Take it as a sign of the economy. After years of taking on massive projects – new emergency rooms and inpatient wings, new critical-care units, major new equipment – Rhode Island’s hospitals are slowing their capital investments to a trickle.
For the next round of certificate-of-need reviews, the R.I. Department of Health approval process for equipment purchases worth more than $1 million, construction or renovations worth over $2 million, and other large projects, only four hospitals have submitted letters at all.
Only one, by Kent Hospital, involves construction – and it’s for a facility that hospital leaders hope to lease from the developer. Two others are competing plans from The Miriam Hospital and Women & Infants Hospital to bring a second da Vinci surgical robot to the state.
And the fourth, from Rhode Island Hospital, is so modest – an outpatient dialysis center in space to be rented for less than $1 million in the first five years – that hospital officials are seeking to have the CON process waived.
Of course the very fact that hospitals have built so much already makes a difference: Women & Infants Hospital is only now completing a $76.8 million, five-story addition, while Rhode Island Hospital has invested some $140 million in its Bridge Building, which includes a new ER, operating suites, coronary units and inpatient wings, and a new parking garage, along with related renovations to the main and Jane Brown buildings.
The Miriam, similarly, has a nearly brand-new wing, and Memorial Hospital of Rhode Island recently opened a new ER. Bradley Hospital, for its part, opened a new 44,000-square-foot inpatient facility last month, part of a still-ongoing $31.1 million project.
But many local hospitals still have substantial areas of their campuses that they would like to renovate; some are outright outdated and obsolete. And technology is changing so fast, plus the competition from out of state is so great, that the pressure on many of these institutions to keep upgrading is huge.
“The constrained financial situation [is] very real,” said Constance A. Howes, president and CEO of Women & Infants. One-third of her hospital’s patients are Medicaid-eligible. The hospital has seen a “definite impact” from the state budget crisis, she added.
“To the extent that the state cuts back on the payments they make to us or increases the fees that we need to pay, we have fewer resources to do the things that we need to do,” she said. “So it’s meaning that for major capital purchases, we are pausing because of the financial situation. People are waiting to see what happens with this economy, and is there a bottom?”
The leadership team at Kent Hospital – a Care New England member like Women & Infants – is keenly aware of that dilemma, but chose to make a major investment in its outpatient surgical facilities because it was woefully overdue, said President and CEO Sandra Coletta.
Kent’s proposal, valued at $15.1 million – $12.1 million for the cost of leasing the space, plus $3 million for equipment – would replace seven operating rooms and procedure rooms in its main building with a new ambulatory surgery center in a stand-alone (but connected) building on the Kent campus. The center would include four ORs and three procedure rooms, with medical offices on the second floor and a third floor shelled for future occupancy.
Coletta said Kent’s operating rooms are “extremely old,” and right now inpatient and outpatient surgeries are done in the same suite, which is not optimal for patients or doctors alike. There are often delays, and it’s “not appropriate for ambulatory surgery.”
In fact, a fifth letter of intent was filed with the Department of Health for a $5.25 million project to relocate Wayland Square Surgicare, currently in Providence, to the Warwick or East Greenwich area – to a still-to-be-determined location.
“Clearly the economy is a challenge,” Coletta said, “but most of the institutions have invested significant dollars in the last few years in terms of building expansions. Kent, on the other hand, has not. … We need to prepare for the future, and we need to update our facilities. Kent has to keep moving. We cannot keep deferring these investments.”
As for the two other major proposals on the table – the Miriam’s and Women & Infants’ requests for approval to buy new surgical robots – expect some lively discussions to come. The Miriam introduced robotic surgery in the state, and it has been collaborating with Women & Infants on gynecological uses, but Howes said it’s time for the hospital to have its own, both to expand the surgical options available to patients and to attract top-quality surgical residents.
Having to pare back on capital investments, however, troubles her.
“All the hospitals in Rhode Island are really safety nets for people,” Howes said. “And sometimes people say, ‘let’s just stop doing things.’ But it’s not a safe or prudent thing to stop doing things, because you can really fall behind, or you can have unsafe situations, or you could not be able to serve your patients well.” •
