Anticipating a high demand for its outpatient services, Howard County General Hospital wants to more than double the size of a three-story ambulatory services facility that it is now building.
A spokesman said the expanded outpatient facilities will be needed for the hospital to compete with doctors who are performing more outpatient surgery in their private offices. In the first eight months of fiscal 1995, the growth rate for outpatient surgeries at the hospital fell for the first time in its 22-year history.
"Everything in the industry is moving to outpatient services," said John Walker, a spokesman for the hospital. "It allows the hospital to compete on price."
The enlarged plan for its new ambulatory services building is just one of several steps the hospital has taken during the past year to remain competitive in the rapidly changing field of health-care delivery.
Last fall, the hospital signed an agreement with the University of Maryland to create a regional oncology center. And this spring, it announced that it is creating an alliance with local doctors so that it can market their services and the hospital to health-maintenance groups.
The hospital, which has a budget of $76 million in fiscal 1995, which ends June 30, also plans $3 million in renovations to existing facilities.
The site plans for the enlarged ambulatory services facility -- filed May 22 with the county's planning and zoning department -- would allow the hospital to add four stories to the ambulatory services building, increasing its height from 27 feet to 91 feet.
The county's subdivision review committee, a group of representatives from several county planning agencies, meets tonight to discuss the new proposal.
The first, three-story phase of the building -- costing $9.5 million -- is under construction next to the hospital in Columbia's Hickory Ridge village. It is expected to be completed during the first quarter of 1996. No date has been set for construction of the proposed addition.
"Our first priority is to complete construction of the . . . building and make its services operational before addressing a new addition," Mr. Walker said. "We filed [the site plans] because we're anticipating future needs."
The hospital's long-range plans to expand its ambulatory services comes as it faces long-term financial challenges.
Its reported profits were up in the last fiscal year, but its occupancy rate has fallen from 81 percent in 1990 to 57 percent in the first nine months of this fiscal year.
That trend is likely to continue with health insurers forcing lower medical care costs and directing patients to less-expensive hospitals and outpatient service facilities, such as surgical centers, diagnostic-imaging centers and testing labs.
To compete, community hospitals throughout the state and the country are being forced to add more ambulatory -- or outpatient -- services, said Nancy Fielder, a spokeswoman for the Maryland Hospital Association.
"Ambulatory services now account for the majority of services provided," Ms. Fielder said. "It used to be if you had surgery, you stayed in the hospital . . . but that has changed dramatically."
From 1984 through 1993, the number of ambulatory surgeries in the United States increased from 5.5 million to 12.6 million, Ms. Fiedler said.
In Maryland, the number of ambulatory surgeries performed in hospitals alone increased 11 percent from 1992 to 1994, she said.
Howard's ambulatory services building will house all the hospital's outpatient services, four operating rooms, a cardiac-diagnostic facility, a birthing center and the hospital's health education programs. Outpatient services are now dispersed throughout the hospital.
Mr. Walker said the hospital has no specific plans for how the 48,000 square feet of additional space in the proposed four-story addition would be used.
The addition would require an exception because at 91 feet, the building would be 11 feet higher than the county limit. It also would require improvements to the building's storm water management system, said Cindy Hamilton, a planner with the planning and zoning department.