The New Hospitals: Medicine Heads for the 'Burbs

Rumors have been circulating that Mount Carmel Health Systems will move the majority of its Mount Carmel West campus operations from Franklinton to Grove City. While Mount Carmel's senior vice president of strategy and planning Hugh Jones says the company has "explored options for the future of that campus" but can't elaborate on that at this time, the reports beg an intriguing question: What happens to health care access when more and more people move to the suburbs and take their steady incomes (and premium insurance coverage) with them?

Freestanding emergency departments have been popping up in suburbs with increased regularity ever since Mount Carmel opened the first one at Diley Ridge in 2010 to serve a growing population in Canal Winchester. Then came OhioHealth's emergency care center at their Westerville facility in 2012.

This spring, Mount Carmel opened a full-service, freestanding emergency department in Grove City that includes 15 exam rooms, lab and imaging services and a medical building for doctors' offices and outpatient services like physical therapy and cardiac rehab. OhioHealth purchased land not too far from that location right around the same time Mount Carmel did in 2012, but OhioHealth has not yet decided (or publicly announced) what they'll

do with it.

"We are trying to determine exactly what we'll do there," says Mike Bernstein, senior vice president of planning and chief strategy officer for OhioHealth. "As we purchased that land, we were trying to anticipate what the future health care needs of the people of that community are. There are a variety of options that we're exploring."

OhioHealth is building a $42 million medical facility in Pickerington, scheduled to open next spring. The 150,000-square-foot facility will include an emergency care center, imaging and rehab services, heart and vascular care, primary care and an outpatient surgery center.

Jones says Mount Carmel plans new facilities based on the needs of the community. The company built the emergency department in Grove City, he says, because there was a clear need. "That corridor [south of I-70, along I-71 south] is one of the faster growing areas in the state," he says. "We were looking at a community that was not being served and had achieved a critical mass and critical need for services."

Still, there is the question of overlap.

"Did we need a freestanding emergency room in Westerville two miles from St. Ann's?" says Cathy Levine, executive director of consumer advocacy organization Universal Health Care Action Network (UHCAN). "My gut tells me no." The Westerville campus is an OhioHealth facility, while the hospital at St. Ann's is part of Mount Carmel's system.

There might be overlap, but it's considered a duplication of service only if there's not enough need to justify it. Several factors indicate there is.

"The population of Central Ohio has been growing, and so it's almost like the maxim of 'retail following rooftops,' " says Bill Lafayette, owner of economic consulting firm Regionomics. "You're looking at population growth as a factor and, to a degree, the income level of the population. You're also looking at the aging of the population. Because older people need more health care than younger people."

OhioHealth's Bernstein says the shift in health care from a fee-for-service environment to value-based care delivery, where preventive medicine is a priority, is driving change.

"The change we see is less demand for inpatient capability," he says. "It's going to drive greater need for more outpatient or ambulatory services done in conjunction with primary care physicians and some specialists."

Convenience is part of value-based health care, he says. It's not just about "delivering the highest quality at the lowest cost," but also "delivering care that's convenient and accessible to the community, close to where they live and work."