Response to FLHSA's Acute Bed Need Task Force Report
January 31, 2008
"We are deeply disappointed with the report's long-term projections for additional bed needs between now and 2015."
We appreciate the complexity of the Task Force’s charge in projecting future bed needs for our region. Changes in our health care delivery system, shifts in insurance coverage, prevalence and standards of care for patients with chronic illnesses, demographic trends, and other factors make accurate projections particularly difficult.
Yet, it is imperative that we begin this process with an accurate and mutually acceptable estimate of community bed need. By failing to add enough beds, we continue to risk patient access and safety; by adding too many beds, we drive up costs unnecessarily.
We agree with the Task Force’s conclusion that 93 new beds are needed immediately to alleviate current overcrowding. Based on the current occupancy at Strong Memorial Hospital of 103%, Strong alone will require 83 beds to achieve 85% occupancy today.
We are deeply disappointed with the report’s long-term projections for additional bed needs between now and 2015. According to the HSA Task Force’s “low estimate,” the need for beds will increase by only 83 by 2015, meaning that 10 of the 93 new beds would actually be taken out of service. We believe that this estimate is extremely low based on several assumptions that are unrealistic. Therefore we dissented from the task force recommendations.
Facing occupancy rates of over 100%, Rochester’s hospitals have already been forced to maximize efficiency, working to discharge patients as soon as they are ready to leave the hospital. Each hospital has also taken steps to shift more care to outpatient settings within the hospitals themselves. In order to reduce 10 beds, we would need to accelerate our length-of-stay reductions at a much faster rate than we’ve been able to achieve in recent years. Therefore, the aggressive length-of-stay reductions (more than 10% decrease) that underlie these projections are unrealistic. We fear that if this projection is adopted, it could be dangerous for our community.
The “high estimate” calls for adding 147 beds (including the 93 immediately needed beds) between now and 2015. This is a much more plausible scenario, yet it may also be too conservative given the growth experienced at the Medical Center. Because of our high concentration of specialty care, URMC attracts patients from a broader geographic area than the 9-county service area considered by the Task Force.
Plus, the Task Force Report assumes that the number of patients from outside the region who will be hospitalized here will remain steady, contrary to the experience of the University of Rochester Medical Center. In fact, we’ve experienced a 16% growth in the number of patients coming here from beyond the 9-county region, and we expect this growth to continue. The Task Force report does not incorporate incremental growth in the number of out-of-area patients in its future projections. We are also concerned that the report doesn’t fully account for the growing complexity of patients and the effect of chronic diseases among our aging population.
We do take some comfort from the fact that this phase-one report repeatedly acknowledges that there are serious issues concerning bed needs that will only be analyzed in phase two by the 2020 Commission. We look forward to participating in that process.