A touch-screen directory, a grove of potted trees and a muffin-bearing kiosk greet visitors entering the six-story atrium at the new Clarian North Medical Center in Carmel.
A much milder scene awaits people walking into Westview Hospital a few miles away, on the west side of Indianapolis. There, a lonely player piano spills soft tunes into a one-story lobby filled with clusters of chairs and pamphlets on volunteering.
"Quiet! Healing in Progress" reads a nearby sign.
Indiana's lone osteopathic hospital has managed to stand strong and live the (relatively) simple life while a wave of health care growth washes through central Indiana. Observers credit strong leadership, dedicated doctors and a fortified care niche with keeping the independent hospital afloat.
However, potentially overwhelming challenges like capital projects and expensive technology upgrades loom.
"Many people predicted [Westview's] demise 20 years ago, but the last 20 years have been the best ... financially," said Edmund Abel, director of health care services for the Indianapolis-based consulting firm Blue & Co. "But the health care market is going to change so rapidly in the next five to 10 years, it's hard to know who's going to survive."
Westview, with 65 staffed beds, ranks as one of central Indiana's smaller acute-care general hospitals. The largest, Clarian Health Partners, which operates five hospitals, has more than 1,600 staffed beds.
Two new Clarian hospitals, a couple of heart hospitals and a handful of multimillion-dollar expansions are among the capital projects added locally in recent years.
Westview also contributed to this growth spurt. It spent $4.5 million on a radiology renovation completed last year. In 1998, it opened a 150,000-square-foot sports club that now dwarfs the one-story hospital.
In the meantime, Westview Medical Campus-as the hospital, sports club and primary-care offices are known-has managed to stay healthy. The state Department of Health reported Westview's profit at more than $678,000 last year. Its gross patient service revenue-money from insurance and government programs like Medicaid or Medicare-rose from $55.4 million in 2003 to $73 million last year.
Porter and others point to Westview's doctor loyalty as the biggest key to success. The hospital's board has managed to retain a medical staff that's attractive to surrounding hospitals, said Steve Thomas, president of local consulting firm Health Evolutions.
That's especially noteworthy because osteopathic medicine became more mainstream over the past decade or two, Abel noted. Westview is no longer the only Indianapolis option for these physicians.
Doctor referrals represent a lifeline for most hospitals, said attorney Mike Paton, a partner in the health care department of the local law firm Barnes & Thornburg.
"Patients pick doctors, and doctors pick hospitals," he noted.
Location helps Westview as well. A nearby Interstate 65 exit provides easy access. Blue-collar neighborhoods north of the hospital are filled with people on commercial insurance, which provides better reimbursement than Medicaid and Medicare.
Leaders who give the hospital steady direction and listen to the medical staff also have been assets, Thomas said.
That leadership has kept the hospital independent, even though Westview has had affiliation talks with "every major player in the city" over the years, Porter said.
The small hospital does have chinks in its armor. State health department figures show a rising percentage of patient revenue coming from Medicaid and Medicare.
The hospital does not provide obstetric or pediatric services, two specialties commonly cited as gateways to future business. One of its specialties, geriatric care, generally attracts Medicare-covered patients.
Westview also has to compete in an environment filled with spiraling costs. For instance, the latest CT scanning machines, which offer 64 "slices" or images, can cost more than $2 million each. And an even better model is expected to hit the market in a couple of years, Abel said.
He also noted that Westview would have a hard time paying for a huge capital project, like replacing its current physical plant. That could cost up to $60 million.
Porter remains undaunted. He said the hospital can lean on tax-exempt bonds to fund smaller-scale projects, and Westview leaders haven't thought about replacing the 31-year-old building.
He still sees room for a neighborhood hospital serving the west side. Others agree.
"It's healthy and good to have local community hospitals in the midst of the very sophisticated health care providers that we've got within the city," Thomas said. "I think it's a nice balance that we've got here in Indianapolis."