Birmingham hospitals are fighting to grab a piece of the 280 corridor. St. Vincent's built the One Nineteen Health and Wellness center on their 35-acre campus where 119 meets 280. Adjacent to that, Brookwood filed for a certificate of need to build an emergency department. Trinity currently seeks to find a new home in the digital hospital where 280 meets I-459. And everyone opposes everyone else's plans.

 

"We all compete for patients who are good payers," says Gerald L. Glandon, PhD, Chair of UAB's Department of Health Services Administration. "You may wake up one day and the people you want to treat — people with insurance, people who can pay for healthcare — have moved."

 

Providers move because populations shift, a chief demographic migrates, and facilities age; thus Trinity's reach for 280. "From a planning perspective, the digital hospital makes great sense," says Bill Heburn, CEO of Trinity. "Our current location is in a market that has contracted."

 

Forty years ago, when Trinity built on Montclair Avenue, it was the main route in and out of the city, and right down the street was the first shopping center in town. "It was the thoroughfare of the community. Now 280 and 459 are the thoroughfares," Heburn says.

 

Hospital planners must be able to read these shifts far into the future, like well-informed fortunetellers. "These are investment decisions that last 30 to 40 years," Glandon says. "What if in 10 years the population moves back downtown?" Revitalizing the urban core, he says, is not so uncommon, citing Chicago and parts of Atlanta and Boston. Birmingham has hopes to do the same.

 

"A few decades ago, the change in Medicare from cost-plus payment to Diagnosis Related Group (DRG ) was a wake-up call," Glandon says. "We all thought, maybe people don't have to stay in the hospital anymore." The resulting drop in inpatient procedures and shortened hospital stays has presented planners with more creative opportunities to reach their markets.

 

The ensuing need for care, but not acute care, created an explosion of rehab, wellness, surgical and diagnostic clinics. "They're a way to develop relationships with patients in that area," Glandon says. "As a healthcare provider, I want the patients. If they need a hospital, then I want them to come to us, so I decentralize by setting up this network of centers."

 

Brookwood, located about three miles from the 280 corridor, says 35 to 40 percent of residents in that area look to them for service. "Hospitals have a community they serve," says Stephen Preston, Brookwood Vice President of External Affairs. "Using zip codes, you look at the top 50 to75 percent of where your patients are coming from. It's very consistent year after year. Good planning is to continue to look for services they need."

 

Down 280, Brookwood found their patients had access to physicians and to inpatient services. "The concern was what happens if there's an emergency. That's why we put together the proposal for the freestanding Emergency Department," Preston says.

 

When Carraway closed, Birmingham's hospital planning adapted. Brookwood looked at patient demand and responded by asking for an emergency certificate of need (CON) for additional psych beds. "We knew they had a significant base, and we had a very good program here," Preston says.

 

The certificate of need presents an interesting challenge and tool for Alabama planners. The CON board's decisions must follow the state health plan that has determined by county the quantity needed in hospital beds, nursing homes, rehab centers, ambulatory centers, large diagnostic equipment, and more.

 

Providers can request an amendment in the state health plan and then apply for newly created space, says Michael A. Morrisey, PhD, Director of the Lister Hill Center for Health Policy at UAB. "But the sense is that it's pretty difficult to get the plan changed."

 

Hospitals often use the state health plan strategically in their turf battles. For example, in their bid to block Brookwood's 280 emergency department, Trinity claimed that the state health plan did not include parameters for such projects. They wanted Brookwood to have to try and amend the state plan.

 

On the horizon for hospital planners lies a possible dramatic change in demographics. A national health plan could make 46 to 48 million people suddenly insured. The richness of the coverage will determine the draw of the healthcare providers.

 

"If everyone got standard Blue Cross, then that makes the inner-city and north Birmingham very attractive," Glandon says. "Even just a stronger insurance mechanism may bring them to the door. So how as a planner are you going to accommodate that?"

 

"Responsible planning for your service area is ongoing and daily," Preston says. "You're constantly looking at your area's needs, and whether or not we are responding appropriately."