Building debate all about medicine

BOISE – Some Idaho hospitals want the state Department of Health and Welfare to temporarily stop construction or expansion of new facilities to prevent doctors in Boise from building a private specialty hospital that could offer surgeries at a lower cost.

Nonprofit and community hospitals pushing the moratorium include Saint Alphonsus and St. Luke’s regional medical centers. They fear specialty hospitals like the one now being promoted in the state capital will draw insured patients, leaving many uninsured patients to be treated at community hospitals.

St. Luke’s relies on revenues from procedures such as orthopedic surgeries in order to treat the uninsured, Medicare and Medicaid patients who receive costly services from the emergency room, children’s hospital or neonatal intensive care unit, Ed Dahlberg, chief executive officer of the St. Luke’s Health System, told the Idaho Statesman.

“Nobody is competing for the uninsured,” Dahlberg said.

Meanwhile, doctors with the specialty hospital say they can provide services for a lower cost than a community hospital. While the new facility may attract insured patients, it also will treat low-income and uninsured patients, said Dr. Kirk Miller, an anesthesiologist and one of 20 doctors promoting the new hospital.

“The solution goes to rectifying the uninsured, not allowing hospitals to maintain a monopoly,” Miller said.

Idaho is one of 13 states without “certificate of need” laws. These are in place in states including Washington to require that health care facilities win state approval before building, expanding or buying some equipment.

Since 1986, when the federal government no longer required such laws, Idaho has allowed the marketplace – not a state agency – to dictate when new facilities can be built.

Now, however, community hospitals say the marketplace is no longer working.

Since 2000, the number of surgical centers in Idaho has nearly doubled to 51, according to Health and Welfare data.

This surge in construction means there’s more competition for insured patients, nonprofit hospitals say.

Two years ago, Dahlberg said, St. Luke’s made $1 million from orthopedic surgeries.

In 2005, the hospital lost $2.6 million performing orthopedic surgeries.

“It’s the loss of volume and the loss of which patients come to you,” said Dahlberg, blaming the slump on new surgery centers.

The moratorium push pits the Idaho Hospital Association, which will support the temporary ban this week at a meeting of the Idaho Board of Health and Welfare, against the Idaho Medical Association. The medical-industry lobby said community hospitals enjoy tax advantages that should offset losses of patients that result from increased competition.

“Yes, (community hospitals) have to provide care to the poor, and they do it well, no doubt about that,” said Robert Seehusen, director of the Idaho Medical Association. “But they are compensated accordingly to take care of these folks.”

In addition to the moratorium, the Idaho Hospital Association wants the 2007 Idaho Legislature, which meets beginning in January, to consider the issue.