If employers, regional health-care providers and the community at large didn't have serious questions about UPMC's proposed hospital in Monroeville before the Monroeville council approved its rezoning request, they certainly should now.
Employers who provide health-care benefits were stunned in November when the University of Pittsburgh Medical Center said it would build a full-service hospital in Monroeville. The proposed hospital would be less than two miles from Forbes Regional, a West Penn Allegheny Health System facility that recently underwent a $24 million upgrade.
Then, in early December, the proposed UPMC hospital, reported to cost $250 million, was given the go-ahead by the Monroeville council, which said it was hard to find any negatives in the plan.
What's truly hard to find is any rationale for the hospital. As reported in the Post-Gazette, UPMC's chief officer for quality improvement and innovation told the council that the hospital would be "big enough to serve those 80 patients that travel every day" down the Parkway East from Monroe- ville to Oakland. She also indicated the building wouldn't be big enough to put anybody out of business. Should we assume she was referring to the 318-bed Forbes Regional, a hospital that surely would compete against a UPMC facility for patients?
Although employers pay a significant portion of health-care costs, everyone who pays for health care should be alarmed at a massive, and what seems to be an unnecessary, expenditure that could increase health-care costs without measurably improving the quality of care.
UPMC has said its 120-bed hospital would respond to demand from patients and physicians. Initial reports indicated the hospital would be full-service and include an emergency room and provisions for cancer care. UPMC later said the hospital would not be full-service and would not provide obstetrics, open-heart surgery and other advanced services. How can a hospital not be full-service at a cost of a quarter of a billion dollars? What services will it offer? What services will be offered that already are available two miles away?
Service duplication virtually ensures increased health-care costs. Instead of one emergency department adequately handling the area's patient volume, two could be available. That would mean more personnel and overhead costs for the same patient volume. The likely result would be higher overall costs, passed along to employers and consumers in the form of higher payments or increased premiums.
UPMC's assertions should be examined. UPMC and the West Penn system should answer these questions for the community before any shovel of dirt is turned:
• 1) What is the quality of care at Forbes Regional? A thorough review and public discussion of the Pennsylvania Health Care Cost Containment Council's 2007 Hospital Performance Report can help answer that question. PHC4 is an independent state agency that addresses escalating health costs and quality of care.
• 2) What is the daily census at Forbes Regional, including patients who come through the emergency department? Is its 318-bed capacity so taxed that we need 120 additional beds in a second hospital with duplicative services? How much would empty beds cost at UPMC and Forbes Regional, and how would those costs be passed along?
• 3) Do the health systems' population projections for the eastern suburbs buck the regional trend of a declining population? Monroeville will lose jobs over the next two years as Westinghouse Electric moves its headquarters to Cranberry. Is council's quick approval a sign that it hopes to replace Westinghouse jobs with UPMC jobs?
• 4) How would UPMC recruit enough nurses for the Monroeville facility? According to a July 2007 report by the American Hospital Association, hospitals need 116,000 RNs to fill vacancies nationwide, a vacancy rate of 8.1 percent. When patient-to-nurse ratios increase, the likelihood of bad outcomes for patients increases.
• 5) What about physician recruitment? The Pennsylvania Medical Society's 2007 State of Medicine report found that the commonwealth has difficulty recruiting and retaining physicians. Residency retention has dropped from 60 percent in 1992 to 22 percent in 2006.
Gov. Ed Rendell's Office of Health Care Reform said it is preparing a review process for large hospital expenditures, but the governor's initiative is not legislatively mandated. Pennsylvania used to require a "certificate of need," which required proof that certain additional health-care facilities, services or technologies were needed. The law expired in 1996.
To stop unnecessary health-care expenditures, the Legislature must enact some form of oversight, especially in these difficult economic times when employers are finding it increasingly difficult to pass along health-care cost increases to employees.
Transparency is a powerful tool in ensuring the reasonable cost and quality of health care -- and it should be required of UPMC and West Penn in determining the necessity of a second hospital in Monroeville. Plenty of questions need to be answered.
M. Christine Whipple is executive director of the Pittsburgh Business Group on Health, an employer-led coalition that promotes value and quality in health care and benefits ( www.pbghpa.com ).