Growth in Idaho's health

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

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 scores of doctors have opened practices to give us more choices and more up-to-date treatments.

Look at Canyon County, where growth is expected to continue fast and furious over the next few years. During the past year, at least two hospitals bought up land they can grow into. St. Luke's Health System bought 117 acres in Caldwell, but hasn't said yet what will go there. Mercy Medical Center bought fields near the new Costco in Nampa, hoping to add more of whatever patients need, maybe starting in 2007. West Valley Medical Center in Caldwell is undergoing remodeling, offering people more help close to home.

The bottom line is the same for all of us, whether we live in Boise, Nampa or a smaller Valley city: "You can get almost anything you need to get done here," said Ed Baker, director of the Center for Health Policy and Public Health Research at Boise State University.

New technology, treatments and choices have a drawback, however: price. "Choice costs money," Baker said.

Nationwide, spending on health care is expected to double, to $4.1 trillion, by 2016, according to a 2007 study by federal economists. Most of us still don't pay the full cost of our own health care, but trends are continuing to shift year by year. In Idaho and elsewhere, some employers have stopped providing health insurance or have started making us pay more of the cost ourselves.

Problems are magnified for the uninsured. As the cost of going to the doctor, getting tests or being hospitalized rises, Idahoans without coverage may be one medical emergency away from financial ruin.

Cheryl Ginsberg, 46, an Emmett mother of two, knows health care can be expensive, but she is willing to pay the price. She underwent the popular LAP-BAND weight-loss procedure during the summer of 2006 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.

By early March 2007, she had shed 70 pounds, a record for her. She could walk and shop without getting so tired she had to sit down. "I still have a long way to go," she said. "But how far I've come is amazing to me."

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 - 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. Investors said in March 2007 that two new, for-profit hospitals would be built in the Valley. One of the hospitals would compete with Saint Al's and St. Luke's, offering many of the same services.

Dozens of specialty clinics, outpatient surgery and 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 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, Boise-based 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 984 Idahoans became ill, and 21 died, according to state health data. The sick packed area hospitals, Fletcher said.

To ensure that it continues to meet the Valley's needs, St. Luke's Meridian Medical Center, 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 also are talking about how to use property St. Luke's owns around the Boise campus, but are nowhere near ready to say anything about their plans, Fletcher said.

Saint Al's growth makes room for more of us

Right now, it's Saint Al's turn to grow. A huge expansion of its Boise campus is nearing completion. A $161.2 million, nine-story tower called the Center for Advanced Healing is set to open in three phases, one each month from September through November 2007.

The first through third floors will open first. The first floor will have a new auditorium, the second floor 16 new operating rooms and the third floor an intensive care unit with 32 patient rooms.

The third-floor waiting room will offer families nutritious food, comfortable seating, helpful staff, even a fireplace. Each floor boasts the latest in hospital architecture. (For more details about services on each floor, see the related story on page 9.)

In 2006, the hospital added a $17.5 million new maternity center, expanded its cancer care center and built a highly specialized, level 3 care unit for very sick or premature newborns.

Eagle is the next city in the spotlight for Saint Al's and St. Luke's. Saint Al's Eagle Health Plaza, a new $17 million, 74,000-square-foot facility at 323 E. Riverside Drive, will offer a 24-hour full-service emergency department, primary care, lab, radiology and medical imaging, vision care, outpatient rehabilitation and pharmacy and home medical equipment services, as well as physician offices and an outpatient surgery and procedure center. Vision care services and a few physician offices are open now. The other services will open this fall.

Not far away, St. Luke's is building a center of its own. 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. This joint venture between the Idaho Elks Hospital and St. Luke's began 10 years ago, but really took off more recently. The venture has 16 clinics, up from two, delivering physical, occupational and speech therapy across the Valley. Two more clinics are expected to open in 2007.

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. The hospital also has plans for its new land along Interstate 84 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.

The hospital presented a plan for the new north Nampa site to the Nampa City Council. Mercy could break ground before the end of the year on a medical office building, freestanding emergency department, diagnostic imaging and laboratory services. A second phase could follow with more office space and a bigger emergency department, along with inpatient rooms, operating suites and other services. All of the new services hinge on the needs of a growing population.

West Valley Medical Center, Caldwell, finished a major expansion of its emergency room. The number of emergency room visits increased to 22,412 in 2005 from 17,690 in 2001. "We can get you in much faster because of the expansion," 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 increased so much that the Idaho Hospital Association in 2007 asked the Idaho Legislature for a way to put the brakes on. The industry trade group wanted a state board to decide whether new surgery centers or expensive equipment really are needed in the Valley or elsewhere in Idaho. The plan went nowhere. Some lawmakers saw it as anti-competitive.

But Steve Millard, president of the hospital association, didn't agree. "We don't think competition works the same way in health care as in other industries, and there are a lot of reasons for that," Millard said.

Two of the main reasons: Most patients don't pay for the majority of their own health care, like they do new cars or groceries, and doctors can direct consumers toward a facility the doctor chooses, which also doesn't happen with cars or groceries.

"The dramatic population growth we've experienced the past 10 years has brought some exciting expansion and development in our health-care market," Millard said. "But with that change and growth also come the responsibility of making sure we can meet all the health-care challenges and needs of our community," he said.

Idaho for a time in the 1980s had a much-criticized certificate-of-need law to keep expensive services from being unnecessarily duplicated, but the version the hospital group wanted this year was new and improved, Millard said.

The hospital group is planning its next move. So far, the issue hasn't grabbed patients' attention. They go where they want for elective procedures, depending on health coverage, where their doctor practices 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."

More people need more medical care, but it's not just the sheer volume of newcomers driving our health-care expansion. It's also our new technology and our aging population.

Our aging bodies rely more on health care, but the upside is that we are in and out of the hospital much faster. Doctors perform more surgeries through tiny incisions, meaning we recover faster and are back at work or play sooner. Here's a rundown of some of what's new in treatments in the Treasure Valley for common medical conditions:

Obesity

The percentage of Idaho adults who are overweight hit 61.4 percent, an all-time high, in 2005, according to the most recent data collected by the state Department of Health and Welfare. One in four Idahoans is 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.

Ginsberg, the Emmett mother of two, underwent the surgery to help her keep up with her family. 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 often must undergo a psychological evaluation before the surgery and eat right and exercise to keep the weight off afterward.

"It's the most fun thing I do," said Dr. Robert M. Cahn, a general surgeon who has performed more than 135 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."

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 give - and how - to help the most in fighting leukemia and other cancers. It also will 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, 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. Some 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-eluting stents, were under investigation in fall 2006 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, but the investigation led to changes in patient care here and across the U.S.

"The issue with drug-eluting stents continues to evolve," said Dr. Marshall Priest of Boise Cardiology Associates. Until more safety data is in, fewer patients in the Treasure Valley are getting the stents, and those patients take drugs for at least a year to ward off blood clots.

Two million Americans have atrial fibrillation, the most common of abnormal heart rhythms. Some have no symptoms and others are 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 is part of a nationwide movement to include hotel-like amenities in new hospital construction. Its new tower and other new facilities will include calming colors, artwork of waterfalls and trees, indirect lighting, music, private rooms with views, noise reduction, wireless Internet connections, room-service-style dining choices and larger patient rooms with pullout daybeds for families. The idea is that patients will stay calm and get well faster.

In addition, remodeling and new construction are ending an era at Saint Al's: No more 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.