The first waves of a health care storm will start lapping at Tri-City hospitals and physician offices next year as the area population ages and retires and health care workers become more sparse.
Health care providers are working now to develop plans to deal with the flood of patients to come.
"We see this perfect storm of more patients, older patients who use more services and lower reimbursements," said Rand Wortman, Kadlec Regional Medical Center CEO. "I think that's the future of health care in general around the United States and certainly in the Tri-Cities too."
The three area hospitals -- Kadlec, Kennewick General Hospital and Lourdes Medical Center -- are going through strategic planning to figure out how they will handle the needs of the baby boomer generation as they start to retire in 2011.
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"The thing we're looking at is, 'Where do we want to be in five years and our goals to do that?' " said Vic Johnson, chairman of the Kennewick Public Hospital District Board.
And Tri-Cities Community Health, one of the largest primary care providers in the region, is making room for an influx of patients. The former La Clinica is expanding its main medical office on Court Street in Pasco, and recently doubled the size of its 5th Avenue Urgent Care center, also in Pasco.
"One of the things that's interesting is the growth that's happened, especially in Pasco," said Diann Kummer, chief operations officer for Tri-Cities Community Health. "The need for medical facilities is only going to grow."
The U.S. Census Bureau considers anyone born between 1946 and 1964 part of the boomer generation. The first of them will turn 65 and move from private insurance onto Medicare in 2011.
Wortman said that presents challenges for health care providers because Medicare tends to pay less for services than insurance companies.
Kummer said Tri-Cities Community Health expects to get a lot of those patients. "A lot of providers don't see Medicare patients. We do," Kummer said.
Kadlec and KGH have expansion plans in the works -- Kadlec to build the remaining floors of its River Pavilion tower, and KGH to build a new hospital at Southridge.
But both plans are dependent on government approval, from the state to add beds to each hospital and for KGH from the federal Department of Housing and Urban Development for a loan to build a new facility.
Meanwhile, both also are looking at expanding medical practice areas where they see needs.
Over the past decade, Kadlec invested in a cardiac surgery practice, and recently expanded into neurosurgery. In the next few months, the Richland hospital will break ground on a new building on Goethals Drive that will house a variety of neurosciences, the Kadlec Neurological Resource Center, diagnostic imaging and rehabilitation services.
Wortman said Kadlec will have four neurosurgeons on staff by October, giving full-time coverage to its emergency department. And three neurologists will be in place by later in the month.
One focus area is pain management, which Wortman said is a need in the Tri-Cities.
Johnson said the Kennewick Public Hospital District Board also has discussed enhancing pain management offerings, as well as care for stroke and cardiac patients.
The board also discussed improving its gerontology offerings to meet the needs of the aging population, Johnson said. "KGH is the only one that has that type of thing now," he said, referring to the Rod Coler Center for Senior Health.
The Coler center offers primary care and medical testing specifically for seniors, as well as nutrition counseling, dementia care and coordination with social services.
While Lourdes Medical Center isn't looking to add beds at its Pasco hospital, within the past year it opened a clinic and imaging center in west Pasco, and just a few days ago unveiled its revamped Same Day Surgery Center.
Lourdes CEO John Serle said the hospital has been investing in technology that will make health care more efficient and add to the services offered in the region rather than duplicating what others already offer.
New surgery robot
That includes the addition of a Mako surgery robot, which can be used for knee and hip replacements. The robot maps a three-dimensional image of the knee or hip, then lets the surgeon map out on the image where the cuts will go. The surgeon then guides the robotic arm while performing the procedure, and the robot won't cut outside the mapped area.
The robot allows for more precisely controlled surgery. That means fewer risks for patients, and surgeons can feel more comfortable performing partial knee replacements, which may extend the life of a patient's natural knee and stave off a total replacement
Serle said it's one of only three robots of its kind in Washington and the only one in Eastern Washington. The other two are in Vancouver and Seattle.
"It's a good example of buying technology in health care and then using it across the region," Serle said. "It will be available to any orthopedic surgeon in the Tri-Cities who wants to use it."
He anticipates the robot will get a lot of use among people in their 40s, 50s and 60s as joints start to wear out and need partial or full replacement.
"Because it's a sizable investment, we need to be able to anticipate (patients)," Serle said. "Understanding the need of the demographic is important. This machine provides a wonderful alternative."
Lourdes also has acquired a new MRI that has a larger opening than the typical MRI machine. It should be more comfortable for patients, who can feel claustrophobic when spending an hour in what amounts to a small tube as they're scanned.
Serle said the new machine replaces Lourdes' old MRI with cutting edge technology that's one of about 20 of its kind in the country.
But the latest technology is expensive, and health care providers face the challenge of trying to offer cutting edge diagnostics and treatment even as reimbursements are dropping and costs are rising.
Wortman said the factors driving rising costs include the expense of technology, a shortage of health care workers nationwide, which means salaries must rise to attract people to the industry, and prescription drug costs that are going up quicker than the rate at which hospitals are reimbursed for them.
"Almost every resource we use is costing more each year relative to reimbursement," Wortman said. "As a country, something has to give. I don't think it matters whether the Republicans take charge of Washington, D.C., or the Democrats remain in charge -- the truth is we have to provide more services for less cost. What doesn't seem to be talked about out there is who's going to be denied services as the economics squeeze tighter and tighter into the future."
Another uncertainty is how the health care reform law enacted by Congress six months ago will unfold over the next few years. It's unclear how that might affect Medicare reimbursements and contracts with private insurance companies, which are claiming coverage mandates in the new law are forcing up premiums and driving down what they can pay providers.
"Insurance companies are telling us that health reform as passed by the Obama administration is going to harm them dramatically, so they want to give us little or no increases moving forward," Wortman said.
New children's services
Not all expanding services relate to older adults. Pediatric offerings also are changing and growing, especially as Seattle Children's Hospital expands its Tri-City clinic in Richland.
Mitesh Parikh, the Seattle hospital's director of strategic planning, said a variety of specialists come to the clinic periodically to treat children with chronic disorders.
Specialties offered now include cardiology, nephrology, orthopedics, prenatal cardiology, pulmonology and rheumatology, as well as pediatric chemotherapy.
Later this fall, Seattle Children's regional clinic will add gastroenterology, general surgery, craniofacial surgery and urology specialties.
The expansion has been driven by conversations with local pediatricians and family doctors, as well as an analysis of what kind of illnesses were bringing Tri-City families to the Seattle hospital.
"As one of the areas that is continuing to grow in population, that has continued to translate into more chronic care needs," Parikh said. "Responding with a local presence made sense."