatric care inside other hospitals. “What you get in a freestanding children’s hospital … is the full continuum of care. Everything can be done there,” says Dahling, who has led the hospital since 2002. The not-for-profit hospital is licensed for 206 beds and serves as headquarters for the Eastern Virginia Medical School’s Department of Pediatrics. King’s Daughters had 5,482 inpatient admissions in its most recent fiscal year, along with more than 162,000 outpatient visits.
King’s Daughters has about 20 teachers working in the hospital to help children keep up with their lessons so they can return to school without falling behind. It also has developmental specialists who try to make sure kids don’t lose ground in their emotional and psychological growth because of the stress of an extended hospital stay, Dahling says. Both services are free. “Those are the kinds of things that separate a freestanding children’s hospital from pretty much anybody else,” he says.
King’s Daughters also has a different strategy for dealing with the health-care demands in its region. While many hospitals are building their facilities in a single location, King’s Daughters is spreading out. For example, it opened a new health center in June in a Suffolk office park. The center is equipped with a pediatric lab and X-ray services and provides speech, physical and occupational therapy.
Dahling says the trend among hospitals is to develop “consolidated ambulatory centers for pediatric care, or for adult care for that matter … We’ve kind of discovered that parents … want to travel less and less to the central site.” So King’s Daughters is trying a “hub-and-spoke” approach, with services scattered around its primary region, Hampton Roads and parts of North Carolina. It’s a market of more than 2 million people, who want “quick and easy access,” Dahling says. “It will be interesting to watch the other centers that are developing large ambulatory centers [and] see how that works.”
A challenge that pediatric care providers face everywhere is financial. Children typically have less access to private insurance and are more dependent on public dollars for health care. At King’s Daughters about 57 percent of patients depend on Medicaid, which covers less than two-thirds of the actual cost of care. “It’s tough to finance a freestanding children’s hospital,” Dahling says.
The financial strain seems likely to increase, given the push to cut funding at the state and federal levels. “Certainly, the federal government is going to spend less for health care,” Dahling says. “But what portion of Medicaid will be hit? I’m spending nights lying awake worrying about this, but there’s really no answer today.”
Smith of U.Va.’s Children’s Hospital says the trend isn’t good for reimbursements from public dollars, but that’s been true for a while. “All of health care is uncertain. There have been a lot of changes and changes yet to be known. So whether it’s an adult or pediatric hospital, we need to see how we can provide quality, efficient and effective care. That’s a challenge for everyone. In children’s medicine, we’re caring for some of the sickest of the sick.”
No matter the funding problems, sometimes hospitals just have to be replaced or improved, says Laurens Sartoris, president of the Virginia Hospital and Healthcare Association. “Like in anything else, in health care, all physical plants have shelf lives, and hospitals tend to have especially short shelf lives,” he says.
Codes change, and the technologies available outstrip what older buildings can offer. He notes that the new Inova facilities are part of a redevelopment of the Fairfax campus that began in 2010.
“A lot of the hospitals in the area are 25, 30 years old, and it’s time for replacing and upgrading,” says Heather Russell of the Inova Children’s Hospital. “I think we’re all finding ourselves in the same place at about the same time.”
Whatever the reason, the new facilities are a significant improvement for the regions they serve. The new Inova hospital is going to change the level of care for its pediatric patients. Its 116 private pediatric rooms will be outfitted with state-of-the-art monitoring equipment, Russell says. The pediatric intensive-care unit will grow from 16 beds to 24. “Right now, we sometimes have to send kids to [Children’s National Medical Center in] D.C.,” she says. “We’d like to keep them here in Northern Virginia.”
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