A State of Change: Southern Delaware hospitals feel the pressure to expand as the population soars
Delaware is known as the “Small Wonder,” but when it comes to health care, the state is facing some big issues. Despite Delaware's size, the challenges can differ drastically for health care systems above and below the Chesapeake & Delaware Canal. In this two-part series, contributor Pam George takes a look at how the state's hospitals are addressing the issues – together and apart. In her second piece, she examines Kent and Sussex Counties.
In the early 1900s, Doctors James Beebe Sr. and Richard C. Beebe often performed tonsillectomies and other surgeries on the kitchen table in Sussex County farmhouses. There were no public hospitals in Sussex County, and the roads north were primitive at best. In 1916, the brothers opened the three-bed Beebe Hospital on land owned by their father in Lewes, their hometown.
In the century since the Beebes brought modern medicine to Sussex County, the hospital has expanded multiple times to care for area residents and coastal tourists – and that’s not about to change anytime soon.
“We’re serving the fastest-growing population in the state, certainly in Southern Delaware,” said Jeffrey M. Fried, president and CEO of Beebe Healthcare. A significant part of that growth has occurred inland in new housing developments, he noted. “To do a better job of serving our community, we needed to figure out how to take care of people without them having to travel all the way to Lewes.”
Offering care close to home is also the mission of Nanticoke Health Services in Western Sussex County, and Milford Memorial, which is part of Bayhealth Medical Center. Like Beebe, Milford is also facing a growth spurt; the town grew 30 percent between 2000 and 2010.
But expansion isn’t easy. Like all hospitals, these health care systems are tasked with reducing costs. Their service area also includes retirees, rural residents and, in the case of Beebe, seasonal population fluctuations, all of which present distinct challenges.
Onward and Upward
The population boom in the early 21st century led to several significant hospital expansions. In 2012, Kent General Hospital in Dover, also part of Bayhealth Medical Center, added a 400,000-square-foot building that tripled the emergency department to 35,000 square feet and integrated cancer care.
Adding on to Bayhealth's Milford Memorial Hospital, however, was a problem. Buildings and residences surround the downtown hospital, portions of which date back to 1938.
The solution is a new six-story hospital, which is currently under construction just off Route 1. “When we looked at spending $300 million of the community assets, it was very important that we look at the right decision not just for five or 10 years but a decision that would serve generations ... 50 to 100 years out,” said Terry Murphy, president and CEO of Bayhealth Medical Center. The six-story hospital will have a planned 128 single-patient beds and an emergency department with up to 30 treatment spaces.
The border between Sussex County and Kent County runs through Milford, and the hospital is in Sussex County, an area under rapid development. Beebe Healthcare, less than 20 minutes to the south, has also recognized the need to expand. Like Milford Memorial, the hospital is old. Portions date back to 1921. The additions since then have created a patchwork quilt of buildings.
“We recognized early on ... that we needed more private rooms – that’s what everybody wants, and it’s what they should have these days,” Fried said. Private rooms improve the patient experience and reduce the risk of infection, he explained.
In late 2015, officials announced plans to build on its original campus in downtown Lewes. Some were surprised given that Beebe has room on its Route 24 campus, which is home to the Tunnell Cancer Center, outpatient facilities, medical offices and a walk-in care clinic.
Replicating the hospital outside the Lewes city limits would cost about $350 million, Fried said. To renovate and expand in Lewes would cost $200 million. The project includes a five-story addition to the existing hospital, which will hold a proposed 112 private rooms, operating rooms and cardiology electrophysiology and interventional rooms.
Beebe plans to put the $150 million saved by building in situ toward services and facilities that keep people out of the hospital. There are already Beebe locations from Milton to Millville and in Millsboro, Long Neck and Georgetown. Beebe’s current improvement project may include the expansion of the Tunnell Cancer Center and services in the Bethany Beach area.
Bayhealth is devoting a portion of its new campus to outpatient services, physician offices and diagnostic services. Milford Memorial will occupy just 50 of the 169 acres. Plans also call for Nemours/A.I. duPont Hospital for Children to have a presence on the site. Said Murphy: “The campus allows us to do so much more.”
Keeping patients out of the hospital isn’t limited to ambulatory and walk-in sites. Nanticoke Health Services, which is licensed for 99 beds, is building an eight-bed observation unit for patients who require 24-to-48-hour stays to determine if they need full inpatient admission to the hospital.
“We’re doing more to make sure if they need to be admitted and if that’s the right clinical decision,” said Steve Rose, president and CEO of Nanticoke Health Services. The unit will also help patients move faster through the emergency department, he said.
Together yet Apart
Given the move toward outpatient care, you might wonder why health care systems are building new hospitals. It's because hospitalized patients typically have multiple chronic conditions. Many are seniors.
To be sure, all of Southern Delaware’s hospitals are concerned about the area’s aging population, which experts predict will double by 2030. “Most of the growth in the county is retirees,” Fried said. “The percent of people in our service area who are over the age of 65, it’s about 26 percent,” which is near twice the national average.
In response, Southern Delaware hospitals are boosting the services that many seniors need, such as cardiology and orthopedics. Nanticoke recently invested in its cancer care program by adding more room for infusions.
Nanticoke Cancer Services in Seaford and Beebe’s Tunnell Cancer Center have an affiliation so Beebe’s radiation oncology physicians can treat patients at Nanticoke. As a result, Seaford-area residents can receive treatment close to home.
The partnership is not unusual. “I see more cooperation among the health care systems here in Delaware than in some of the other areas where I’ve worked before,” Fried said.
In September, Christiana Care Health System, Bayhealth Medical Center, Beebe Healthcare and Nanticoke Health Services formed eBright Health, an alliance to share strategies to improve population health, treatments and outreach. It’s part of Delaware’s Quality Partners Accountable Care Organization (ACO) Medicare Shared Saving Program, which began in January 2016.
The ACO focuses on Medicare populations. “About 65 percent of our revenue here is from Medicare,” Fried said. “Like most hospitals, we lose money on every Medicare patient on average. It certainly affects us from a financial standpoint to manage what we do here.” If ACO groups are successful at lowering costs and improving care, they get a share of the savings. eBright will also give the hospitals greater buying power when it comes to third-party contracts.
Both Beebe and Nanticoke have remained independently operated throughout their existence. Rose doesn’t foresee a merger anytime soon. “eBright Health has been filling that void,” he said. “And, in fact, it’s a better model than a merger.”