Growth in Idaho's health

Valley's health-care providers expand to serve growing population and give consumers more choices for their medical care

By Colleen LaMay

Idaho health-care consumers are just like any others across the nation: We want the latest machines and medicines, the best doctors and well-equipped, attractive hospitals. As the Treasure Valley’s population has exploded, we are getting our wish. Hospitals bursting at the seams have expanded to make room for new patients and new technology, and hundreds of doctors have opened practices to give us more choices and more up-to-date treatments.

"You can get almost anything you need to get done here," said Ed Baker, director of the Center for Health Policy at Boise State University. New technology, treatments and choices have a drawback, however: price. "Choice costs money," Baker said. Meanwhile, here as elsewhere, health insurance costs rise each year, and some Valley residents are one medical emergency away from a financial emergency.

Cheryl Ginsberg, an Emmett mother of two, knows health care can be expensive, and she is willing to pay the price. She underwent the popular LAP-BAND weight-loss procedure this past summer at Saint Alphonsus Regional Medical Center in Boise to help her lose 200 pounds. Her insurance did not cover the nearly $20,000 cost of the procedure.

"I know people say you have to do it for yourself, but I’m also doing it for my kids," she said. "They’re very active, and I don’t want to miss out on any more than I already have with them." Not so long ago, Ginsberg would have had to leave Idaho to have the surgery, but the past decade has seen the Valley’s two biggest acute- care hospitals — Saint Al’s and St. Luke’s Health System — more than double in size and add new locations and procedures, mirroring a national trend in hospital construction in other fast-growing U.S. markets.

St. Luke’s and Saint Al’s are not the only health-care facilities in the Valley to grow. Dozens of specialty clinics, outpatient surgery, rehabilitation centers and medical clinics have opened. Health-care providers of all stripes have "super-sized" in the past five years.

Sandra Bruce, president and chief executive officer of Saint Al’s for a decade, said the effect of growth on the bucolic Treasure Valley was hard to grasp in the 1990s. "There were estimates for population growth, but no one really understood the implications totally for health care, and particularly for the West (Valley) the growth has exceeded most of our expectations," she said.

The growth has kept both of the big, nonprofit hospitals very busy. "We find ourselves literally filling up from time to time," said Gary Fletcher, chief executive officer at St. Luke’s hospitals in Boise and Meridian.

Treasure Valley hospitals responded quickly as Idahoans fell prey in 2006 to the nation’s biggest outbreak of West Nile virus. A total of 962 Idahoans became ill, and 21 died, according to statewide figures. The sick packed area hospitals, Fletcher said.

To ensure that it continues to meet the Valley’s needs, St. Luke’s Meridian Medical Center, a 104-bed, full-service hospital that opened in 2002 in the middle of the fastest-growing part of the Valley, has room to grow someday into a hospital the size of St. Luke’s Boise, Fletcher said. In the meantime, the Meridian hospital can expand into its now-empty top floor.

Hospital officials in October 2006 bought 117 acres of land in Caldwell for future development. They also are talking about how to use property St. Luke’s owns around the Boise campus, but are nowhere near ready to make an announcement, Fletcher said.

Saint Al’s expands to help a growing community

Right now, it’s Saint Al’s turn to grow. A huge expansion at its Boise campus is adding a $161.2 million, nine-story patient-care tower that will open this year. It will have the capacity for 32 patient rooms, all of them private, on each floor. It will open with 22 intensive care beds, with a capacity for 32, a 16-suite surgery center, new pre- and post-operative recovery rooms with a new central sterile processing area, an auditorium and a new main entrance to the hospital, complete with a sweeping staircase to the second floor.

A new, $17.5 million Family Maternity Center and level III neonatal intensive care unit and an expanded Cancer Care Center opened in 2006.

The next city in the hospitals’ growth spurt is Eagle. The new, $17 million, Saint Al’s Eagle Health Plaza, 323 E. Riverside Drive, offers 74,000 square feet of primary care, lab, radiology and medical imaging, vision care, outpatient rehabilitation and pharmacy services, as well as physician offices and an outpatient surgery and procedure center. Other services will open in phases within a year.

St. Luke’s is not far behind. Eagle Medical Center is under construction at 3101 E. State St. It will have 62,000 square feet of space for doctors’ offices, radiology, laboratory services, outpatient surgery and outpatient rehabilitation. It is scheduled to open in 2008. Other bricks-and-mortar expansions in the Valley include:

St. Luke’s Idaho Elks Rehabilitation Services. Smaller facilities, such as the nonprofit Idaho Elks, also are flourishing. For example, a joint venture between the Elks and St. Luke’s, called St. Luke’s Idaho Elks Rehabilitation Services, began 10 years ago, but really took off more recently. The venture has 16 clinics, up from two, delivering physical therapy and other services at sites throughout the Valley. Two more clinics are expected to open this year.

Mercy Medical Center, Nampa. The nonprofit hospital’s fourth floor, which houses orthopedics and other services, is all new, with 21 beds, new equipment, Internet access and bigger rooms. During the summer, the hospital also purchased property along Interstate 84 near the new Costco store in Nampa. "We are committed to providing quality care to our community, so we need to grow as the community grows," said Ken Taylor, acting marketing director at Mercy.

West Valley Medical Center, Caldwell, just finished a major expansion of its emergency room. The number of emergency room visits increased from 17,690 in 2001 to 22,412 in 2005. "We can get you in much faster," said John McGee, marketing and public relations director for West Valley.

The rural Walter Knox Memorial Hospital in Emmett completed a two-year, $6 million expansion in 2005.

Free-standing surgery centers, often physician-owned, have mushroomed with the population. At least 21 of the facilities now dot the Valley, providing orthopedic, general and other specialty surgery options. The number of such centers has increased so much that the Idaho Hospital Association plans to ask the Idaho Legislature this year for a way to put the brakes on, if evidence shows the centers drive up health-care costs.

At issue is duplication of services. Costs for health care can increase if hospitals or free-standing clinics offer too many of the same services without enough paying customers to go around. The result for patients may be bigger hospital bills and higher insurance rates. "The dramatic population growth we’ve experienced the past 10 years has brought some exciting expansion and development in our health-care market, said Steve Millard, president of the Idaho Hospital Association, an industry trade group.

"But with that change and growth also comes the responsibility of making sure we can meet all the health-care challenges and needs of our community," Millard said. Idaho once had a law requiring hospitals to justify the need for new services. No more. Both of the major nonprofit hospitals offer a full array of services, with competition from freestanding, for-profit clinics.

For their part, patients go where they want for elective procedures, depending on health coverage, physician recommendations and how far they want to drive. "People’s time is pretty valuable," said Columbus Candies, director of St. Luke’s Idaho Elks Rehabilitation Services. "If therapy is accessible and close to where they live or work, they are more likely to come to a clinic where things can be done more efficiently."

Here as elsewhere, the growth in health-care services is fueled not only by population growth, but also by the demands of aging baby boomers and by new technology. Thanks to improvements in health care, patients spend less time in hospital beds. Doctors perform more surgeries through tiny incisions, meaning shorter recovery times and a quicker return to work. Here’s a rundown of some of what’s new in treatments in the Treasure Valley for common medical conditions:

Obesity

More than half of Idaho adults, 58.2 percent, are overweight, according to data collected by the state Department of Health and Welfare. More than one in three of those people are severely overweight, or obese.

An increasingly popular treatment for obesity is laparoscopic adjustable gastric banding with the LAP-BAND system, developed by a California company. Through two tiny incisions, a doctor slips a small ring over the upper part of a patient’s stomach so the patient will feel full without eating much. Most patients who are candidates for the procedure spend, at most, one night in the hospital after the surgery, which takes an hour or less.

The surgery is not a magic bullet for the average patient, a 40-year-old woman who suffers from two obesity-related ailments, such as high blood pressure and sleep apnea. Patients must undergo a psychological evaluation before the surgery and — afterward — eat right and exercise to keep the weight off.

"It’s the most fun thing I do," said Dr. Robert M. Cahn, a general surgeon who has performed 136 of the procedures in the past two years at Saint Al’s. "The patients do so well, and they are so happy," he said. "It is a transforming experience."

The total cost of the procedure is about $19,500, according to Sherry McClendon, business manager for surgical services at Saint Al’s. At press time in January 2007, Blue Cross of Idaho and Regence BlueShield of Idaho, the state’s largest insurers, were joining the ranks of companies offering coverage of LAP-BAND and other gastric-banding surgeries. Hospitals and doctors in the Valley were preparing to show they met national quality standards for weight-loss procedures.

Cancer

At St. Luke’s Mountain States Tumor Institute, with five locations, the staff is using more drugs targeted to attack only cancer cells. "The normal cell is not injured, and the abnormal cell is the only one that is affected," said Dr. Thomas Beck, medical director of MSTI. "This represents a boom as far as the number of choices we have."

With five-year survival rates rising for breast, colon, lung and other common cancers, patients are learning to live with cancer as a chronic disease, but a disease that requires years of expensive drug treatments, sometimes costing up to $100,000 annually. MSTI is conducting more than 100 clinical trials to determine which drugs to administer, and how, to gain the biggest benefit in fighting leukemia and other cancers. It also is about to recruit patients who are or were heavy smokers for a trial on prevention and early detection of lung cancer. If detected early, lung cancer is curable.

Genetic counselors at MSTI started a program aimed at helping identify women who are at high risk of developing breast cancer because it runs in their families. Counselors now can determine with up to 80 percent accuracy which of those women will get breast cancer, Beck said.

Heart disease

Doctors at St. Luke’s Boise Regional Medical Center, which performs more heart procedures than any other hospital in the state, are working to save Idahoans from the No. 1 killer in Idaho and the nation.

New help for patients with blocked arteries. Patients who need stents to prop open their diseased arteries can dramatically reduce the chances they will need more surgery later if a drug is used to coat the stents. The drug does a better job than bare metal at keeping the artery from clogging up again later. Stents are a kind of scaffolding that doctors insert into arteries during angioplasty. The special stents, known as drug-eluding stents, were under investigation this fall by the federal Food and Drug Administration because of the possibility that they caused blood clots in some patients. In December, a panel of U.S. heart experts said the devices should stay on the market.

In Boise, physicians are leaning toward keeping patients on drugs to prevent blood clots for a longer period of time than in the past, just to be safe. "We are monitoring at both hospitals outcomes as far as what is going on," said Dr. Marshall Priest of Idaho Cardiology Associates. "The bottom line is these stents are indeed safe."

Two million Americans have atrial fibrillation, some with no symptoms and others nearly debilitated by the condition. It is more common as people age. New treatment options for patients with severe symptoms are less invasive than ever before and require much shorter hospital stays. "We are on the verge of new modalities that can treat and cure atrial fibrillation," said Dr. Craig Olsen, a cardiothoracic surgeon.

Healing environment

Saint Al’s, which employs many of the same heart specialists as St. Luke’s and has its own, newly expanded cancer treatment center, is part of a nationwide movement to include hotel-like amenities in new hospital construction. Its new, nine-story tower and other new facilities will include many of the following features: calming colors, artwork of waterfalls and trees, indirect lighting, music, private rooms with views, noise reduction, wireless Internet connections, room-service-style dining options, and larger patient rooms with pullout daybeds for family members staying overnight. The idea is that all this will help patients stay calm and get well faster.

In addition, remodeling and new construction will virtually rid Saint Al’s of shared hospital rooms, which can spread infection.

"The consumers don’t want to share those rooms, and there is a definite decrease in hospital acquired infections when you don’t have two sets of caregivers going back and forth," Bruce said.

Colleen LaMay writes for Idaho Health. To offer story ideas or comments, contact her at clamay@idahostatesman.com or 377-6448.