THE VIRGINIAN-PILOT
Copyright (c) 1994, Landmark Communications, Inc.
DATE: Friday, August 12, 1994 TAG: 9408120569
SECTION: FRONT PAGE: A1 EDITION: FINAL
SOURCE: BY DIANE TENNANT, STAFF WRITER
DATELINE: NORFOLK LENGTH: Long : 159 lines
The blessings of the state and the prayers of parents will join today as Children's Hospital of The King's Daughters opens its new eight-story addition, nearly tripling the size of Virginia's only pediatric hospital.
The $72 million wing will house all inpatient rooms, the region's first pediatric emergency room, diagnostic services, family support areas and a greatly expanded intensive care unit for newborn and premature babies. The existing hospital will house expanded outpatient services and allow hospital offices that are now scattered throughout the community to move back into the central facility.
``It is a project that was needed at a cost that was the best we all could do,'' said Paul M. Boynton, executive director of Eastern Virginia Health Systems Agency, which reviewed the hospital expansion plans for the state. ``I'm very, very pleased with the quality of care there. It's a facility that needs to be highly valued.''
The hospital originally planned an $81 million renovation and expansion, which would have added 56 beds. Although King's Daughters has the highest occupancy rate of any Hampton Roads hospital, its plans were too large and too expensive for the state to accept. The hospital reduced the plan to $72 million and dropped the number of additional beds to 34. Some of those beds have since been added.
Including interest payments on bonds, the project will cost $137 million.
The hospital has raised nearly $10 million in community donations and will use $12 million from its reserves. The remaining $50million came from bonds, which sold in two hours, said Richard D. Knox Jr., the hospital's chief financial officer.
``There was a lot of interest because we're an A-1 rated hospital,'' he said. ``There's a lot of interest in this hospital.''
King's Daughters is the region's most expensive hospital, and the most profitable, although it is a nonprofit institution. All ``profits'' return to operating the facility.
However, its rates were 21 percent below the average for pediatric hospitals nationwide in 1991, when the state reviewed its figures.
Costs are higher at King's Daughters because more than half of its beds are tertiary, meaning that it provides care for the sickest children and has numerous specialists on staff. Hospitals from eastern Virginia and northeastern North Carolina refer patients to King's Daughters for specialized treatment. A general hospital has less than 10 percent tertiary beds.
Despite that, the hospital does not turn patients away because they cannot pay. Hillary Rodham Clinton's health care reform task force called the hospital at one point to ask about its practice of having Medicaid eligibility workers on site to help patients sign up for financial help.
``We were the first hospital to do that,'' Knox said. ``That's just our philosophy, treat the patient first, then worry about the finances.''
King's Daughters has promised the state that its rates will not skyrocket because of the expansion, he said.
The hospital is the largest pediatric CHAMPUS provider in the nation and Virginia's largest Medicaid provider. Population projections of a 14 percent increase in children in this region by the year 2000 helped convince the state that expansion was needed.
The hospital was founded on service to the poor. In 1896 a charitable organization of women called The King's Daughters began sending a single nurse around the city to treat poor children. She rode a bicycle. In the early 1900s, a clinic opened. It served 11,215 a year by 1930. In 1961 the first bona fide hospital was built at a cost of $1.25million.
One of the most radical tenets of that facility was its contention that sick children would be better off if their parents could stay overnight with them. That is still the hospital's philosophy, but it has become more and more difficult as services and patient load have grown.
The expansion will remedy that, Knox said.
``We're treating a family, we're not just treating a child,'' he explained. ``There's just not been the space to let them stay with their child, which is what they want. This is a traumatic time for the child, but also for the parent. The nicest thing about the new hospital is it gives us the space finally to have the family stay.''
Nationwide, health care reform has cut hospital admissions, said Larry McAndrews, president of the National Association of Children's Hospitals and Related Institutions. Because children need inpatient services only one-fifth or one-tenth as often as do adults, general hospitals have often reduced pediatric services because they can't afford to keep specialists on staff.
``In some markets, this has meant the children's hospitals have seen an increase in demand,'' McAndrews said. ``I think the addition of new beds has relatively plateaued. There are a few markets where they're adding beds, but not many.
``What's happening in managed care is that there is a strong effort being made to keep kids out of the hospital through both managing the care that a child receives and also by doing more on an ambulatory basis.''
In line with that, King's Daughters will expand its outpatient services.
``The real challenge will be to maintain quality during a heavy emphasis on cost reduction,'' said Barbara L. Biehner, chief operating officer.
The hospital will turn more and more to outreach programs and prevention services, although it will still be the regional referral center for children who need specialized treatment, she said. In the future, she explained, ``we're not going to be paid to make people well. We're going to be paid to manage people's health. That is where the challenge is.''
King's Daughters treats many victims of avoidable accidents, children who would not have been patients had they received immunizations, been strapped into car seats or worn bicycle helmets, Biehner said. ``So much of what we need to do is in health and wellness and prevention.''
Still, she said, there will be a need for tertiary care, and the region will be best served by having one facility to do that.
``I think regionalization will still be a critical component no matter what reform turns out to be,'' she said. ``I still think there will be a need for tertiary services, and they need to be regionalized.''
The biggest threat to children's hospitals is from general hospitals, some of which are adding pediatric services, McAndrews said. But while they can add space, they don't treat the volume of patients needed to keep pediatric specialists and subspecialists on hand, he said.
The result is that patients in general hospitals do not receive specialized care, and children's hospitals lose the patient volume they need to keep those specialists on board, McAndrews said.
King's Daughters, which already has a large number of community pediatricians with whom it works directly, has begun working with other hospitals and doctors to develop referral standards and cooperative agreements.
``I think the challenge is to get out of the competitive mode and into the collaborative mode,'' Biehner said. ``We should be looking at the need in the community and how we can provide that.''
The hospital's expansion will support the specialized services that are unique to a children's hospital and will expand the outpatient and diagnostic services available. Both are essential if the hospital is to continue the century of service begun by one visiting nurse, said Sara Bishop, chairman of the hospital board.
``We are not duplicating what is already there,'' Bishop said. ``We wanted a facility that was pediatric focused, . . . but one that would provide comfort to a family in stress.
``We needed equipment that was specially built for children. We were at the point of drastically needing more space.
``It is a building that will take us into the future.'' ILLUSTRATION: Staff color photo by IAN MARTIN
A mix of community donations, cash reserves and bonds was used to
finance the addition, opening today.
Graphic
CHILDREN'S HOSPITAL OF THE KING'S DAUGHTERS
EXPANSION'S COST: $72 million.
SIZE: Eight floors, which will nearly triple the hospital's total
space.
FEATURES: The addition will house all inpatient rooms, the region's
first pediatric emergency room, diagnostic services, family support
areas and a greatly expanded intensive care unit for newborn and
premature babies. The existing hospital will house expanded
outpatient services and allow hospital offices that are now
scattered throughout the community to move back to a central
facility.
[Includes color map].
For copy of map, see microfilm
KEYWORDS: CHILDREN'S HOSPITAL OF THE KING'S DAUGHTERS
by CNB