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Health builders thinking small: Local hospital development in for change

April 25, 2005

Just north of Indianapolis, Clarian Health Partners plans to open a 170-bed hospital this December, a suburban complement to the 76-bed hospital it opened last December in Avon.

To the south, St. Francis Hospital and Health Centers unveiled a heart center in March, counterbalancing the two stand-alone heart hospitals that sprang up on the north side a few years ago.

These projects offer a snapshot of how health care development has progressed over the past few years in central Indiana. Take a good look at the image, because that picture is about to change.

Indianapolis may have finally reached its capacity for in-patient hospital beds, according to those close to the action. That doesn't mean the stream of new construction projects will dry up or that the growth spurt health care has seen over the past few years will end. To understand what's over the horizon, experts offer two pieces of advice: Think small and think grocery stores.

Deeni Taylor looks over the central Indiana health care landscape and sees no vacancy in at least one part of it.

"There's plenty of hospitals or overall hospital beds to take care of everyone in Indianapolis," said St. Vincent Health's chief strategy officer and system vice president.

Taylor also thinks the construction of ambulatory surgery centers-places where patients stay for less than 24 hours to have procedures done-may slow as well.

Future projects, he believes, will focus on new outpatient offices and diagnostic centers, or renovations to existing hospitals. Most of the older ones were built to fit more than one patient per room. Hospitals need to adjust to patient and federal government demands for more privacy.

Mark Dixon also sees no new inpatient hospitals in the near future. Community Health Network's chief operating officer predicts more growth in outpatient clinics for specialties like oncology or radiology.

Technology has evolved to allow more people to receive chemotherapy or MRI exams in these outpatient settings, leaving hospitals to handle more complex procedures.

That doesn't mean Community will ignore its hospitals. The network already launched a major expansion of its north campus and plans to break ground later this year on a multimillion-dollar cancer center at Community Hospital East, Dixon said.

Any new hospital construction likely 69 corridor, which leads north to Anderson, as an area ripe for growth, even though Hamilton County has seen rapid health care development.

No one will build downtown, which already has several hospitals and a poor payer mix, said Edmund Abel, director of health care services for the Indianapolis-based consulting firm Blue & Co. Anything built in Marion County will wind up near the Interstate 465 beltway, he said.

The south side of Indianapolis presents a good opportunity with its interstate access and population growth, according to Jeff Williams, a health care consultant for the Indianapolis office of PricewaterhouseCoopers LLP.

McCaslin agrees. He wonders how long the competition will "let St. Francis have that marketplace all to themselves."

"That's a question I don't have an answer to, but I think it begs an answer," he said.

Rumors have floated for the past four or five years that either Clarian or St. Vincent wants to build there, said Ice Miller attorney Gregory Pemberton.

North-side-based St. Vincent has no plans to look south "at this time," Taylor said, adding that he wouldn't want to rule will involve a niche, said Dan Miesle, a Michigan-based consultant who works in the Indianapolis market.

OrthoIndy opened a specialty hospital this year, and Clarian plans to break ground on its cancer hospital this summer. Miesle said a neuroscience center might fit this market, too.

A federal moratorium on specialty hospitals partly owned by physicians may influence any development plans in that area. The moratorium expires in June, and Congress has yet to decide whether to extend it.

The trend toward smaller outpatient settings is nothing new. It began in the 1990s, when hospitals started reaching deeper into suburban markets, said Bob Morr, vice president of the Indiana Hospital and Health Association.

The smaller outpatient centers or primary care networks act as roots for the hospital.

They help draw business to the inpatient hospital when the need for complicated care arises, said Mike McCaslin, a principal in the health care group for Indianapolis-based Somerset: Accountants and Advisors.

Where these roots will spread remains an open debate. Some see the Interstate anything out.

Clarian spokesman Jon Mills also left the possibility open. He said Clarian, headquartered downtown, is always "assessing and evaluating the demand for services."

As a general rule, future health care development will resemble retail growth, according to Todd Jensen, senior vice president for health care at Lauth Property Group.

People dislike driving more than 15 minutes for outpatient services. That means health care planners will look for suburban population pockets that sport good demographics-employed people with commercial insurance-and lack certain services within a 10-minute drive.

Jensen remembers asking a local doctor group once how they figured out where to place their satellite offices. They gave a simple response: Follow the grocery stores.

However, Jay Brehm threw a wrench into that concept. The regional chief financial officer for St. Francis noted that the cost of health insurance is rising. That, combined with technology advances, might change how often people use health care in the future and make planning more difficult.

"That's all changing and I don't think anybody really knows what the impact will do to utilization rates," he said.

However, one thing does seem certain, at least as far as big projects are concerned. Pemberton noted that Clarian, St. Francis and Community have all launched plans for or recently finished large projects. The next step in that category may be to simply wait.

"I think many of the financial bets have been made at this point," Pemberton said. "The money's been committed to these projects ... now they've got to get them in the ground and see what success they have."
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