"I think the key point on all of this is that the state has approved these improvements and/or new construction to meet the demands of modern health care," said Jim Reiter, a spokesman for the Maryland Hospital Association.

"Many facilities were built decades ago, when technology and health care protocols were far different; getting people the right care, at the right time and in the right place, sometimes requires a new or improved place," he said. "And with the baby boomers aging and becoming sicker, hospitals today have to be ready not just to meet today's demands, but those of the future as well."

Many projects were in the works long before the recession, which has tamped down the level of new construction, said Richard Gianello of HFS Consultants, which offers financial services to hospitals.

He said the Hopkins project is among the largest he's heard about nationwide, but many other hospitals have decided that they need new facilities. Like Hopkins, most use a mix of philanthropy, debt and cash to pay for them.

In addition to making services more marketable to patients and doctors, who have rising expectations, hospitals can cut energy and staff costs with new, efficient buildings.

But some hospital administrators who haven't started construction are putting it off, waiting to see what happens with the court challenge to federal health care reform and with federal and state budgets, which can affect the amount they get paid.

Health care reform, Gianello said, could increase the number of paying customers, compared to the amount of charity care hospitals provide. But federal and state budget cuts could slash payments from programs such as Medicare and Medicaid.

"For some hospitals, that may tip the scale," he said. "It takes two to three years to get something built, so they may be waiting. Though one positive thing right now is interest rates are the lowest they've ever been. If they are going to do it, now is a good time."


Hospital highlights

The new $1.1 billion Johns Hopkins Hospital at 1800 Orleans St. in East Baltimore will include:

•1.6 million square feet of space, with two connected 12-story towers

•560 private patient rooms with sleeper sofas, full bathrooms and Internet access

•33 operating rooms, with imaging capabilities

•Adult and children's emergency rooms that are more than three times the size of existing emergency departments, able to accommodate 110,000 annual visits

•The children's center will be named for Charlotte R. Bloomberg, mother of New York Mayor Michael R. Bloomberg, and the adult center will be named for Sheikh Zayed bin Sultan Al Nahyan, first president of the United Arab Emirates

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