Health Compass Newsletter

By Robert Holland, MD, PhD, CMH Board of Trustees President

The announcement of a major remodel of CMH has generated considerable local interest. The effort will be one of the largest single construction projects for Clatsop County and will propel CMH into being one of the most modern small hospitals in the country.

Many questions have been received as to why the Board of Trustees decided to retain the 25 inpatient bed size, rather than increasing that number. With the cost of hospital construction now exceeding $1,000 per square foot, every inch of space must be scrutinized.

A shift to outpatient care

As a clinician with nearly 40 years of experience, I have witnessed a revolution in how medicine has developed and seen a giant shift away from inpatient care to extensive application of outpatient treatment and surgeries. When I trained, patients undergoing gallbladder surgery or a hysterectomy could anticipate spending three to five days in the hospital recovering.

Now, those having gallbladder removal, hysterectomies, knee and hip replacements, and many other procedures go home the same day and recover quickly. Change in surgery procedures alone removes much of the need for inpatient beds.

Powerful antibiotics that can be administered to outpatients, infusion centers, endoscopy clinics and increased office procedures have irreversibly changed the needs for inpatient admission. Patients are admitted now only with more serious conditions that are not yet amenable to outpatient therapy.

Medicare requirements

CMH is considered a Critical Access Hospital by Medicare, a designation which provides cost-based reimbursement allowing smaller hospitals in rural areas to afford providing lower-volume care in essential geographic areas. Requirements for this designation include limiting bed count.

A practical, creative solution

With this background, the board employed due diligence to evaluate countywide demographic and market share for inpatient bed needs. We took into account that the current average daily inpatient census is 12 patients and the average length of stay is three days.

We found that between CMH and the capacity of Providence Seaside Hospital, the county would have access to 50 beds.

Rather than increase the number of beds, the board decided to add four dedicated observation beds, which allow stays of up to 48 hours; add more Emergency Department and outpatient surgery pre- and post-operative rooms; and expand our telemedicine and virtual care options.

With these plans, CMH can modernize and serve community needs without necessitating any change in Medicare designation. We can add high-tech, state-of-the-art medicine in a Planetree atmosphere within appropriate fiscal limits.

Categories: BuildCMH