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In Depth: Health Care Quarterly
	From the May 11, 2001 print edition

Evergreen expects operating deficit to deliver newborn ICU

It's bad enough being stuck in rush hour on the 520 bridge in the rain - but imagine being stuck in rush hour on the 520 bridge in the rain as you are delivering twins.

That's what happened on Oct. 15, 1996, to Carol Robertson of Carnation. Thirty-two weeks into her pregnancy, she went into labor and rushed to Evergreen Healthcare, a Kirkland community hospital 45 minutes from her home. Because she was eight weeks early, doctors tried to stave off delivery with medications, but the contractions kept coming.

To make matters worse, she couldn't deliver at Evergreen: The twins needed what's known as a level III neonatal intensive care unit with specialized equipment for handling high-risk babies who are born too early. Very premature babies are at greater risk for problems such as metabolic diseases, bacterial infections and respiratory distress syndrome because their organs haven't fully formed. The closest such place was Seattle - another half-hour away.

Robertson is not alone.

Eastside doctors routinely refer high-risk pregnancies to Seattle hospitals such as Swedish Hospital and the University of Washington Medical Center.

But not for long.

Evergreen has just received approval from the state to build its own level III unit, and expects it to be completed by January 2002. It will be the first hospital on the Eastside to receive such approval, although Overlake Hospital in Bellevue has begun the application process.

"A baby born early has very specific needs," said Dr. Stephen Chentow, a neonatologist at Evergreen, "they need monitoring, respiratory support, and ventilators."

One reason the hospital was granted the certificate is because the demand is there. As the young-family demographic on the Eastside grows, so does the need for maternity care. Evergreen expects this year's 4,000 births to rise to 4,500 by next year.

"The rationale for moving ahead is more programmatic than a business decision," Hagerman said, adding that the upgrade is a natural extension of its existing program, which can accommodate babies requiring level II care who don't have quite as extensive medical needs.

Another factor for the approval is because Evergreen had a cost-effective framework in place. When the original building was constructed seven years ago, the two top floors, four and five, were purposely left empty, and mothballed. The plan has been to fill them in as needed - the level III nursery will occupy four rooms with capacity for eight beds. The capital outlay for such a project is $350,000, with additional expenses such as staff training and hiring more neonatologists.

Lynn Hagerman, the hospital's vice president of program development, said she expects a $1 million operating deficit for the first three years; $500,000 the first year, $300,000 the second, and $200,000 the third.

"After that it starts to pay for itself," Hagerman said, adding that maternity care is never a profit line, with the average birth costing around $4,000 and requiring a 24- to 48-hour stay. By comparison, it can cost $12,000 to $20,000 and often more than a month's stay for a baby born who requires level III care.

"We feel that the investment is returned not just in better patient care, but in improved patient stays," Chentow said.

Naturally, money isn't foremost on the minds of families who are in crisis-pregnancy situations. There are other considerations in what makes a top-notch infant intensive-care unit. The hospital where Robertson had her twins didn't have the facilities for her to stay overnight, and because she was recovering from Caesarian surgery, she needed to find rides into Seattle every day for 10 days.

"After just giving birth and being so tired, I had to sit in the waiting room and pump milk every two hours. It was exhausting. The babies were being fed by a tube. It was scary," Robertson said.

Evergreen is hoping to address such physical and emotional issues by enabling each family in the birthing units - for normal deliveries or level III - their privacy, with the added comforts of a bed, shower, microwave and refrigerator. And the babies will have their own "pods."

"Typically, a small nursery has 10 to 20 families in little cubicles and families don't have any space. The noise and lights intrudes on all the babies and families," Chentow said. But substantial research shows that babies thrive in a more private environment and are ready to go home sooner. "Neonatology has been around 40 to 50 years. In the early days, they focused on the high-tech end of things. We've learned that what are real basic things - the amount of noise, light and handling are just as important as IV fluids and things like that."

And with the new unit, the learning will continue. Evergreen will use the opportunity to affiliate with Children's Hospital and the University of Washington Academic Medical Center's obstetrical research program.

While there is no direct financial collaboration, the experts from the Children's and the UW will provide training and clinical support.

"They want to help us respond to that community need," Hagerman said.

No one has felt that community need more personally than Robertson. After the twins' transfer to Evergreen, they were kept there for another five weeks and released. The boys are growing up fine, and Robertson gave birth to a girl, Alexis, eight months ago.

Copyright 2001 American City Business Journals Inc. Click for permission to reprint (PRC# 1.1659.429973)

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