It is a time of expansion. It is a time of cutting back.
With Medicare and managed care triggering a loss of revenue, hospitals in the Toledo area have been closing some sites and cutting back staff while opening other facilities and bringing in expertise and technology.
ProMedica Health System and Mercy Health Partners, the two major health-care systems in the Toledo area, each are vying for the profitable markets, while planning the closure of less profitable sites. For the short term, at least, this trend has translated into higher-quality health care for consumers.
The long-term effects remain unclear.
ProMedica owns Toledo Hospital, Flower Hospital, and Toledo Children's Hospital, as well as a number of hospitals, long-term care facilities, and systems in the region. It also owns Paramount Health Care, the largest health-maintenance organization in the northwest Ohio-southeast Michigan region.
Over the last year, ProMedica has been busily buying, building, and creating new alliances.
In March, it became a partner in Lima Memorial Hospital in Lima, O.
In May, together with the Medical College of Ohio Foundation, it opened the Wildwood Health Pavilion, which includes an ambulatory surgery center, doctors' offices, and a state-of-the-art health club.
In July, it entered into partnership with the Lenawee Health Alliance in Michigan, a system that includes Bixby Medical Center in Adrian and Herrick Memorial Hospital in Tecumseh.
In September, the trauma center at the Toledo Hospital was approved as a level-1 trauma center, the third in the region.
In December, Fostoria Community Hospital's trustees agreed to negotiate to create an alliance with ProMedica.
In January, ProMedica began construction of the Bay Park Community Hospital, a 266,000-square-foot facility to be built in Oregon on 50 acres at Brown and Wheeling roads west of I-280. The 70-bed hospital will offer general medical and surgical services, pediatrics, obstetrics, a full-service emergency center, laboratory and X-ray facilities. The cost of the hospital, including the land, is $79 million.
Mercy Health Partners - which owns St. Charles Mercy Medical Center, St. Vincent Mercy Medical Center, Riverside Mercy and Mercy hospitals in Tiffin and Willard - also is expanding.
In September, it hired a new president and chief executive officer, David Jimenez, brought from the Adventist Health System in Winter Park, Fla.
In November, over the objections of a vocal segment of the community, it won approval from the Toledo city council to build a 62-bed hospital and medical office building in West Toledo, on 16 acres near Secor Road and Sylvania Avenue.
In December, expanding on a successful partnership at the Fort Meigs Center in Perrysburg, Mercy joined forces with the YMCA of Greater Toledo to operate the health club at Riverside Mercy Hospital.
The two major systems laid claims in Maumee, but one of them has retreated.
Mercy has abandoned plans to build a 38-acre medical campus along Dussel Drive and Arrowhead Road near the I-475 interchange.
ProMedica, which last May paid $5.5 million for 32 acres of land on Indian Wood Circle near Woodland Drive, has yet to release its plans for that property.
Maumee is dominated by a player that has stayed out of the competition, but has vigorously protected its own turf: St. Luke's Hospital. Among the initiatives now being considered by St. Luke's is a heart center.
Another player is the Medical College of Ohio, a teaching hospital that offers degrees in medicine, nursing, and graduate education.
Apart from its role as an educational institution, MCO is fast becoming a national player. Over the past year, it opened a cancer institute and a liver-transplant center and was named by U.S. News & World Report as among the top 50 hospitals nationally in two departments. In December, its board of trustees approved a $16 million, _five-year capital plan, which includes renovation of existing buildings and construction of new ones.
In August, Mercy and MCO opened the Mercy Children's Hospital, a 48-bed hospital that will compete with Toledo Children's Hospital.
The hospital systems are also expanding their expertise, recruiting talent and technology.
In January, MCO opened its Cancer Institute. Dr. Edgar Staren, recruited last year from Rush University Medical College in Chicago, will be the institute's director and Dr. Donald P. Braun, another recruit from Rush, will be its administrative director. A noted breast-cancer specialist and chairman of MCO's department of surgery, Dr. Staren has pioneered such screening and treatment procedures as guided ultrasound to detect breast cancer without invasive surgery, the freezing of breast-cancer cells, and the removal of cancerous cells through the use of a suction device.
Later in the year, the institute will open a gynecological oncology center, headed by Dr. James Fanning, associate professor of medicine at MCO, and a comprehensive lung-cancer center. Centers for skin, prostrate, bladder, kidney, and other forms of cancer will open in future years.
In November, MCO won final approval from the United Network for Organ Sharing to become a liver-transplant center, one of 126 nationwide and the only one in northwest Ohio. Dr. Lawrence P. McChesney, chief of MCO's division of transplantation, will head the center.
Competition has taken to the skies, as well: Toledo last year initiated ProMedica Air, an emergency flight service that will compete with St. Vincent's Life Flight service.
Growth has come at a cost.
When the West Toledo hospital is completed, Mercy plans to close its 310-bed hospital at Riverside Mercy in North Toledo. When it completes its Bay Park site, ProMedica will close about 70 beds at Toledo Hospital. In November, Mercy announced that later this year it will be terminating the employment of 119 doctors employed by St. Vincent and St. Charles, a move that will also affect about 580 support staff and drive the doctors back into private practice. Additional layoffs may be in store.
The jury remains out on how the cutbacks and the expansion will affect the quality and cost of patient care in the long term. But, for many residents of the Toledo area, there is a lot of it.
Area hospitals also stepping up their care
Like their urban counterparts, hospitals in communities throughout northwest Ohio and southeast Michigan also are adding services, expanding surgery and urgent-care units, and ensuring that their facilities can provide up-to-date programs.
Firelands Community Hospital in Sandusky, for example, is expanding its capabilities to provide a level of cardiac care previously found only in larger cities such as Toledo or Cleveland.
Mike Sanders, public relations coordinator at Firelands, said a study found heart problems in the Sandusky area are 14 per cent greater than the national average. Heart disease is the leading cause of death among Erie County residents.
The hospital, citing encouragement from its physicians and community members, began an expansion program in November to add a wing that will allow the facility to expand its heart-cauterization program to include open-heart surgery.
The first phase of the $11.1 million project is expected to be completed in the spring.
Mr. Sanders said the Cleveland Clinics' Health Network is overseeing the expansion.
"In addition to the advanced training our heart staff members are receiving, we are also recruiting experts not currently available in our community, such as an open-heart surgeon and [other specialists] to operate the heart-lung machine during heart surgery," Mr. Sanders said.
In Bryan, the Community Hospital of Williams County, which last year added a wing to combine its imaging services such as radiology and ultrasound, is expanding its services for cancer patients.
Phil Ennen, the hospital's chief operating officer, said a project that began in April will permit the hospital to add a device that will allow oncology specialists to deliver precise doses of radiation.
The 2,000-square-foot addition and related equipment will cost an estimated $1 million, he said.
"This will allow us to expand the number of patients treated locally," Mr. Ennen said.
In southeast Michigan, plans are continuing on the Lenawee Health Alliance, which involves expanding clinics and services in smaller medical centers such as Hudson and Morenci.
In the Lima area, ground was broken on a $10 million medical park that will include a cancer-treatment center and a women's health facility.
The complex, on 67 acres about three miles from Lima Memorial Hospital, is expected to open in about a year. Lima Memorial and its partners, ProMedica Health System of Toledo and Blanchard Valley Health Association of Findlay, said the cancer institute include radiation therapy, outpatient chemotherapy, and survivorship support systems.
Clinical research studies also will be performed at the cancer institute. The women's health center will be staffed entirely by women and have the latest technology for mammograms, ultrasounds, and breast exams.
In July, the Lenawee Health Alliance announced a merger with the ProMedica Health System of Toledo.
Executives from the health-care systems provided assurances that the merger would retain local control of the Michigan system.
The partnership will improve health-care services in the southeastern Michigan county, said John Robertstad, president and chief executive officer of Lenawee Health.
Lenawee Health executives said the merger will enable them to expand and offer more services for residents, including a possible high-risk obstetrics unit.
For ProMedica, the deal creates a Michigan presence for the Toledo company, which operates several hospitals, including The Toledo Hospital, Flower Hospital, and Defiance Hospital.
Lenawee Health includes Herrick, Bixby Medical Center in Adrian, and other nursing homes and health centers.
But about 1,500 Lenawee Health patients visit ProMedica facilities in Toledo each year for services they cannot receive locally, Mr. Robertstad said.
This is the latest merger for ProMedica, which has joined forces with other health-care providers in Ohio. The company, with revenue of $900 million, has 11,400 employees and 2,576 beds.
Recognizing an increasing emphasis on managed care and the need for more services and doctors, Lenawee Health trustees began searching for a medical partner about 18 months ago.
The county's goal has been to attract about 15 doctors annually, but the number has stayed around 10 a year. The merger is expected to attract more doctors to the community.
Lenawee Health officials said that after reviewing three other organizations, ProMedica emerged as the best candidate.
Defiance Hospital officials announced plans in May to build a $40 million medical center by mid-2001 to replace their small, aging facility.
The complex will be on 50 acres outside the city at U.S. 24 and State Rt. 15. The hospital is now inside the city limits. Hospital officials believe the new location will be more accessible to the public.
Officials have been researching a possible move for five years. The board last year hired NBBJ of Columbus to conduct a site-feasibility study.
Plans call for construction of a two-story, 150,000-to-180,000-square-foot building. It would include larger, private rooms, a private emergency room setting, and a women's and children's center.
Officials decided to build the complex because of the projected cost of renovating the current facility.
The hospital on East Second Street was built in 1949. The land is owned by the city of Defiance, but is leased to the hospital through 2036.
The buildings and equipment are owned by Defiance Hospital, a member of ProMedica Health System in Toledo.
Wood County Hospital announced plans last month for a full-service medical clinic in North Baltimore as part of its effort to offer convenient health care to surrounding communities.
Design plans are not complete for the clinic, which will be built on about an acre on State Rt. 18 next to Blakely Care Center.
The building is expected to be a mirror image of a 2,000-square-foot clinic that the hospital opened last year in Deshler.
The hospital plans to open the clinic before the end of the year. The North Baltimore facility will be the fourth rural clinic opened by the hospital, said Stan Korducki, Wood County Hospital's chief operating officer. In 1999, the hospital opened primary-care clinics in Deshler, Bradner, and Grand Rapids.
Off-site clinics provide convenient health care to the hospital's remote service areas, Mr. Korducki said.
In the past, he said, "They have been underserviced with primary-care access.''
City officials asked the hospital for a doctor to serve North Baltimore. A part-time area physician with Wood County Hospital privileges now serves the area.
The hospital will recruit a full-time physician for the new clinic, which will have enough room and equipment for a second physician at peak times.