MetroHealth making smaller hospitals a focus

MetroHealth's 12- and 16-bed hospitals coming online next year will join the ranks of a series of other so-called "micro-hospitals" popping up around the country.

These small 24/7 inpatient facilities are designed to fill service gaps in hyper-local markets that couldn't support a full-scale hospital.

In a $25 million project, MetroHealth plans to add single-occupancy patient rooms to its Cleveland Heights and Parma facilities, each of which already has an emergency department and services including lab, pharmacy and radiology. With the addition of 12 beds in Cleveland Heights and 16 in Parma, the facilities will each become community hospitals — a term Dr. Akram Boutros, president and CEO of MetroHealth, prefers to micro-hospital.

"Cleveland has never experienced the feeling, the ambiance and care that gets generated in this kind of a community hospital," Boutros said. "Cleveland is used to much larger facilities and mega towers from University Hospitals, Cleveland Clinic and MetroHealth. ... There are so many reasons to do this, but first and foremost, it's demand from our own patients, who said we should do this."

Both of the facilities — located at 10 Severance Circle in Cleveland Heights and 12301 Snow Road in Parma — are former HealthSpan urgent care sites and medical offices. The HealthSpan dissolution last year has allowed MetroHealth to expand quickly and at a relatively modest cost. In addition to taking on these sites, MetroHealth hired many of the physicians that had been part of HealthSpan's medical group, including bringing on the group's top doc, Dr. Nabil Chehade, as its new vice president of population health.

MetroHealth announced in 2015 plans to take over the two urgent care centers and transform them into freestanding emergency departments, which came online in February 2016. Boutros said the possibility of converting these to community hospitals was a "major consideration" in the decision to bring on the facilities. Supportive staff and patient focus groups subsequently affirmed the idea.

In Cleveland Heights, the new patient rooms will be built on an empty floor. In Parma, they're looking to gut a floor that had housed procedure rooms. The total $25 million pricetag for the new facilities is significantly less than it would cost to build these community hospitals from scratch — $70 million to $100 million each, Boutros estimated.

The two locations already have "very robust" outpatient primary and specialty services, he said. "So adding the inpatient, private rooms just completes the offering to the community."

Health systems with micro-hospitals are often using them as entry points into specific markets, according to a report from Advisory Board, a global firm offering research technology and consulting to improve healthcare performance. Micro-hospitals can treat some high-acuity needs when necessary, but the goal is not to be all things to all patients. A good rule of thumb is locating the facilities within 18 to 20 miles of a full-service hospital, according to Advisory Board.

Several times a day, patients are transferred to other facilities or to MetroHealth's main campus from the Parma and Cleveland Heights locations. Of the cases that originate from these emergency rooms, about 70% would be appropriate for a community hospital, Boutros said.

MetroHealth's community hospitals, which are slated to be ready for patients by January, will offer adult medicine and focus on caring for patients in need of shorter stays, he said. Patients in need of pediatrics and obstetrics, intensive care or things like cardiac surgery would be transported to a larger facility. But most of those decisions would be made during a risk assessment up front to determine how the patient is best treated.

The expanded MetroHealth facilities, meanwhile, give the health system another foothold in the community. In particular, the expansion of the Cleveland Heights facility gives MetroHealth another anchor on the city's East Side — an area in which the system had only a modest presence until a few years ago.

Moreover, the expansions in Cleveland Heights and Parma escalate MetroHealth's efforts in areas where University Hospitals — the region's second-largest health system, behind the Cleveland Clinic — has a strong presence. The system's flagship UH Cleveland Medical Center sits about 3.5 miles away MetroHealth's Severance Circle location. Also, UH Parma Medical Center, a 332-bed facility UH took over in 2014, sits about the same distance from MetroHealth's expanding Parma site.

Boutros said he doesn't worry about competition.

"Our focus is to maintain our mission and our strategy, our mission for a healthier community and our strategy to serve everyone in Cuyahoga County with high-quality, low-cost care," he said. "This is all about the patient, not about competition."

Though in recent years, there's been some activity and interest in micro-hospitals across the country, the small-scale hospital model hasn't really taken off in Ohio, said John Palmer, director of public affairs for the Ohio Hospital Association. Ohio has some hospitals with fewer beds, but MetroHealth's approach of converting existing facilities is a new emergence in the state.

"I think what we're seeing is obviously hospitals becoming more, I think, in-tune to the communities," Palmer said. "What is appropriate? And then what ultimately are they able to provide? So whether it's an urgent care facility, whether it's an independent emergency department, whether it's a smaller scale hospital. ... Ohio's seeing a lot of activity with different service line changes."

As the healthcare industry nationwide sees a shift from inpatient to outpatient care, smaller hospitals may be one solution. As patients are treated in Cleveland Heights and Parma, Boutros said he expects the number of patients needing inpatient care at MetroHealth's West 25th street main campus will decrease proportionately.

The project to convert the facilities comes as MetroHealth takes major steps toward a dramatic transformation of its main campus. Earlier this month, investors reacted favorably to the system's $945.7 million bond issuance to fund the makeover, which includes the construction of a new 12-story, 270-bed hospital.

With construction in Cleveland Heights and Parma scheduled to be completed by the end of the year, Boutros said they'll be able to understand the inpatient impact of the remote locations before building the new tower. MetroHealth says the new facilities' aesthetics will be similar to the expanded Critical Care Pavilion, another major project that opened in 2016.

Including these small community hospitals, 80% of Cuyahoga County residents will be within a 15-minute drive of a MetroHealth hospital, according to the system.

Though the small hospital concept is new to Cleveland, Boutros is confident that the community will appreciate it.

"I expect that people who experience it are going to be so positively impacted by it that, given a choice for most of their care, that they will choose this site over the larger, more complex, harder to navigate sites," he said.

"MetroHealth making smaller hospitals a focus" originally appeared in Crain's Cleveland Business.