County officials have been consumed in recent months by concerns over how public infrastructures like roads and schools can keep pace with population growth, leaving some residents and officials to ask: what about the hospital?
Between 2010 and 2035, the county’s population is expected to grow by 14 percent, according to state data. With that, Howard County is set to have one of the state’s largest increases of residents over 60 years old between 2015 and 2040.
All this growth is putting a strain on the county’s sole hospital, Howard County General Hospital, hospital President Steve Snelgrove said.
Snelgrove has spoken before the Howard County Council during its growth and development discussions, bringing up issues the hospital faces, including the need to provide new programs and services for the aging sector of the population, such as orthopedics and mature women’s health services.
“We just see huge growth and need going forward,” Snelgrove told the council in September. “The aging of the population alone is going to more than consume probably any capacity we can develop in the short term. We really need to get on this now.”
Unlike the county’s schools and roads, the hospital cannot be regulated by the county’s land-use policy, the adequate public facilities ordinance, because it is not a publicly owned entity; the nonprofit hospital is part of the Johns Hopkins Medicine System.
To help address its growing demand for services, the hospital is in the midst of both short- and long-term planning to ensure its infrastructure, much like the county’s, can keep pace with population growth.
In the short term, the hospital is in the beginning stages of a $45 million, two-story expansion, which will include new space for psychiatric care and observational units. The expansion will create approximately 30 more patient beds, according to Snelgrove, beds he said are needed to serve the county’s expanded population.
Looking into the long-term, Snelgrove said the hospital is constructing a facility master plan that looks at how the hospital can continue to meet the changing needs of a population that is getting increasingly older, meaning they will need more health care. The master plan includes a look at everything from the walkability of the hospital campus to its centers for expert care in areas such as cancer and women’s health, as well as more operational issues such as physician office space.
Snelgrove said the plan looks approximately a decade into the future for what the hospital can expect to need to provide, and includes the need to construct another bed tower on the hospital’s campus for an additional 50 beds.
The hospital hopes to release the master plan to the community within the next year.
The challenge, Snelgrove said, is in finding the funding for all of these plans.
Under the state’s hospital funding system, called a “global revenue system,” the Health Services Cost Review Commission sets limits on how much revenue hospitals have the authority to bill for patient services; so when a hospital sees an increase in patient volume, such as in Howard County, it does not make more money beyond its previously set revenue cap. For fiscal 2018, Howard County General’s revenue cap is $313 million.
If the hospital is set to make more money beyond the cap due to an increase in patient volume, it must lower the amount that it charges for services because it cannot go over the revenue cap, according to Paul Parker, director of the state’s Center for Health Care Facilities Planning and Development.
“The whole process is actually one in which hospitals are not necessarily strongly incentivized to increase in volume,” Parker said.
At Howard County General, this means that as the hospital has seen more growth in the last several years, particularly with the partial closing of Laurel Regional Hospital, it has become constrained in its attempts to fund capital projects to meet the demand, Snelgrove told the council in September.
The hospital is hoping to fund its current $45 million capital project in three ways: a third from philanthropies, a third from debt it will incur and a third from operational improvements, Snelgrove said.
The hospital is also requesting $5 million from the county this year to go toward the project; it requested that amount last year but was denied the funding by County Executive Allan Kittleman.
For the first time this year, the hospital plans to request to be added as a regular line-item in the county’s budget, much like other nonprofits in the county, Snelgrove said. The hospital hasn’t determined how much it will request, but this will be in addition to the $5 million in capital project funding they are requesting.
“If we don’t create the health care capacity in the community, it will have repercussions in many other ways. We don’t want people to drive great distances to get the quality of care that we provide here,” Snelgrove said. “There’s a ripple effect that can go on significantly beyond what most people think when we don’t have adequate health care. It’s just as important as schools, parks and businesses.”
Kittleman said it was too early in the fiscal year to comment on whether the county would be able to fund either of the hospital’s requests. The county’s fiscal 2019 budget will be approved in the spring.
Meanwhile, the hospital’s patient numbers continue to go up.
Hospital sizes are regulated by the state’s Health Care Commission, which regulates how many beds a hospital is licensed to host, updated on a yearly basis. Howard County General is currently licensed for 267 beds, but only physically has 244 beds in its facility. Licenses are granted based on the average daily number of patients in the hospital from the previous year, according to Parker.
The hospital has been steadily increasing its bed count, and therefore its patient numbers, over the last decade; in 2008 the hospital was licensed for 219 beds, according to state data. That increase is an anomaly in the state, where the total number of beds statewide has been steadily decreasing.
The key moving forward, Snelgrove said, will be making sure the hospital is able to continue to bring residents top-quality care.
“We aspire to keep our community healthy and well and disease free, and yet we know because of our demographics we’re going to continue to outpace the growth of other counties,” Snelgrove said. “We really need to work hand-in-hand with the community to make sure we have adequate health care.”